October is Depression Awareness Month. Raising awareness and keeping it as part of the discussion is remarkably important, whether you know little about it or you are a mental health professional. October being Depression Awareness Month also seems quite fitting, as many of those that experience seasonal pattern depression begin to experience symptoms around this time.
Depression is often a term widely used to describe one’s mood, though there is far more to clinical depression than simply feeling depressed. Sadness is certainly part of depression, but there is also much more.
Let’s unpack some of the subtypes (or specifiers) of major depressive disorder as well as their symptoms. My goal is to explore these symptoms with as little psychobabble as possible. There will be a little, but I’ll try to keep it to a minimum! Knowledge is power and can make a world of difference when it comes to getting the help you deserve when you need it.
This information is by no means all inclusive, however, it’s a starting point for growing your knowledge base.
Symptoms of Major Depressive Disorder (MDD)
Major Depressive Disorder is one of the more common and the one most often thought of when they think about depressive disorders. This disorder consists of major depressive episodes, or periods of time where you would experience these symptoms. Depressive episodes mean that there are periods of time where one feels depressive symptoms and also periods of time when they don’t. Remission is quite possible with depression, though it rarely improves on its own.
In order to be diagnosed with a major depressive episode you must experience five or more of the following symptoms during a two week period:
- Depressed mood most of the day, nearly every day. This means that almost every day for two weeks you feel sad, melancholy, down, etc.
- Decreased interest or enjoyment of activities for most of the day. It is important to recognize that this is in reference to enjoyable activities, things you previously liked doing. This is not in reference to things that were not all that enticing in the first place, like vacuuming.
- Significant weight loss when you are not trying to lose weight or the opposite, significant weight gain for no explainable reason. To be more specific this is generally determined if you have a change of more than 5% body weight in a month. Increased or decreased appetite can also be of concern and be wrapped into this particular symptom.
- Sleep disturbance, whether that means difficulty sleeping or sleeping too much. This can be an indicator of depression and is referred to clinically as insomnia (the inability to sleep) or hypersomnia (sleeping too much).
- Feeling keyed up or restless. The opposite is also of concern, if you feel that you are slowed down, almost like you are walking through jello.
- Feeling tired or having a lack of energy nearly every day.
- Feelings of worthlessness or feeling excessive guilt. This guilt is often referred to as “inappropriate” meaning that you know that you didn’t necessarily do anything wrong, though you can’t stop feeling guilty. These feelings of guilt can be overwhelming.
- Having a hard time concentrating and/or making decisions. These symptoms can leave you feeling indecisive and can be very upsetting, especially if you tend to be a decisive person otherwise.
- Frequent, recurrent thoughts of death. This does not necessarily mean that you are thinking of suicide, though that can be part of depression. Sometimes when experiencing symptoms of depression there are simply thoughts about death that are upsetting with no plans or intentions to act.
These symptoms must also cause problems for you. In order to be diagnosed with Major Depressive Disorder the symptoms above have to cause you difficulty in functioning. These challenges can occur in your social life, work life or other important areas. It goes without saying that the above symptoms are intrusive and would likely cause a great deal of distress. Depression is powerful and often takes a toll on those facing it.
If you are thinking that these symptoms are rather broad, you’re right! Depressive Disorders, as well as many other disorders, have what is called “Specifiers.” These Specifiers further describe symptoms as Depression can look very different for each person. On paper (or screen) it appears rather straightforward, though we are all unique and symptoms can manifest in different ways.
Some individuals experience symptoms of depression along with anxiety, but don’t necessarily have an anxiety disorder as well. This would be the specifier “with anxious distress.”
Other specifiers include: with mixed features, with melancholic features, with atypical features, with mood-congruent psychotic features, with catatonia, with peripartum onset and with seasonal pattern.
I want to take the opportunity to look at the last two as they are often discussed as postpartum depression and seasonal depressive disorder. Clinically they are considered two types of Major Depressive Disorder and the above symptoms are seen. Having this knowledge can be remarkably helpful if this sounds like something that you have experienced.
Major Depressive Disorder with Peripartum Onset
The above is a whole lot of clinical terms for what you likely know as Postpartum Depression. This specifier is used when symptoms of MDD are experienced during pregnancy or within four weeks of delivery.
Symptoms that occur with this type of onset include the symptoms of MDD that I mentioned above but also include some other symptoms unique to this diagnosis. Many with Peripartum Onset report difficulty bonding with their baby, fear of not being a good mother and intrusive thoughts/worries about their baby being harmed by themselves or others.
While these are symptoms or feelings often reported, everyone’s experience is their own. If this sounds familiar you deserve support. Whether you are a new mom or adding another child to your family, this transition can be lovely and terrifying all at the same time. Know that help is available, and you aren’t alone. You aren’t supposed to be able to do this all by yourself.
Major Depressive Disorder with Seasonal Pattern
MDD with Seasonal Pattern is often referred to as Seasonal Depression. With this specifier individuals report symptoms beginning at a particular time of year. For most it is in the Fall, with Winter looming and the days getting shorter. For some these symptoms occur in association with summer. Everyone is unique!
Symptoms will begin at a particular time of year and will dissipate/go into remission at the end of that particular season. There must be two years where the episodes of MDD follow this pattern to meet criteria.
Generally, when it comes to MDD with Seasonal Patterns you will experience depressive episodes more with seasonal changes and may not experience depressive episodes in relation to anything else. Folks with MDD may only experience one episode in their lifetime, others may experience many. This diagnosis can look very different for different individuals making it important to voice your concerns to a professional you trust and explore your treatment options.
Treatment Options, You Say?
Yes. Depression is very treatable! MDD can go into remission, you can work through Depression and come out stronger on the other side.
Just as symptoms can look different for everyone, so can treatment. The important part is finding a treatment plan that works for you. The options are likely to look different depending on onset and features as well. For example, with seasonal onset you may find light therapy to be particularly helpful while this may not be as effective for other subtypes.
For many, this includes therapy and medication management. While this route has proven to be effective it isn’t a one size fits all approach to getting better. What helps you to work through your MDD symptoms and find remission may be very different from what someone else needs and that’s okay. It doesn’t mean you are doing it wrong, in fact I might argue it means you are doing it right. You are doing what is right for you.
When exploring treatment options, be authentic to yourself and open to options that can help. Remember, no one is an island. You may think you need to work through Depression on your own but I can assure you that is unlikely to get you to remission.
To Sum It Up
Major Depressive Disorder is treatable. While there are symptoms or “criteria items” needed to make a clinical diagnosis of MDD, if you are experiencing any of the above symptoms you may want to talk with a professional. It is easy to minimize your experience and say, “I don’t meet all that criteria, I’m fine.” It’s great if you are truly feeling “fine, but it can be hard to feel your best if you are experiencing any of the symptoms of MDD.
MDD is not the only type of depressive disorder. There are others to include Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder as well as Depressive Disorders associated with medical conditions and substance use. These types of disorders are worth attention and I did not want to gloss over them quickly. I encourage you to educate yourself about these diagnoses and I’m sure we will expand upon them together in the future at some point.
If you are concerned about your mood, and the symptoms discussed here resonate with you, I hope that you dig deeper and explore your options for improving them. Remission is possible, and you aren’t alone. It can be hard to have a depressive disorder. It can be hard to get help. Choose your hard, my fellow humans. And don’t forget, therapy can help.
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