MAJOR DEPRESSIVE DISORDER

Depression is a psychological state that can be both emotionally and physically draining. Being depressed is different than feeling sad; sadness is often manageable and fleeting, whereas the symptoms of depression can be constant and debilitating.

Major Depressive Disorder (MDD) is one type of Depressive Disorder that can greatly interfere with people’s lives and your happiness. According to the manual used to diagnose psychological disorders, a person may have Major Depressive Disorder if they have experienced at least 5 of the following symptoms, nearly every day, during the same 2-week period:[1]

  • Depressed mood most of the day
  • Loss of interest in pleasurable or previously enjoyed activities, most of the day
  • Weight loss or gain of at least 5% over a one-month period
  • Insomnia (inability to sleep) or hyper-somnia (oversleeping)
  • Bodily restlessness or feeling physically slowed down
  • Fatigue or loss of energy
  • Feeling worthless or inappropriate guilt
  • Difficulty thinking, concentrating, or making decisions
  • Recurrent thoughts of death, suicidal ideation, or a suicide plan or attempt

The first two symptoms must be present in order to be diagnosed with MDD. Additionally, the symptoms do not need to be reported by the person experiencing them; clients can still be diagnosed with MDD if others observe the presence of these symptoms. Additional criteria for diagnosing MDD include:

  • The symptoms must cause significant psychological distress or impairment in social, occupational, or other important areas of functioning
  • The MDD episode cannot be linked to the psychological effects of substance abuse or schizoaffective disorders
  • The absence of a manic or hypo-manic episode

Canadian Statistics

  • Approximately 8% of adults will experience MDD at some point in their lives.[2]
  • In 2012, an episode of MDD was the most common type of mood disorder (4.7% of population aged 15 and older met criteria).[3]
  • In 2012, approximately half of Canadians experiencing MDD had 6 or more doctor’s visits to a mental health professional or took an antidepressant.[4]
  • In 2013, the estimated percentage of the Canadian population that experienced MDD in one year was 5-8.2%.[5]
  • Fifty to Eighty percent of older adults who commit suicide have MDD.5
  • In 2013, only 33% of people with MDD sought professional help.5
  • Females experience 3 times the rate of MDD than males, beginning in adolescence.5
  • Adolescents are the group of people who are least likely to receive treatment for MDD.5
  • In 2012, 4.8% of people with MDD had abused alcohol within the last year. Alcohol dependence was reported at 4.5%.[6]

Behaviours Associated with MDD:

  • Not going to your soccer club for several weeks in a row because it does not sound fun anymore
  • Sleeping during the day because you feel too sad and tired to get up
  • Failing a college course because you could not focus in class
  • Missing your best friend’s birthday celebration because you feel so insecure about yourself
  • Ignoring an invitation to your friend’s wedding because you cannot decide if you want to go
  • Feeling overwhelmed and delaying responding to an email request from a colleague who is asking you to present at a conference

Feelings Associated with MDD:

  • Exhaustion
  • Sadness
  • Dissociation
  • Hopelessness
  • Shame
  • Numbness

Thoughts Associated with MDD:

  • “I deserve to feel lonely and sad because I am a horrible person.”
  • “There’s no point in going to that party because I’m going to be too tired to talk to anyone.”
  • “I might as well just quit my job because I’m so bad at it.”
  • “I should just keep to myself. No one cares about me anyways.”

MDD and the Body:

The bodily symptoms of MDD can be so severe that people visit the doctor without knowing that they are experiencing a mental health condition. Physical pain and mental depression have been linked to the same neurotransmitters in the brain, thus explaining the physical symptoms associated with MDD.[7] The two neurotransmitters that influence both pain and mood are norepinephrine and serotonin. If these neurotransmitters are imbalanced, both mood and physical well-being can be negatively affected. Research has found that people with more pain in their bodies tend to have more severe MDD.7 Some of the physical symptoms of MDD are:

  • Appetite changes
  • Joint pain
  • Fatigue
  • Back pain
  • Gastrointestinal issues
  • Aching muscle/joints

MDD and the Brain:

The main area of the brain associated with MDD is the hippocampus. Research has shown that one of the main roles of the hippocampus is to create and retrieve memories.[8] More specifically, impairments in a person’s ability to learn and remember are common in people who are experiencing MDD.[9],[10] Recalling memories from the past is also negatively impacted by MDD.9

In recent years, scientists have been able to find a link between the size of the hippocampus and depression. The general conclusion is that a smaller hippocampus is associated with MDD.[11] Some research has indicated that smaller hippocampal volumes are genetically determined, and certain genes can increase the chances of someone’s brain being more adversely affected by stress.9 There is evidence to support the claim that stress causes brain changes, such as reductions in hippocampal volume.9 Research has also indicated that recurrent episodes of MDD might cause reductions in hippocampal volume.[12]

Does Psychology Work?

There are many effective psychological treatments for MDD.

  • Cognitive Behavioural Therapy (CBT): This therapy can be used to help people change their behaviours and feelings by teaching them how to change their thoughts. Researchers have reviewed a large number of studies on the effects of CBT on patients with MDD. They found that a compared to pharmacological treatment, CBT was more effective in the long-term.[13] At the 1- to 2-year follow-up, individuals who received CBT continued to have lower rates of depression. Additional research studies have provided evidence that CBT is an effective treatment for Chronic Depression, and works as well as other well-respected forms of psychological therapy.[14]
  • Mindfulness Therapy (MT): MT is another type of treatment that has been shown to have a positive effect on people who are experiencing MDD. Mindfulness can be described as a way of paying attention to the present moment without judging the experience. MT combines CBT with mindfulness meditations and exercises, such as yoga, sitting meditation, and body scanning. Research on MT has shown that it is effective at preventing future episodes of MDD once clients are depression free.[15] One reason why MT is an effective treatment is that Depression is associated with thinking about the past or future. MT teaches clients how to stay present in the moment, thus reducing depressive thinking about another point in time.15 Research has also shown that clients who enroll in MT for Depression are less likely to quit treatment than people in other forms of therapy.[16]
  • Emotionally-Focused Therapy (EFT): EFT for couples has been shown to help treat MDD when the person is in a committed relationship. Research has shown that there is a strong connection between relationship satisfaction and depressive symptoms. People who reported dissatisfying relationships had greater symptoms of depression. Moreover, people who experienced depressive symptoms had higher rates of relationship dissatisfaction. It is a negative cyclical loop in that the more unsatisfying the relationship, the more depressed a person becomes; and the more depressed a person becomes, the more dissatisfied they are in their relationship. Research has shown that people with depression and relationship problems have higher rates of relapse if the relationship issues are left unresolved.[17]

Tips to Help Manage MDD:

  • Reduce Alcohol Intake: Research has shown that increased alcohol use can also increase your risk of depression. The reasons behind this are still being explored, and some of the theories include:[18]
    • Alcohol misuse can create disruptions in relationships, work, and physical health. These situations may lead to greater feelings of depression because alcohol is a “brain depressant.”
    • There is a similar genetic component in both Alcohol Misuse and MDD.
    • Alcohol Misuse may lead to metabolic changes that increase your chances of experiencing MDD. Studies have shown that alcohol intake can reduce folate levels in the body, which is linked to MDD.18
  • Get More Exercise: When you are feeling depressed and exhausted, one of the last things you probably want to do is to workout. Although getting yourself to begin exercising might be extremely difficult, the payoff can be worth it. Research has shown that getting more cardio exercise can help reduce depressive symptoms, especially when done most days for at least 30 minutes.[19]
  • Connect with Nature: Research has shown that interacting with nature can improve memory and mood symptoms associated with MDD.[20] Walking in nature, whether it is done alone or with others, can work at reducing the symptoms of Depression

It is possible to have various combinations of the above symptoms and still meet the criteria for MDD. In turn, your experience of Depression will likely be distinct in some ways when compared to other people, but will also have the main features that everyone with MDD experiences. It is also possible that you may also experience multiple other mental health, behavioural, or emotional issues at the same time. For example, we often counsel people who have issues with depression and childhood or relational traumas. In these cases, we would personalize our approach to suit your unique needs and would likely use multiple interventions and treatment modalities to provide you with the best and fastest results. Hopewell Psychological Clinicians provide a range of evidence-based services and we also work with couples, families, and children/adolescents, to ensure that we are helping you achieve your own personal well-being as well as a greater satisfaction and happiness in your interpersonal relationships.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Reynolds, Cecil, & Kamphaus, Randy W. “Major Depressive Disorder.” Pearson Clinical. Pearson, 2013. Web. 19 Apr. 2017.

[2] “Fast Facts about Mental illness.” Canadian Mental Health Association. Canadian Mental Health Association, 2016. Web. 19 April 2017.

[3] “Canadian Community Health Survey: Mental Health, 2012.” Statistics Canada. Government of Canada, 18 Sep. 2012. Web. 19 Apr. 2017.

[4] Patten, S. B. et al. “Major Depression in Canada: What has changed over the past 10 years?” Canadian Journal of Psychiatry 61 (2016): 80-85.

[5] “Depression and Suicide Prevention.” Center for Suicide Prevention. Center for Suicide Prevention, 2015. Web. 19 Apr. 2017.

[6] Patten, S. B., et al. “Descriptive Epidemiology of Major Depressive Disorder in Canada in 2012.” The Canadian Journal of Psychiatry (2015).

[7] Trivedi, Madhukar H. “The Link Between Depression and Physical Symptoms.” The Primary are Companion to the Journal of Clinical Psychiatry 6.1 (2004): 12-16.

[8] Duncan, Katherine, et al. “Evidence for the area CA1 as a match/mismatch detector: A high-resolution fMRI study of the human hippocampus.” Hippocampus 22.3 (2012): 389-398.

[9] Suzuki, Wendy A. “Associate Learning and the Hippocampus.” Psychological Science Agenda. American Psychological Agenda, Feb. 2005. Web. 19 Apr. 2017.

[10] Fairhall, S. F., et al. “Memory related dysregulation of hippocampal function in major depressive disorder.” Biological Psychology 85 (2010): 499-503.

[11] MacQueen, G., and Frodi, T, “The hippocampus in major depression: evidence for the convergence of the bench and the bedside in psychiatric research.” Molecular Psychiatry 16 (2011): 252-264.

[12] McKinnon, M. C., et al. “A meta-analysis examining clinical predictors of hippocampal volume in patients with major depressive disorder.” Journal of Psychiatry & Neuroscience 34.1 (2009): 41-54.

[13] Cuijpers, Pim, et al. “A Meta-analysis of Cognitive-behavioural Therapy for Adults with Depression, Alone and in Comparison with Other Treatments.” Canadian Journal of Psychiatry 58.7 (2013): 376-85.

[14] Hofmann, S. G., et al. “The efficacy of cognitive behavioral therapy: a review of meta-analyses.” Cognitive Therapy & Research 36.5 (2012): 427-440.

[15] Piet, Jacob, and Hougaard, Esben. “The effect of mindfulness-based cognitive therapy for preventing recurrent major depressive disorder: a systematic review and meta-analysis.” Clinical Psychology Review 31 (2011): 1032-1040.

[16] Khoury, Bassam, et al. “Mindfulness-based therapy: a comprehensive meta-analysis.” Clinical Psychology Review 33 (2013): 763-771.

[17] Wittenborn, Andrea K., et al. “Treating Depression in Men: The Role of Emotionally Focused Couple Therapy.” Contemporary Family Therapy 34 (2012): 89-103.

[18] Boden, Joseph M., and Fergusson, David M. “Alcohol and Depression” Addiction 106 (2011): 906-914.

[19] Carek, Peter J., et al. “Exercise for the Treatment of Depression and Anxiety.” International Journal of Psychiatry in Medicine 41.1 (2011): 15-28.

[20] Berman, G. Marc, et al. “Interacting with Nature Improves Cognition and Affect for Individuals with Depression.” Journal of Affective Disorders 140.3 (2013): 300-305.

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