Depressive Disorders

Major Depressive Disorder (MDD)

MDD, commonly referred to as depression, is a mood disorder that causes persistent sadness and loss of interest. MDD affects the way you think, feel, and behave, leading to various emotional and physical problems. People with MDD may have difficulty performing normal daily activities and may feel that life isn’t worth living. Depression is more than just sadness, and it’s not something you can “snap out of”. It’s not a short-term thing; it’s a long-term psychiatric disorder. That’s not meant to be discouraging, quite the opposite. If you’re struggling with depression, it’s not just that you’re sad, moody, or lazy; it’s a psychiatric disorder that requires treatment. That means there are plans and ways you can treat it and make progress.

Symptoms

• Feelings of sadness, emptiness, or hopelessness

• Angry outbursts, irritability, or frustration, sometimes over seemingly small things

• Loss of interest in things you used to care about, such as hobbies, activities, sex, etc

• Sleep issues, insomnia, or sleeping too much

• Over-tiredness and lack of energy – small tasks taking large amounts of effort

• Reduced appetite and weight loss or increased cravings and weight gain

• Anxiety or restlessness

• Slowed thinking, speaking, or body movements

• Feelings of worthlessness, guilt, or fixating on past failures, embarrassments, or self-blame

• Trouble thinking or concentrating, making decisions, or remembering things

• Frequent or recurring thoughts of death or suicide

• Unexplained physical problems such as back pain or headaches

Symptoms are often severe enough to be noticeable in daily activities and relationships with others. Some people may feel generally miserable without necessarily knowing why.

Causes

Researchers don’t know the exact cause(s) of depression, but they think several factors can contribute to its development. These may include:

• Brain chemistry (Imbalances of neurotransmitters, including serotonin and dopamine, can contribute to the development of depression)

• Genetics (Having a biological parent or sibling with depression makes you three times more likely to develop the condition than the general population, so researchers know there is a genetic component. However, you can develop depression without a family history.)

• Stressful life events (Experiencing trauma, death of loved ones, divorce, isolation, lack of support, etc., can cause or contribute to depression)

• Medical conditions (Chronic pain and chronic conditions like diabetes can cause depression)

• Medication (Some medications can cause depression as a side effect. Additionally, substance use or abuse can cause depression or worsen it.)

Treatment

If you are struggling with MDD, rest assured that it is one of the most treatable mental illnesses. Approximately 80-90% of people with MDD who seek treatment eventually respond well and experience improvement. These treatment options include:

• Psychotherapy (talk therapy)

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavior Therapy (DBT)

• Behavioral Activation (BA)

• Medication

• Complementary Medicine (acupuncture, hypnosis, biofeedback, etc.)

Persistent Depressive Disorder (PDD)

PDD is a mild to moderate chronic depression. It constitutes a dark, dull, or sad mood for the majority of the day on most days for two years or more. PDD is common and can happen to anyone at any age.

What is the difference between MDD and PDD?

PDD is another form of depression. It’s less severe than MDD, but it lasts much longer. It lasts at least two years in adults and at least one year in children and adolescents. During this time, symptoms can’t be absent for more than two consecutive months without ruling out criteria for PDD.

How common is PDD?

PDD is very common. 3% or more of the U.S. population will experience it. PDD is more common in women and those with a genetic component (family members with the same condition).

Symptoms

• Sad, low, or dark mood

• Fatigue

• Feelings of hopelessness, worthlessness, or isolation

• Lack of appetite or overeating

• Lack of concentration

• Low self-esteem

• Trouble at work or school

• Trouble sleeping or sleeping too much

• Most people with PDD will also have an episode of MDD at some point.

Causes

Researchers don’t know exactly what causes PDD, but they suspect it may be related to low levels of serotonin. PDD also may be triggered by a traumatic life experience or event.

Treatment

• Psychotherapy (talk therapy)

• Cognitive Behavioral Therapy (CBT)

• Medications

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a childhood disorder that causes chronic and intense irritability and frequent temper tantrums that are out of proportion to the situation. Symptoms must begin before the age of 10 to meet diagnostic criteria.

What is the difference between DMDD, Oppositional Defiant Disorder (ODD), and Bipolar Disorder?

ODD is a behavioral disorder in which a child exhibits a consistent pattern of defiant and sometimes hostile behavior, especially toward authority figures. While some symptoms overlap with ODD, DMDD is considered a more severe condition with a significant mood component. Therefore, children who meet the criteria for both ODD and DMDD are diagnosed with DMDD only.

Bipolar disorder is a lifelong mood disorder that causes extreme changes in mood, energy levels, thought patterns, and behavior. These changes can last for varying lengths of time, from days to months, and sometimes interfere with a person’s ability to carry out daily tasks. While similar behaviors may overlap between Bipolar Disorder and DMDD, the symptoms of BD are contained within episodes, while the symptoms of DMDD are ongoing. In addition, BD is less common in children and adolescents and is usually a lifelong condition. In contrast, DMDD is a childhood disorder that is more likely to “morph” into MDD or generalized anxiety disorder later in life.

Who Does DMDD Affect?

Symptoms of DMDD often begin before the age of 10. DMDD is not diagnosed in children under the age of six or over the age of 18.

How Common is DMDD?

DMDD is a relatively new diagnosis, so research is still needed to determine its prevalence. However, current research suggests that it may affect approximately 2-5% of children in the United States.

Symptoms

• Irritable or angry mood most of the day, almost every day

• Severe temper tantrums that are disproportionate to the situation (generally 3+ times per week)

• Issues with daily functioning due to irritability in more than just one environment.

Treatment

Because DMDD is a newly understood condition, little research has been done on its treatment. As a result, the current treatment pathway is based on other childhood conditions such as anxiety and ADHD. Fortunately, studies have shown that these treatments work well for people with DMDD.

• Psychotherapy (talk therapy)

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavior Therapy (DBT)

• Parental Training

• Medication

Substance/Medication-Induced Depressive Disorder

A Substance-Induced Depressive Disorder is a persistent, significant emotional disorder or disturbance that stems directly from the physiological effects of:

• Substances (including legal substances such as alcohol) or illegal substances

• Some medications

Overview

This disorder is challenging because it has a wide variety of causes and symptoms, and each case is very individual. For example, it may be due to the person abusing an illicit substance or misusing a prescribed medication. In addition, the symptoms can vary widely due to the different potential causes, the mixed drugs that may be involved, and the different comorbidities that the patient may be dealing with.

Sources

Much of this page was inspired by Mayo Clinic and Cleveland Clinic articles.

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