Depression and Mood Disorders

Major Depressive Disorder (or MDD) is a common and serious medical condition which often requires medical treatment. Depression refers to a persistently low, sad, or depressed mood that can be so profound that it makes day-to-day activities feel difficult, insurmountable, and joyless. It is important to understand that depression is more than just “sadness” and there are in fact different types of depression with various causes. Depression is the leading cause of disability worldwide, and one of the leading causes of death in teens, adolescents, and young adults.

It is important to note that not everyone with depression experiences it the same.  Additionally, symptoms can overlap with other mental health conditions, further highlighting the need for a professional diagnosis.  Common symptoms of depression include:

• Persistent Sadness: A pervasive feeling of sadness, emptiness, or hopelessness that persists for an extended period.
• Hopelessness and helplessness: Depression can lead to an overwhelming feeling that things will never improve and that no one can help you to feel better.
• Loss of Interest and Pleasure: Often referred to as anhedonia, there can be a significant decrease or loss of interest or enjoyment in previously enjoyable activities.
• Fatigue and Low Energy: Persistent feelings of fatigue, low energy levels, or a general sense of being physically and mentally drained.
• Difficulty with routine tasks: Everyday tasks may feel exhausting, and even basic, routine behaviors or tasks may require an enormous amount of exertion.
• Sleep Disturbances: Changes in sleep patterns might including insomnia or hypersomnia.
• Appetite and Weight Changes: Some individuals may experience a loss of appetite and weight loss, while others may have increased cravings and overeat, leading to weight gain.
• Feelings of Worthlessness and Guilt: Individuals with depression often engage in negative self-talk, have low self-esteem, and may believe they are a burden to others.
• Difficulty Concentrating: Individuals may experience cognitive impairments, such as poor concentration, difficulty with focus, slowed thinking, difficulty organizing thoughts, and/or forgetfulness.
• Irritability and Restlessness: This may manifest as a short temper, increased frustration, or an inability to relax or sit still.
• Withdrawal and Social Isolation: Individuals may avoid social activities, cancel plans, or isolate themselves from friends and family.
• Physical Symptoms: Depression can present with various physical symptoms, such as headaches, stomachaches, muscle aches, and other unexplained bodily discomfort.
• Lack of future orientation: Many may find it difficult to think about or plan for the future; this often contributes to feeling of hopelessness and helplessness.
• Thoughts of Death or Suicide: These thoughts may range from fleeting or passive thoughts to detailed plans or preoccupation with death.

Depression is a complex condition with no single cause. Instead, it is often the result of a combination of biological, environmental, and psychological factors—this is often referred to as the bio-psycho-social model. Some of the known causes of depression include:

• Biological Factors
  • Genetics: Research has shown that individuals with a family history of depression are more likely to develop the condition.
  • Brain Chemistry: Chemicals in the brain, known as neurotransmitters, are involved in mood regulation.  Disruptions of these chemicals can lead to symptoms of depression.
  • Medical Conditions: Certain medical conditions, such as chronic pain, heart disease, or cancer, can increase the risk of developing depression.
• Psychological Factors
  • Negative Thinking Patterns: Persistent negative thoughts, self-criticism, shame/guilt, and distorted thinking patterns can contribute to the onset and maintenance of depression.
  • Low Self-Esteem: Low self-esteem and/or negative self-perceptions can contribute to feelings of sadness and hopelessness which contribute to the development of depression.
  • Perfectionism: The constant pressure to be flawless and fear of failure can contribute to depressive symptoms.
  • Lack of Coping Skills: Inadequate coping strategies may lead to feelings of helplessness, amplifying depressive symptoms.
  • Trauma and Past Experiences: Unresolved trauma or unresolved grief can contribute to depressive symptoms.
  • Cognitive Vulnerability: Certain cognitive vulnerabilities, such as a tendency to focus on negative events, interpret ambiguous situations negatively, or ruminate excessively, can contribute to the development of depression.
  • Learned Helplessness: Individuals who have experienced repeated negative events without a sense of control or ability to change their circumstances may develop learned helplessness. This belief that one has no control over their life circumstances can contribute to feelings of hopelessness and depression.
  • Personality Factors: Certain personality traits, such as high neuroticism, low extraversion, or high levels of self-criticism, can increase the risk of developing depression. These traits may influence an individual’s emotional stability and resilience.
• Social Factors
  • Social Isolation: People who have few supportive relationships or limited interaction with others may be at a higher risk of developing depression.
  • Relationship Difficulties: Relationship problems and lack of emotional support can contribute to feelings of sadness, hopelessness, and loneliness, increasing one’s risk for depression.
  • Childhood Adversity: Adverse childhood experiences, such as abuse, neglect, or growing up in a dysfunctional family environment, can have long-term effects on mental health.
  • Trauma:  Even in the absence of PTSD, trauma can contribute to the development of depression.
  • Social Stressors: Stressful life events, such as financial difficulties, job loss, academic pressure, or discrimination, can contribute to the development of depression.
  • Cultural Factors: Factors such as stigma around mental health, cultural beliefs about expressing emotions, or societal pressure to meet certain standards can affect individuals’ vulnerability to depression.
  • Social Comparison: Comparing oneself to others, especially in the era of social media, can contribute to feelings of inadequacy, low self-esteem, and depression. Constant exposure to carefully curated portrayals of others’ lives can fuel negative self-comparisons.

Depression is a treatable mental health condition, and several approaches can be effective in managing and alleviating symptoms. It’s important to note that the treatment approach for depression may vary for each individual, and a combination of treatments may be recommended based on the severity of symptoms and individual needs. It’s advisable to consult with a mental health professional who can conduct a comprehensive evaluation and develop a tailored treatment plan.  The most common treatments for depression include:

• Psychotherapy: Psychotherapy, also known as talk therapy or counseling, involves working with a mental health professional to explore and address the underlying causes and triggers of depression. Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Psychodynamic Therapy are some of the commonly used therapeutic approaches for depression . Therapy can help individuals develop coping skills, challenge negative thought patterns, and learn healthier ways to manage emotions and stress.
• Medication: Antidepressant medications can be prescribed by psychiatrists or other healthcare clinicians to help alleviate symptoms of depression. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are commonly prescribed antidepressants. It’s important to note that medication should be prescribed and monitored by a healthcare professional, and the selection of the appropriate medication depends on individual needs and considerations.
• Lifestyle Changes: Making certain lifestyle modifications can have a positive impact on managing depression. Regular exercise, maintaining a balanced diet, getting enough sleep, and reducing the use of alcohol or drugs can help improve mood and overall well-being. Engaging in activities that bring pleasure and practicing stress reduction techniques, such as mindfulness or meditation, can also be beneficial.
• Social Support: Building and maintaining a strong support network is essential in managing depression. Friends, family, or support groups can provide emotional support, understanding, and encouragement. Engaging in social activities and maintaining healthy relationships can help alleviate feelings of isolation and provide a sense of belonging.
• Self-Care: Practicing self-care is crucial in managing depression. This includes engaging in activities that promote self-nurturing and well-being, such as pursuing hobbies, engaging in relaxation techniques, setting boundaries, and prioritizing self-care routines.
• Support Groups: Participating in support groups or group therapy sessions can provide individuals with a sense of community and support. Sharing experiences, insights, and coping strategies with others who have similar challenges can be comforting and empowering.
• Treatment for Co-occurring Disorders: Individuals with depression often have other co-occurring mental health conditions such as PTSD, bipolar disorder, or substance use disorders. Addressing these underlying issues through appropriate treatment, such as dual diagnosis programs, is crucial for comprehensive recovery.
• Targeted nutrition and dietary supplements: Diet and nutrition can play a significant role in our mental health.  Dietary changes and supplements can often play an important role in improving mental and physical health.  Additionally, genetic testing can also reveal very specific genetic alterations which might impact the brain and body’s ability to process certain chemicals needed for optimal brain health.  When identified, dietary supplements may be beneficial in improving mental and physical health.
• Approaches to Treatment Resistant Depression:  It is not uncommon for depression to not respond to the “routine” treatment.  When that is the case, there are several approaches that are specifically designed for treatment resistance.  These include Transcranial Magnetic Stimulation (TMS), Spravato (intanasal esketamine), Vagal Nerve Stimulation (VNS), and Electroconvulsive Therapy (ECT). These treatments are typically administered under the guidance of a psychiatrist.
• Neurofeedback: Neurofeedback is a non-invasive technique that uses real-time feedback to train individuals to self-regulate their brainwaves. 
• Emergency and Supportive Services: Depending on the severity of depression, additional support services may be recommended. These can include intensive outpatient programs (IOP), partial hospitalization programs (PHP), or even inpatient admission (IP) if the depression is severe or accompanied by significant risk.  Please follow this link for supportive services in the Philadelphia and Montgomery County areas.

Depression is a complex mental health condition, and there are different types or subtypes of depression that can vary in their symptoms, duration, and underlying causes. Here are some common types of depression:

• Major Depressive Disorder (MDD): Also known as clinical depression, MDD is characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities. It typically lasts for at least two weeks or longer and significantly impacts daily functioning.
• Persistent Depressive Disorder (PDD): Formerly known as dysthymia, PDD is a chronic form of depression that lasts for two years or more. Symptoms may be less severe than MDD but are more persistent, affecting daily life over an extended period.
• Seasonal Affective Disorder (SAD): SAD is a subtype of depression that occurs cyclically during certain seasons, typically in fall or winter, when there is less sunlight. It is characterized by low mood, increased sleep, weight gain, and a lack of energy. Symptoms tend to improve in the spring and summer months.
• Postpartum Depression (PPD): PPD occurs in individuals after childbirth, usually within the first year. Hormonal changes, combined with the stress and adjustments of new parenthood, can contribute to symptoms such as sadness, anxiety, and difficulty bonding with the baby.
• Bipolar Disorder: Bipolar disorder involves alternating periods of depression and mania or hypomania. The depressive episodes in bipolar disorder are similar to MDD, but they are interspersed with periods of elevated mood, increased energy, and impulsive behavior during manic or hypomanic episodes.
• Psychotic Depression: Psychotic depression is characterized by severe depression accompanied by psychotic symptoms, such as delusions or hallucinations. These symptoms often revolve around themes of guilt, worthlessness, or personal inadequacy.
• Atypical Depression: Atypical depression is characterized by a specific pattern of symptoms that includes mood reactivity (improved mood in response to positive events), increased appetite or weight gain, excessive sleepiness, heavy limbs, and sensitivity to rejection.
• Situational Depression: Situational or reactive depression refers to a temporary depressive state triggered by specific life events or stressors, such as the loss of a loved one, a breakup, or financial difficulties. These depressive symptoms are generally a response to the situation and may resolve once the stressor is addressed.

It’s important to note that the diagnosis and classification of depression are made by qualified mental health professionals.  Each individual’s experience of depression may differ, and a comprehensive assessment is necessary to determine the most appropriate diagnosis and treatment approach.

It is important to be aware that depression is NOT the same as sadness. While there is a component of sadness in depression there are critical differences. In depression, the intensity of the emotions is so powerful and so overwhelming that it takes over all aspects of an individual’s life. It is as if important areas of the brain shut down and are no longer able to work properly in the face of such intense pain. An analogy would be the difference between a spot of rust on a piece of iron (sadness), and after that rust has worn away and eaten through the iron such that it loses its integrity, stability, and ability to maintain its form (depression).

If feel that you may be depressed, you can take this quiz now. Please note, this is quiz is for screening purposes only and NOT intended to diagnosis any medical or mental health condition.