Major Depressive Disorder - Diagnostic Criteria and Clinical Presentation

Major Depressive Disorder (MDD), also known as unipolar depression, is one of the most common mental disorders. It prevails throughout life in about 16% of the general population, according to an American study carried out by the National Comorbidity Survey Replication (NCS-R).

A recent study by the World Health Organization (WHO) found that around 280 million people suffer from Major Depressive Disorder worldwide. This number shows that the prevalence of MDD was higher than alcohol-related disorders.

Therefore, it is important to know this disorder well, and its diagnostic criteria and clinical presentation. Read and find out everything about MDD.

Evolution Of Major Depression

MDD is one of the most common mental disorders worldwide. Up to 6% of the population experiences an episode of major depression, with the majority of patients beginning their first episode in their 20s. There is a higher risk of episodes among the elderly and women.

Another important issue highlighted by research is that some people have episodes of MDD frequently. Researchers interviewed people who had not been treated for 13 years and showed that only half of the people recovered in the same year, the average person took 3 years to become depression-free after their first episode and 15% of them did not recover. There are effective treatments for depression, and not treating it can lead to serious problems. It is worth mentioning that individuals who are not treated have a lower quality of life, a higher risk of suicide, and worse prognoses if they have an associated medical condition.

Diagnostic Criteria & Clinical Presentation 

It is necessary to have very active listening and vision. The most obvious symptoms can be noticed by observing the patient's physiognomy and body language. Some common characteristics are:

• Show unhappiness

• Eyes normally full of water

• Frown

• The corners of the mouth are directed downwards

• Indifferent facial expression

• Portrait posture

• Few body movements and, when there are any, they are usually performed slowly.

There are more extreme cases, in which patients report not feeling their usual emotions, immersing themselves in a colorless and lifeless world, with no more tears to shed.

Furthermore, the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-V) explains that Major Depressive Disorder can be diagnosed when the patient presents 5 or more of the actions below, every day, for at least 2 weeks:

• Depressed mood for a large part of the day (for most of the day, the subject has a strong feeling of sadness for no apparent reason, lack of hope about their goals, difficulty in starting a project in the present or preparing one for the future, the feeling of empty, even if you can't explain exactly what

• Drastic decrease in interest or pleasure in any type of activities

• Very significant weight gain or loss, around 5 kilos (either increase or loss)

• Insomnia (difficulty sleeping) or hypersomnia (difficulty staying awake, due to excessive sleep)

• Change in motor capacity, which may cause agitation or psychomotor delay

• Energy depletion, ie extreme fatigue

• The feeling of not being useful to anyone, encouraging excessive and/or inappropriate guilt

• Difficulty concentrating and making decisions

• Constant thoughts of suicide and death.

Guilt 

The guilt linked to the depressive episode also exists in most cases, in which patients develop negative evaluations of themselves, impacting the construction of personal value. In these cases, the subject shows concern fixated on moments of weakness or failures that occurred in the near or distant past.

Distorted Interpretation Of Events

Furthermore, distorted interpretation of events is common, with a tendency to exaggerate self-responsibility in the face of adversity, which can reach delusional proportions. Another point present is self-recrimination for dealing with depression, nurturing the thought that weakness is linked to the disorder.

Autonomy In Decision-Making

This also impacts autonomy in decision-making. Many people find it difficult to concentrate, think clearly, and make decisions, as they become easily distracted and even experience negative impacts related to memory.

Psychotic Symptoms 

The patient may also present some psychotic symptoms, such as delusions and/or hallucinations. These symptoms can be classified as congruent, about delusions of guilt, hypochondria, derogatory hallucinations, and feelings of ruin) or incongruent with the mood — this is the case of persecutory delusions and hallucinations involving emotional ties, for example.

More About Major Depressive Disorder

MDD can appear for the first time at any age, with the first episode being more common at the beginning of puberty. However, it is more common among those aged 18 to 29, comparing the rates with those in the elderly. It also happens more often among women.

It is important to say that major depressive disorder can be chronic or have periods of remission throughout life. The damage caused can be mild or lead to the individual's total disability, including catatonia.

Causes Of Major Depressive Disorder

The exact causes of major depressive disorder are not fully understood, but it is believed to be a complex combination of biological, genetic, psychological, and environmental factors.

Discover some of them below.

Neurotransmitter Dysregulation

In the brains of people with major depressive disorder, there may be a dysregulation of neurotransmitters, chemical substances responsible for communication between neurons.

Serotonin, dopamine, and norepinephrine are some of the neurotransmitters that play a crucial role in regulating mood.

The low availability of these substances may be associated with the manifestation of depressive symptoms.

Genetic Predisposition

A family history of depression may indicate a genetic predisposition to developing major depressive disorder.

Studies show that individuals with first-degree relatives who have had depression have an increased risk of developing the illness.

Stressful Life Events

Stressful events, such as the loss of loved ones, financial problems, interpersonal conflicts, or significant changes, can play a role in triggering major depressive disorder.

These events can overwhelm emotional coping mechanisms, leading to the manifestation of depressive symptoms.

Medical Conditions

Some medical conditions, such as chronic illnesses, hormonal disorders, or nutritional deficiencies, may be associated with the development of depression.

For example, diseases that affect the functioning of the central nervous system or that cause chronic pain may be related to the onset of depression in some people.

It is important to highlight that these factors can interact with each other, and not all people with major depressive disorder will have the same causes.

Each individual is unique, and the interaction of these factors is complex and specific to each case.

Furthermore, it is essential to remember that depression is not the result of personal weakness or lack of willpower.

It is a medical condition that can affect anyone, regardless of their age, gender, or origin.

Major Depressive Disorder (MDD) Is Treatable

Even in cases where depression is deeper, a full recovery for the patient is possible. After identifying the causes that led to the disorder, the doctor can guide his patient on the best way to treat the problem.

Guidance may be for controlled dosages of antidepressant medications, talking therapies, or a combination of the two types. Before deciding on any type of treatment, the doctor will perform clinical examinations, asking questions about the patient's health and the symptoms that are most apparent.

In some cases, there may also be a need for laboratory tests. They exclude possibilities of other disorders and help identify physical problems already triggered by depression.

Medication Use

The patient may require antidepressant drugs, such as

• Tricyclic antidepressants

• Selective serotonin reuptake inhibitors

• Monoamine oxidase inhibitors

• Serotonin and norepinephrine reuptake inhibitors.

These medications can cause effects such as weight gain, drowsiness, nausea and vomiting, diarrhea, and sexual impotence. Among more serious complications, we can highlight seizures, heart problems, and delirium. If you experience one of the three, it is recommended to return to the doctor as urgently as possible.

Talk Therapy Or Psychotherapy

There are three types of psychotherapy:

• Cognitive-behavioral therapy: one that helps the patient improve their negative thoughts. It will show positive and realistic solutions so that there is a change in behavior and, consequently, an improvement in the situation;
• Interpersonal Therapy: aimed at patients with relationship problems. The doctor will help change behaviors that problematize the patient's relationships and increase depression;
• Problem-solving therapy: indicated when depression was caused by trauma or a stressful experience.

Treatments take time to start working. People who use a medicine usually start to feel better within two weeks, but it can take four to eight weeks for the medicine to take full effect. It is also noted that it is common to experience improvement within a few weeks after starting therapy or counseling, but it may take eight to ten weeks to achieve greater results.

It is important to highlight that each stage of treatment must be monitored by a psychiatrist — and it is common for the patient to have to try different treatments or combinations of treatments before finding the best approach. The doctor, therapist, or counselor can work together with the patient to find the right treatment and help manage symptoms and problems until the treatment takes effect.

Is There Any Effective Way To Prevent Major Depressive Disorder?

As with other topics related to mental health, everything will depend on the subject. There is no promise that if you follow certain activities, there will be no risk of developing Major Depressive Disorder.

However, the way you deal with situations will directly impact your mental health, developing the mindset of how to position yourself in the face of a problem, for example. Additionally, some interesting tips are:

• Try breathing exercises whenever you are subjected to a stressful situation to find ways to deal with problems with as little stress as possible.

• Eat a good diet, get a good night's sleep, and practice physical activity. All these actions will build a positive channel with yourself.

• Therapy is not just for when the problem has already happened. Constantly undergoing therapy, as a form of personal development, is fundamental for re-signifying traumas that could affect the way I see the world and, consequently, promoting self-knowledge.

• Be aware of the consumption of alcohol and other drugs, as they can physiologically and psychologically impact your life

The most important thing when dealing with Major Depressive Disorder is to understand that it is not a death sentence. The treatment is proven to be effective, enabling the subject to give new meaning to their traumas and, little by little, learn to live with themselves and others more healthily. Therefore, this discourse must be reinforced by all health professionals involved in the treatment.

Conclusion

As seen in the post “ Major depressive disorder: what it is, diagnostic criteria and clinical presentation”, this psychological problem is a serious but treatable condition that affects the mental and emotional health of patients.

Recognizing your symptoms and seeking professional help are important steps in dealing with depression and improving your quality of life. With support, appropriate treatment, and emotional support, it is possible to overcome depression and live a full and meaningful life.