The Truth About Major Depressive Disorder
Author Stephanie Fjetland M.S.S.W., F.D.S
What is “Major Depressive Disorder”?
This is a loaded question to me. Finding it to be one of the most Googled mental health topics over and over again made me put it on my top ten starter topics for my mental health and social justice blog, “Kinda Unprofessional” hosted on “The Petty Cow”.
It was such a commonly searched and cited issue, that almost immediately, I knew that it had to become my second topic out of the almost 200 topics I told myself that I would write freely
about.
People ask this question for a lot of reasons. They need an answer for how they or someone they love is feeling or behaving. They want or desire validation, reference, or resource towards an answer that goes deeper than just questioning the powers of the internet. The reality of what someone is feeling and thinking when printed in black and white holds a lot of weight to the reader. The complications behind the information are at the discretion of the writer. The motive behind the writing then becomes who am I answering this question for? What do I know? What do I believe they need to know? How can I be of use to those asking?
That’s how I walk into this topic. I could do an essay based on regurgitating the DSM V criteria, which I do touch on here to some extent. I could hire someone with a PHD to write 1500 clinical and respectable words about the topic and hope the algorithm finds me useful enough to get site views. Alternatively, I could approach it like I do everything. Carefully, with respect, with disclosure, with experience, and with far too many words for one article.
I had to remind myself that my mission is to be useful and concise. I choose to start with the most basic psychosocial and educational explanation of the topic. Then explain the diagnostic criteria for the decision. Then I go into the things I don’t believe anyone else credentialed is willing to tell you. I believe everyone needs to have access to information. With that being said, I believe they also need the opportunity to understand the information. Over the course of my career, more than anything, the thing my former patients and clients needed and appreciated about me was that I told them the truth.
Major Depressive Disorder is defined as a diagnosable psychological and chemical mental disorder that affects the way a person feels, thinks, functions and behaves. It is characterized by not just the manifestation of low mood and sadness. It is a chronic imbalance. It is a cyclic and episodic. When authentic it is lethal when untreated.
Major Depressive Disorder is diagnosed by clinically observing the symptoms in historical report, physical presentation over time, biology, psychosocial history, and when done correctly it is diagnosed after a full spectrum initial assessment and clinical interview using scientific testing and tools like questionnaires or scaled symptom surveys designed by empirically designed by psychologists. It is not something that should be given as a label during a fifteen minute interview while in crisis.
Just because a person feels depressed it does not mean they have a serious chronic mood disorder. When transparent and best practicing, Major Depressive Disorder is a serious condition that shouldn’t be taken lightly. There are several other types of depression or explanations for psychological depression, physiological depression, and social or occupational dysfunction. It is important to know that just because you are depressed doesn’t mean you have major depression disorder. Alternatively, it also means that if a person does have it, it can be managed when appropriately diagnosed and treated.
Whatever type of experience someone might be seeking answers to, there can be hope.
If a person has experienced a trauma, loss, or is going through a circumstantial or biological transition there is a good chance their symptoms can be managed or changed by gaining insight, therapies, non medicinal treatment modules, and time.
“Depression” when reported in layman’s terms is not a good barometer for a true prognosis of illness.
Don’t allow yourself to count yourself out as hopeless because you’re feeling dissonant or traumatized and don’t have the words to explain it to yourself. Those are different things with different causes and implications.
At the same time, if you continue to meet criteria for Major Depressive Disorder and are suffering the effects of such symptoms you may very well benefit from and find relief from the appropriate treatments. There is a dangerously fine line in between mood and medicine. If you are thinking of harming yourself or someone else please go to the bottom of the page and call someone for help.
So what are the symptoms and diagnostic criteria for Major Depressive Disorder?
Diagnostics begin with the experience of multiple congruent symptoms that onset and establish for over at least a two week time period. Meaning a person is having multiple symptoms at the same time and they are unchanged over a measurable period of time at minimum.
If you lost someone to death, lost your job, or ended a long term relationship last week you may feel trapped in depression but it doesn’t mean it is major depressive disorder.
That is not said to negate the severity of the feelings or the potential of risk of self that those circumstances might create. Those are valid, complicated, and life altering experiences. These experiences deserve the opportunity of time and discernment to be treated as such for the best outcome before being labeled as a chronic mood disorder.
You can be devastated by an event and not be suicidal. You can be chronically suicidal and have your sociological and rational needs met. The foundation you build your truth and treatment plan from deserves to be fully informed and appropriately assessed, period.
Two people may present with the same feelings and symptoms in one moment but one might need time and psychological processing in therapy temporarily then return to fully functioning. Meanwhile another expressing the same feelings and perceptions might need life long medication management to achieve a functional baseline or continue to decline despite motivation for change.
Major Depressive Disorder is overdiagnosed as a gateway to treatment in more settings than it should be. It is often an umbrella disorder used by ten minute clinicians in order to open the door to insurance benefits and billing in different levels of treatment and therapies.
It is often blanketly misdiagnosed as it is used as an initial excuse to treat a patient in a moment of crisis without acuity, and it often leads to psychotropic medications and treatment planning that is inappropriate for the individual patient in their long term reality.
I cannot leave that information out.
The diagnosis of this disorder is a double edged sword not to be taken lightly.
That being said, lets focus on what it is and what to do about it.
The diagnostic criteria for MDD per the current diagnostics manual, The DSMV, include experiencing at least four of the following symptoms for at least two weeks and more.
Symptoms include:
Loss of interest
Depressed mood
Weight gain or loss
Psychomotor agitation or retardation
Feeling worthless or unjustifiably guilty
Decreased concentration
and
Thoughts of death or suicide
When the disorder is active, the manifestation of the combination of these symptoms begins to outwardly affect a person physically, socially, and occupationally if untreated or inappropriately treated.
If you are able and insightful, do a self check with yourself and your symptoms. If you don’t remember how you have been feeling or behaving or how long you’ve felt that way, write down how you assess yourself today and make a goal to revisit your thoughts and what you wrote down after two weeks go by.
This allows you to see where you find yourself currently and again after tracking yourself for a measurable interval of time.
In two weeks time you might have motivated yourself out of what could have been a dark time or circumstance or you might find yourself deciding it is time to seek potential treatment for symptoms that are sustaining.
Symptoms don’t equal forever or a lifetime in reality. Feeling depressed may go as deep as forever emotionally but understanding that it is a chemical response and can potentially be changed for the better is empowering.
If you find yourself still suffering the side effects of depression or another disorder, allow yourself the muster and priority to seek treatment. You deserve it.
Take what you wrote with you when you seek and find help.
Statistics for Major Depressive Disorder show the disorder is more prominent in women, adolescence, and people claiming more than one cultural ethnicity. Risk factors include heredity, substance use, socioeconomic disprivilege, intellectual delay, and trauma.
You can read the specifics in the references section at the end of this article.
What you need to know is like I mentioned previously Major Depressive Disorder is a diagnostic double edge sword. It is often over diagnosed and misdiagnosed used as a catch all blanket diagnostic in early stages of treatment.
A “working” or “initial” diagnosis is just a starting point for clinicians and doctors to use in filing insurance claims for treatment. While doctors are required to name what illness or disorder they will be treating in order to be reimbursed by health insurances, true diagnostics require time. They also require historical review and the assessment of symptoms over time to be diagnosed accurately.
In acute inpatient settings and many county funded mental health authority clinics the treatable conditions are limited to only a few specific and over generalized diagnostics. Sometimes the only way a person gets treatment is by getting qualified to be treated for the wrong thing.
Major Depressive Disorder is often used as a way for hospitals and indigent clinics to qualify a person or their payor source in order to receive payment. Healthcare is an industry not a person.
If person who lost a loved one to death goes into an inpatient psychiatric treatment facility for suicidal ideations during early bereavement the hospital can’t bill their insurance for grief or circumstantial depression.
The hospital has to label them something they can get paid for. So doctor’s narrow their opinions down to the most likely left on the list of things they know they can get paid for.
The patient may not actually need or benefit from the treatment planning or medications that are approved to be used for treating a chronic mood disorder. It might be detrimental or hinder progress.
First time inpatient patients are often discharged for follow up outpatient care that may or may not continue in approximate or appropriate treatment.
They might be set up for failure at the gate. Oftentimes therapy is recommended but unattainable as an out of pocket cost. Contemporarily clinicians are more often choosing not to work with insurances and offer cash only services to provide services at all.
Charity and sliding scale programs often require proof of low income and indigence. They often have waitlists and long admission processes that delay the patient from being able to continue recommended treatment or the refilling medications started by hospital doctors. Stopping these medications can be dangerous and create the patient more problems psychologically and biologically than they started with.
The experience of running into complicated social service access barriers while already in a state of mood episode or crisis is frustrating and defeating. Trying to find help and being denied access often makes the person seeking help feel more depressed and hopeless as they run into roadblocks and dramatically discontinue mind altering psychotropic medications.
The diagnosis and treatment of Major Depressive Disorder is not something to be taken lightly. While you may very well be suffering the symptoms of an imbalance I think everyone deserves the empowerment of being informed of the reality of contemporary practices in medicine and social welfare. These systems and processes put in place for treatment are often not acting in the best interest of the person in the real world. There may be some setbacks and roadblocks to finding a course to effective and accessible resources that work.
Major Depression is a cyclic and chronic condition. It’s truth is that there will be more episodes over time. It will likely relapse. It will require maintenance to keep an established baseline. Once in remission, it will require diligence in preventative measures and supports to help prevent and lessen the future onset of symptoms. A person may find their perfect drug or reason for living in their first battle with symptoms but those cases are often not true major depression.
Consequences of unmanaged or inappropriately treated Major Depression often result in more the person experiencing exaggerated symptoms and further social and occupational impairment. Death by suicide is a common side effect of the symptoms of the illness when untreated.
The reality is that it is a true disorder and should be respected as such. The silver lining is that it can also be treated in a way that restores the person’s quality of life and functioning when resources are accessible.
Education is the key to empowerment and progress.
Resilience comes from continuing to seek options and retaining your will to survive while surviving something difficult.
We all have that in us.
I like to think that if we took all the social and political implications of mental health practices off the table, everyone could find their way to a balanced and sustainable life they enjoy living.
If you or someone you know is experiencing the symptoms listed please seek resources for appropriate treatment. It can change your life.
If you are struggling to access services and feel hopeless in your quest for relief please know those feelings are real and valid. You deserve better than our system is set up. Please don’t allow these barriers to prevent you from continuing to try to find your way to a healthy lifestyle.
I struggle with what resources to offer since I am distrusting and jaded after spending a career in clinical social work and human service. I am also not practicing, not treating, and not liable for the consequences of anyone’s thoughts, choices, or behaviors.
NAMI is a great starting place for resources and education.
They can help guide you to resources in your area. Service areas have so many differences that I can do justice to a single individual while speaking globally to the whole.
NAMI is an excellent place to find information and education for a variety of mental health disorders and resources. It is supportive to family members seeking guidance and support. It is national and regionalized. You can visit their site here.
If you are looking for something to change how you feel for the better in this moment and you aren’t tired of reading, check out my last post “15 Things You Can Do Right Now to Recover From a Setback” below.
If you are thinking of harming yourself or someone else please call your local mental health authority or hotline number for crisis intervention and referral.
These symptoms can come to pass. Time and circumstances will come to change. It can get better.
The national suicide crisis operates twenty four hours a day by calling the number or visiting their website below.
If you enjoyed this article please comment, share, like The Petty Cow on social media and join the mailing list for updates on new content on other topics. Our goal is achieve sustainable revenue though ads and traffic that allow for the content to remain free for everyone.
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Other references:
“Are You Going Through Depression?”
https://blogs.baruch.cuny.edu/youareworthit/?page_id=50
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