What is Major Depressive Disorder?

Having clinical depression isn’t the same as feeling a bit depressed. Let’s think of it as a mental health spectrum. On the one end, your mental health is great, you’re feeling good, and are accomplishing what you need to get done. 

On the other end, you’re not well at all. Maybe you’re struggling to cope with crippling depression, or maybe you might even have suicidal thoughts.

Somewhere in the middle of that spectrum is where the threshold for clinical depression lies and major depressive disorder is diagnosed. This is when depression becomes so difficult that it impacts your life, your feelings of hope, thought patterns, and it can even show up as physical ailments. 

If you are experiencing depression, it’s important to pay attention to your needs and seek help. You don’t have to feel this way and there is help available.

If you are in crisis, seek medical assistance immediately. 

What is major depressive disorder (MDD)?

Major depressive disorder is a serious mood disorder that can cause significant impediments in someone’s life and affect their physical health. It is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as having nine distinct physical and emotional symptoms. In order to be diagnosed with major depressive disorder, the DSM-5 says that at least five of those distinct symptoms should be present almost every day for at least a two-week period. 

• Consistent depressed mood
• Diminished interest in most or all activities
• Significant unintentional weight loss or gain
• Insomnia (trouble sleeping) or hypersomnia (excessive sleeping)
• Slowed mental processes and reduced physical movement
• Tiredness, fatigue, loss of energy, or decreased efficiency
• Difficulty concentrating or indecisiveness
• Feelings of worthlessness or excessive, inappropriate guilt
• Increased thoughts of death or suicidal thoughts (with or without a specific plan to commit suicide)

In addition, at least one of the symptoms must be either a depressed mood or a loss of interest and these symptoms have to be causing significant distress or impairment in your ability to function. It’s important to remember that everyone’s threshold for distress is different, so trust that what you’re feeling is important and that you don’t have to go through this alone. 

It can be difficult to quantify your own feelings or quality of life, particularly if you’ve been experiencing troublesome moods and emotions for a while. That’s why it’s important to talk to your doctor to see if you are experiencing major depressive disorder. 

Major depressive disorder can be a lifelong disorder, but with the right treatment, recurrences can be significantly lessened in both quantity and severity.  

Treatments for major depressive disorder

While there is no cure for major depressive disorder, treatments have come a long way. Some individuals even see their depression go into full remission with treatment, while for others, treatment can lessen the severity and frequency of episodes. 

However, the more episodes of depression you experience, the likelihood of experiencing another in the future is higher. That’s why it’s important to talk to a doctor. 

Medications for major depression

There are a variety of different medications that help alleviate the symptoms of major depressive disorder. It’s usually advisable to combine medications with talk therapy to help with coping mechanisms and reframing thoughts.  

Antidepressants mostly fall within two categories:

SSRIs: SSRIs are selective serotonin reuptake inhibitors. They work by blocking the reuptake of serotonin by the neurons, thus allowing more serotonin to work its magic. 

Serotonin is a handy little chemical called a neurotransmitter and is believed to be responsible for mood regulation, feelings of happiness, sleep quality, appetite, and digestion, among other things. 

Not every SSRI works for everyone and patience is needed for full effects to be seen (anywhere between 4-6 weeks). 

SNRIs: SNRIs are serotonin and norepinephrine reuptake inhibitors and work much the same as SSRIs with the key difference being the addition of the neurotransmitter, norepinephrine. Some individuals who find SSRIs don’t work see positive results with SNRIs. 

It’s important to get a full assessment of your depression to make sure these medications are right for you.

Talk therapy

Sometimes talk therapy works on its own, but often it’s more effective when combined with medications. This is why it’s best to talk to your doctor. 

There are multiple variations of talk therapy, each focusing on a different aspect of mental health needs. Not all types of talk therapy work for everyone. Depending on your depression, you may need to be in therapy for a while, so patience is key.

There are a few forms of talk therapy that have shown promising results in individuals with major depressive disorder. 

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a particularly effective treatment for both anxiety and depression and when combined with antidepressant medications, it is even more effective. 

CBT works by helping you reframe your thoughts, resulting in different patterns of thinking and being able to recognize harmful thoughts as they happen. It also helps provide coping mechanisms.

Cognitive behavioural therapy can help with:

• Using problem-solving skills to cope in difficult situations
• Helping you to recognize distorted thoughts, such as unfounded assumptions or beliefs that are harming you
• Helping you recognize and gain confidence in your own abilities

Cognitive behavioural therapy is an active therapy in which patients are asked to monitor their thoughts and feelings related to their depression. This is then worked through with a psychotherapist who is trained in CBT.  

Interpersonal psychotherapy 

Interpersonal psychotherapy (IPT) is another form of talk therapy that focuses on improving interpersonal (between people) functioning. It helps you look at your relationships in a more objective and healthy way. 

Solution-focused therapy

Solution-focused therapy (SFT) helps with goal-setting and solutions for achieving those goals. It does this by reframing your thoughts towards a more positive outlook, rather than remaining mired in negative thoughts that depression can often create. 

Reducing stress

Reducing stress is also a bonus, no matter the state of your mental health. When we’re under stress, our bodies react by producing stress hormones, which in the longer term, can harm both our physical and mental health.

Of course, it’s nearly impossible to remove all stress. Obligations will always bring some amount of stress, but talking about any feelings of overwhelm you may have with key people in your life can help with this. 

Some simple ways to reduce stress are:

• Schedule some time for yourself and do something just for yourself (even if that’s lying in bed and reading a book).
• Consider your work commute. If there’s anything stressful about it, see if you can find a way to reduce that stress, like calming music or even commuting at different times.
• Reduce social media exposure.
• Make a soothing cup of tea.
• Commit to small walks.
• Practice relaxation techniques such as meditation or breathing exercises.

Reducing stress is always an ongoing process. What you may be able to handle one day, could be overwhelming the next. Finding your middle ground is the key and talk therapy can also help you with that.

Lifestyle changes

Lifestyle changes can also help reduce stress, but some of them bear mentioning on their own. Some lifestyle changes you can make are:

• Eat a balanced diet.
• Get regular exercise.
• Commit to a healthy sleep routine, including reducing screen time.
• If you smoke, consider quitting.
• Quit illicit drug use.
• Reduce alcohol intake. Alcohol is a depressant and should not be consumed while taking antidepressant medications.
• Keep connections with close friends and family, even when you’re feeling down. 

In addition to these, group therapy or support networks are also beneficial. Depression can be incredibly isolating and knowing you’re not alone can make all the difference. 

Be kind to yourself

Above all, be kind to yourself. Major depressive disorder is a medical condition with treatment available.

Consider starting a gratitude journal. This is a type of journal where you document things you are grateful for, no matter how small. Maybe it’s a perfect cup of coffee, or perhaps it’s that you had a productive day. Or maybe it’s the friendships you’ve cultivated. Anything you might be grateful for. This journal can help remind you of the good in your life when you might be struggling. And all of those good things are a result of you.  

There’s always hope

There’s help for major depressive disorder and you don’t have to face it alone. You can talk to a healthcare practitioner about your treatment options. 

Here are some free Canadian mental health resources you can turn to if you are struggling with major depressive disorder or just want some more information. 

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If you are having suicidal thoughts, please seek help immediately by going to your nearest emergency department or by calling 911. You can also contact Crisis Services Canada’s national suicide-prevention hotline at 1-833-456-4566 if you are considering suicide or are concerned about someone who may be.