What is Major Depressive Disorder (MDD)?
MDD is marked by at least two weeks of a depressed mood in which nearly all interest in previously enjoyed activities is lost. For further details from the DSM V, click here.
What are the signs and symptoms (from DSM V)?
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
for complete diagnostic criteria, signs and symptoms, please see the DSM V
What tools are used to assess depression?
- Beck Depression Inventory – 2nd Edition (BDI-II)
- Hamilton Depression Scale
- Center for Epidemiological Studies Depression Scale (CES-D)
These assessments are for use by trained mental health professionals
Many self-assessments are available online as well
- The Anxiety and Depression Association of America offers an online test, here.
- The patient health questionnaire (PHQ9) is commonly used and available in Spanish
- Psychology Today offers an online screening test to self-administer, here.
Be sure to share the results of your screening test with your primary care provider (PCP).
What treatments or therapies are available?
The most common methods used for treating MDD are talk therapy and medication.
CBT has been used effectively to treat MDD by working with presenting problems and symptoms:
- Automatic negative thinking
- Rumination and self-attack
- Withdrawal and avoidance
- Unhelpful behaviors
The goals of CBT for depression generally include
- identifying and stepping back from negative thoughts (cognitions)
- counteracting negative thoughts/views
- developing a more balanced self-view
- increasing activity levels, particularly those which the client enjoys, derives pleasure/sense of accomplishment from
- increasing active engagement and problem solving*
*from An Introduction to Cognitive Behavior Therapy by Kenneryly, Kirk, and Westbrook
Common medications used to treat MDD
- Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants such as Lexapro (escitalopram), Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine), Zoloft (sertraline), and Viibryd (vilazodone)
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) such as Pristiq (desvenlafaxin), Cymbalta (duloxetine), Effexor (venlafaxine),
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors
Treating depression with antidepressants
Be sure to get guidance from a qualified mental health professional and a prescription from a qualified doctor, ARNP, PA, or psychiatrist.
Never discontinue use of any antidepressant without checking with your prescriber