We all get down sometimes. Just like any mood or emotion, feeling depressed or “down” is completely normal. It can be a natural reaction to bad news or a stressful event. Or maybe the weather is gloomy and that can make you feel a bit low.
Or maybe you’re getting over a cold, which can deplete your serotonin and bring on a bit of a mood slump.
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.
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.
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.
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.
There are a variety of different depression 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.
Some SSRI antidepressants are escitalopram, fluoxetine, and sertraline. 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.
Some SNRI antidepressants are venlafaxine, duloxetine, and desvenlafaxine.
It’s important to get a full assessment of your depression to make sure these medications are right for you.
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 (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:
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 (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 (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 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:
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 can also help reduce stress, but some of them bear mentioning on their own. Some lifestyle changes you can make are:
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.
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 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.
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.
The views expressed here are those of the author and, as with the rest of the content on Active Ingredients, are not a substitute for professional medical advice, diagnosis, or treatment. If you have any medical questions or concerns, please talk to your healthcare practitioner.