Throughout our lives, it is possible to feel sad for some reason or to go through a bad patch in the emotional arena. And although nobody likes to go through these bumps, the truth is that suffering can even make you grow as a person , and, in short, be positive for your personal development.

However, it is necessary to be aware that, in some cases, what we might think of as simple sadness or an emotional slump, is actually a depressive process; that is, pathological. There are different types of depression, and in this article we will talk about the most serious depressive disorder: major depression . Let’s see what this psychopathological phenomenon consists of.

  • Related text: “Are there several types of depression?”

Major depression: what is it?

Major depression, also known as unipolar depression, is a mood disorder characterized by the appearance of one or more depressive episodes lasting at least two weeks, and presenting a set of symptoms of predominantly emotional nature (pathological sadness, apathy, anhedonia, hopelessness, decline, irritability, etc.). However, symptoms of a cognitive, volitional and somatic nature are also usually present during its course.

Thus, people with major depression are not simply “sad”, but tend to show an extreme lack of initiative to do anything, as well as an inability to be cheerful and feel pleasure, a phenomenon known as anhedonia. They also experience other problems, both physical and psychological, that significantly impair their quality of life.

On the other hand, major depression also affects how you think and reason. In general, a total or partial lack of motivation makes people who have entered into such a crisis seem absent and unwilling to do anything, even think a lot (which doesn’t mean they have a mental disability).

The major depressive picture can be divided into mild, moderate and severe, and usually begins during young adulthood, although it can occur at virtually any stage of life. The individual suffering from this condition may experience phases of normal mood between depressive phases that may last months or years.

On the other hand, major depression is a type of unipolar depression, that is, it does not present phases of mania (which differs from bipolarity), and the patient can have very serious problems if not treated properly.

Is it a unique psychopathological phenomenon?

While major depression is one of the most important concepts in the world of psychiatry and clinical and health psychology, many researchers question whether it’s more than just a collection of similar disorders that actually don’t share any common cause or logic of functioning. This is because people who experience depression can manifest symptoms in a variety of ways, and they respond to treatment in ways that are also very diverse.

New ways of classifying these symptoms are likely to emerge as more research is done. However, at present the psychological construct of “major depression” helps to treat many people who need treatment from professionals and who can benefit from therapy , which is important if we consider that this alteration of mental health is linked to the risk of suicide and that it also usually produces great suffering.

Common symptoms

According to the fifth edition of the Diagnostic Manual of Mental Disorders (DSM-V), for the diagnosis of major depression, the subject must present five (or more) of the following symptoms during the depressive period (at least two weeks) .

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These should represent a change from the patient’s previous activity; and one of the symptoms should be (1) depressed mood or (2) loss of interest or ability to feel pleasure (anhedonia).

  • Depressed mood most of the day , almost every day (1)
  • Loss of interest in activities that were previously rewarding (2)
  • Weight loss or gain
  • Insomnia or hypersomnia
  • Low self-esteem
  • Concentration and decision making problems
  • Feelings of guilt
  • Suicidal thoughts
  • Psychomotor agitation or delay almost every day
  • Fatigue or loss of energy almost every day

It is important not to confuse major depression with other similar mood disorders, such as dysthymia. This psychological disorder is also associated with many of the symptoms of major depression, but there are some differences. Primarily, what distinguishes dysthymia from major depression is that dysthymia develops over longer cycles (at least two years), the intensity of symptoms is less, and anhedonia is typically absent.

Types of major depression

In addition, the DSM-V specifies that the symptoms must cause clinically significant discomfort or impairment in social, occupational or other important areas of functioning. The episode cannot be attributed to the physiological effects of a substance or other medical condition, and the major depressive episode is not best explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified disorders on the spectrum of schizophrenia and other psychotic disorders.

There are two types of major depression:

  • Major depression with single episode : there is only one depressive event in the patient’s life.
  • Recurrent major depression : Depressive symptoms appear in two or more episodes in the patient’s life. The separation between depressive episodes should be at least 2 months without symptoms

Causes of this mood disorder

Major depression is a multifactorial phenomenon , so different factors could cause this psychopathology: genetic factors, childhood experiences and current psychosocial adversities (social context and personality aspects).

In addition, difficulties in social relationships, cognitive dysfunctions or socio-economic status may be risk factors for the development of this disorder. Probably, however, the interaction of biological, psychological and social factors favours the appearance of major depression.

Also major depression has been linked to a lack of dopamine in the brain’s reward system, which makes the person aimless. This can be the trigger for a sedentary and monotonous lifestyle and the serious self-esteem problems that often occur in these cases.

Treatment

Major depression is a serious but fortunately treatable pathology . Treatment options usually vary depending on the severity of the symptoms, and in severe cases, the administration of psychotropic drugs combined with psychotherapy seems to be the most appropriate treatment.

However, in recent years other treatments have been shown to be effective, e.g. Electroconvulsive Therapy (ECT) , which is often used when depressive symptoms are severe or drug therapy is not successful. However, this therapy is not comparable to the old electroshock therapy , as the intensity of the shocks is much lower and it is painless.

On the other hand, while Mindfulness has shown some effectiveness in intervening in cases of mild depression, with major depression it does not seem to work.

However, people diagnosed with major depression can easily relapse into this type of crisis , so treatment is planned as a lifelong aid (although not necessarily on a weekly basis). In addition, the methods used to avoid relapses are different from those used when the patient is experiencing a depressive crisis.

Treatment with psychotherapy

Psychological therapy has proven to be an effective tool for the treatment of depression , especially cognitive behavioural therapy. This type of therapy considers the patient as a system that processes information from the environment before issuing a response. In other words, the individual classifies, evaluates and gives meaning to the stimulus according to his or her set of experiences coming from the interaction with the environment and their beliefs, assumptions, attitudes, world views and self-evaluations.

In cognitive behavioral therapy, different techniques are employed that are intended to have a positive effect on low self-esteem, negative problem-solving styles, or the way people think and evaluate events around the patient. Below are some of the most common cognitive-behavioral techniques:

  • Self-monitoring , record sheets or realistic technical goal setting are techniques that are often used and have proven to be effective.
  • Cognitive restructuring : Cognitive restructuring is employed so that the patient can become aware of his own emotions or thoughts and can detect irrational thoughts and replace them with more adaptive ideas or beliefs. Among the best known programs for the treatment of depression are: Aaron Beck’s cognitive restructuring program or Albert Ellis’.
  • Development of problem solving skills : Problem solving deficits are related to depression, so training in problem solving is a good therapeutic strategy. In addition, social skills training and assertive training are also useful treatments for this condition.

Other forms of psychological therapy have also proven effective in treating depression. For example: interpersonal psychotherapy, which treats depression as an illness associated with dysfunction in personal relationships; or mindfulness-based cognitive therapy (MBCT).

Pharmacological treatment

Although in less severe cases of depression or in other types of depression it is not always necessary to apply psychotropic drugs, in severe cases of depressive disorder it is advisable to administer different medications for a certain period of time.

The most commonly used antidepressant drugs are as follows:

  • Tricyclic antidepressants (TCAs) : These are known as first generation antidepressant drugs, although they are rarely used as first drug alternatives because of their side effects. Common side effects caused by these drugs include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking, and fatigue. These drugs can also affect blood pressure and heart rate, so they are not recommended for older people. Some examples are: Amitriptyline, Clomipramine or Nortriptyline.
  • Monoamine Oxidase Inhibitors (MAOIs) : MAOIs are antidepressants that act by blocking the action of the enzyme monoamine oxidase. Like the above, they are used less often because of their serious side effects: weakness, dizziness, headaches, and tremors. Tranylcypromine or Iproniazid are some examples of this drug.
  • Selective Serotonin Reuptake Inhibitors (SSRIs) : These are the most widely used and are usually the first choice in the pharmacological treatment of depression. These medications usually have fewer side effects than other antidepressants, although they can also cause dry mouth, nausea, nervousness, insomnia, sexual problems, and headache. Fluoxetine (Prozac) is the best-known SSRI, although other drugs from this group are also often used, such as: Citalopram, Paroxetine or Sertraline.

Excess Serotonin and Serotoninergic Syndrome

Although it is also possible to find other types of antidepressants such as Selective Noradrenaline Reuptake Inhibitors (SNRIs), Selective Noradrenaline and Dopamine Reuptake Inhibitors (SNDRs), or atypical antidepressants, when taking antidepressants that have the ability to increase serotonin release, care must be taken with their overdose or drug interaction.

The excess of serotonin stimulation on the post-synaptic receptors 5-HT1A and 5-HT2A at a central and peripheral level has negative effects for the organism that can become very serious and even deadly due to the Serotoninergic Syndrome.

  • You can learn more about this syndrome in our article: “Serotonergic syndrome: causes, symptoms and treatment”

Bibliographic references:

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  • Drake RE, Cimpean D, Torrey WC. (2009). Shared decision making in mental health: prospects for personalized medicine. Dialogues Clin Neurosci.
  • Kramer, Peter D. (2006). Against depression. Barcelona: Seix Barral.
  • World Health Organization. ICD 10. (1992). Tenth Revision of the International Classification of Diseases. Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Madrid: Meditor.
  • Perestelo Pérez L, González Lorenzo M, Rivero Santana AJ, Pérez Ramos J. (2007). Decision-making tools for patients with depression. Quality Plan for the MSPS NHS. SESCS; 2010. STD reports.