What is depression, and do you have it?

This is a question many adults find themselves facing on a regular basis. As a human being, our emotions fluctuate constantly and it is normal to find yourself feeling low, seemingly with no way to escape. Especially in our hyperconnected world, we find it far too easy to compare ourselves to others and find ourselves falling short. While social media and an overexposure to influencers certainly have contributed to the epidemic of reduced self confidence and body image issues, has it increased the risk of depression?

What depression is, medically

Major Depressive Disorder (MDD) is a medical diagnosis formally clarified in the DSM5 (Diagnostic and Statistics Manual 5) by the American Psychiatric Association (APA). It is a narrow and specific condition that covers more than the occasional feelings of melancholy and sadness. This does not mean that those who do not meet the strict criteria of MDD are fine and just need to 'get over it', but those who receive the diagnosis of MDD have reached a stage that requires medical intervention.

The hallmark symptom

The core feature of MDD is a feeling of low mood (sadness / depression) OR a loss of enjoyment in previously pleasurable activities (anhedonia) that persists for more than two weeks and is present for most of the day and for most days of the week. This is the hallmark of MDD and can present in several different ways.

How it shows up day to day

The most common experience that people with MDD have, is that they have reduced motivation to face the day. They find themselves sitting in bed contemplating if they should even get up and go to work. They wonder if what they are doing is good enough or if they are even acknowledged for the work they do. Many people with MDD describe the desire to sleep and never wake up. If you have been feeling this way for a prolonged period, you may have MDD and should consider booking a session with a professional healthcare practitioner.

The other symptoms doctors look for

The other symptoms required to make the diagnosis of MDD are any four of the following: weight change of 5% or more (either gain or loss); increased or decreased sleep; increased or decreased physical movement (as noted by others); loss of energy (fatigue); feeling worthless or having an overwhelming sense of guilt; reduced concentration or attention; suicidal thoughts or behaviour.

In addition to the five main symptoms (hallmark plus four additional), the condition must cause a noticeable decline in social or occupational functioning (e.g. inability to interact with others or perform duties at work) and there cannot be another medical condition that explains all the symptoms (such as a thyroid condition). Thus, MDD, as with most mental illnesses, is a diagnosis of exclusion.

Treatment starts with therapy

However, having a mental illness is not the end of the world. Treatment does exist and has been shown to be beneficial for those suffering from MDD. The first modality prescribed is not medication, but psychotherapy with a registered clinical psychologist. Often the circumstances leading to MDD are beyond our control, but learning to frame the situation and master our own inner world allows us to handle the emotions that come with the difficulty better. A psychologist who has been trained in specific modalities, such as CBT (Cognitive Behavioural Therapy) or EMDR (Eye Movement Desensitization and Reprocessing) can teach one to control their behaviour by changing the Negative Automatic Thoughts (NAT) that they may have.

Therapy is not a one-and-done situation and requires a commitment and willingness to change. It took a long time for the MDD to develop, and it will take while to get out of it, especially if there is a difficulty changing the extenuating circumstances that lead to the declining mood. However, those who have gone to therapy and stuck with it, have shown immense improvement in their mood, functioning, and daily life.

When medication is added

In some instances, where the symptoms of the MDD are quite severe and the effect it has on a patient is impairing (as measured by scales such as the Hamilton Depression Rating Scale), the doctor may prescribe medication as a way to help alleviate the severity of the symptoms whilst the patient attends therapy.

These meds are known by a variety of names, the most famous being Prozac, but they all fall under the umbrella name of antidepressants. As the name suggests, they are developed specifically to combat depression, but since they have a wide spectrum of effect, they can also be prescribed to help combat anxiety, OCD, PTSD, and even eating disorders.

The meds are used to help rebalance the chemicals in the brain (a common theory for the cause of MDD is an imbalance in the chemical called Serotonin in the brain, but this is still hotly debated). Every patient is unique and the medication used to treat one patient may not work for the other, thus your doctor may trial one medication, increase the dose slowly, and if there is still no noticeable benefit, trial you on another one.

Do not despair, this doesn't mean that the MDD is untreatable, just that the correct regimen hasn't yet been tried for you. As with therapy, the medication takes time to work and consistency with the dosing schedule is extremely important. The tablets do not take effect immediately and it will take at least two weeks before the symptoms begin to abate.

If you are still concerned about the recent changes in your mood and feel that you may have MDD or any other mental illness, book an online session with one of our highly qualified medical professionals today to conduct a full psychiatric assessment. Our talented doctors are trained in the diagnostic interviews specific for conditions described in the DSM5 and can help you begin your journey to mental wellness.

If you are in immediate danger or thinking of harming yourself, this is not the place to wait. Call 10177 for an ambulance, or 112 from a cell phone.

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