Major depressive disorder (MDD) is rooted in genetic, biological, environmental and psychological factors. While this disorder usually presents itself in adulthood, sometimes after a major illness, it can show up in children and adolescents as irritability rather than low mood. In adults, MDD can be caused by medications used to treat a medical condition. All cases, even the most severe, can be successfully treated. The sooner a patient is diagnosed, the easier the disorder is to treat.
There are five forms of presentation: persistent depressive disorder (dysthymia), postpartum disorder, psychotic depression, seasonal affective disorder and bipolar disorder.
Types of Presentations
Persistent Depressive Disorder (dysthymia)
Persistent depressive disorder is a low mood that can span the length of two years. A patient may have major depressive episodes and periods of less severe symptoms. To be diagnosed with this disorder, symptoms must last for two years.
Postpartum goes beyond the typical baby blues characterized by mild depression and anxiety symptoms that usually clear up two weeks after birth. With this disorder, patients experience a major depression pre- or postpartum. This experience is marked by sadness, anxiety and exhaustion. Given the severity of these symptoms, patients have trouble caring for themselves and their offspring.
Psychotic depression is an unfortunate combination of severe depression and psychosis, with delusions and hallucinations.
Seasonal Affective Disorder
Seasonal affective disorder usually occurs during the winter months when there is a lack of sunshine. Symptoms include social isolation, sleeping too much and weight gain. This disorder can occur every year during the onset of the colder months.
Bipolar disorder is not the same as depression, but is included with MDD for the periods of morbidly low moods that are similar to the benchmarks of major depression.
Diagnosis and Treatment
Depression, even in the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Treatment includes medications and psychotherapy separately or in tandem. However, if the patient is not progressing, electroconvulsive therapy and similar brain stimulation therapies can be explored. Antidepressants may improve the way the brain sends out signals to control mood and stress. Doctors may try several antidepressants at varying doses to manage symptoms and side effects. These medications are to be taken for two to four weeks before the effectiveness can be assessed. If the patient would like to get off the medication after six months to a year, a doctor should monitor them to prevent withdrawal symptoms.
Psychotherapy is a valuable tool when dealing with depression, including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. Brain stimulation therapies are a solid alternative when medication and therapy do not produce the desired results, or when a first-line intervention is needed. Electroconvulsive therapy (ECT) can be performed on an outpatient basis as a series of sessions.