Understanding Major Depressive Disorder (MDD). What It Means and Why Diagnostics Matters

Introduction. What is Major Depressive Disorder (MDD)?

Very often we take for granted that we can naturally maintain good mental health. Most of us have come to expect and accept the usual ups and down that come with life. We can feel sad during certain times in our lives; however, it is important to understand though when we cross the line into a clinical depression.

For this reason, we want to explain what the Major Depressive Disorder (called also Major Depression) is, and describe its signs, symptoms and diagnostics.

Depressive symptoms can appear also in course of other psychiatric disorders such as Bipolar Disorder or PTSD. Some physical illnesses, for example hypothyroidism or diabetes can mimic depression.

When depression affects your ability to function in life, it is essential to seek psychiatric help. Your psychiatrist or psychologist has the knowledge to be able to assess your depression.

Major Depressive Disorder (MDD). Signs and symptoms

The symptoms of Major Depressive Disorder have such profound effect that it affects people’s ability to function. People feel “pressed down” in their mood and vitality. Psychiatrists count depression to the category of “affective disorders” because it affects how you think and feel. Depression influences emotions and energy levels. Other associated symptoms are sleeplessness, underlying anxiety, sometimes even delusions. MDD frequently appears in phases, called episodes, which continue for weeks or months, sometimes for years.

The first step in recognizing the signs and symptoms of clinical depression is a detailed psychiatric investigation consisting of a patient interview and physical examination. Psychiatrists will recommend laboratory tests, and in more severe cases, an EEG and MRI to rule out underlying physical disorders. Your psychiatrist will prescribe the medication best suited for you and your condition. The best medication is medication that alleviates your symptoms and does not have side effects. The goal of psychiatric treatment of depression is to achieve a full recovery, which means that the depression is cured, and a relapse prevented.

Major Depressive Disorder (MDD). Diagnostics

A diagnosis of depression is based on the signs and symptoms developed by the patient. Typical symptoms are low mood, fatigue, loss of appetite and sleeplessness. In severe cases, patients suffer from loss of affect (feelings and emotions) and experience slowdown of thinking (brain fog). In such state, the patient is not able to feel happy or sad but feels “numb”.

DSM 5 Criteria of Major Depressive Disorder

The current classification systems DSM 5 and ICD 10 , categorize depression based on the severity of the symptoms and codes them as mild, moderate, or severe. The phenomenological description based on description and quantification of symptoms do not tell us nothing about the underlying root causes.

The second key step in the diagnostic procedure is identifying the frequency of episodes (single or recurrent episodes) and the presence or absence of delusional symptoms.

• Depressed mood, most of the day, nearly every day, can be irritable mood

• Loss of interest/pleasure: markedly diminished interest/pleasure in all (or almost all) activities.

• Weight loss or gain: significant weight loss or gain or decrease or increase in appetite nearly every day.

• Insomnia or hypersomnia: nearly every day

• Psychomotor agitation or retardation: nearly every day

• Fatigue or loss of energy, nearly every day

• Feeling worthless or excessive/inappropriate guilt: nearly every day

• Decreased concentration: nearly every day

• Thoughts of death/suicide: recurrent thoughts of death or recurrent suicidal ideation

Additional required criteria: must have all 4, plus ≥5 depressive symptoms above and the symptoms cause clinically significant distress in social, occupational, or other important areas of functioning.

Social impact of Major Depressive Disorder

Depression leads to mental and physical inhibition (mental block) that impairs a patient’s social and occupational functioning. In consequence, depressed people are often unable to carry out even the simplest daily activities. They cannot keep their apartment clean or maintain personal hygiene. Other symptoms include feelings of helplessness, social self-isolation, difficulty concentrating, and spinning thoughts (compulsive thoughts). Patients with depression often experience decreased or complete lack of sexual interest (loss of libido). In the most severe cases associated with emptiness and helplessness, patients might begin to have suicidal ideations and think of suicide as the only solution.

Sense of guilt and inferiority

The main themes of depression relate to the person’s ‘spiritual salvation’, material and health condition. The person might believe to be the greatest sinner (guilt delusion), or he might claim to be utterly poor despite his good financial situation (poverty delusion). Patients overestimate negative events. Pleasant experiences have no effect. Depressed people tend to feel guilty and inferior to others.

Social withdrawal

A common symptom of depression is social withdrawal. It can be described as a behaviour where the average number of regular social contacts in a given society is involuntarily and significantly reduced.

Whether the lack of social interactions is externally imposed or stems from internal inhibitions is irrelevant. Initially avoiding situations like large gatherings can lead to a spiral towards complete social isolation. Social avoidance can not only be a symptom of a depression but also can trigger it. For instance, there is a significantly higher prevalence of depressive symptoms among adolescents who reported having no close friends.

The approach to overcoming social isolation depends on the reasons behind its occurrence, which often involve a combination of factors. The lack of contacts can have far-reaching consequences. In many cases, psychotherapy is the preferred method to stop the vicious circle by addressing underlying emotional issues.

Social stigma, and misperception

When family and friends are not familiar with clinical depression, they might seriously underestimate what a depressed person is going through. Very often, a family member will think they are observing someone being lazy, angry and negative. Well-meant advice for a quick pick-me-up only makes depressed people feel worse, because simple remedies that work with sadness will not work for the patient. It is very important for us to understand that clinical depression is a condition that needs appropriate, professional attention and treatment.

Diagnosing Major Depressive Disorder (MDD) at CHMC in Dubai

Depression isn’t a disorder that you can treat on your own; it’s a serious condition triggered by multiple factors. Therefore, the condition must be diagnosed and treated by an experienced psychiatrists and follow standardized procedures. In consequence, the treatment of depression at CHMC adheres to the international standard following a number of steps.

Anamnesis

Anamnesis means a medical history review. The psychiatrist asks you about your personal and family medical history. The reason is to identify possible genetic or environmental factors causing the depression.

In the second step, your psychiatrist will assess the symptoms by asking for their quality, quantity, and duration. These symptoms may include persistent sadness, empty mood, loss of energy, fatigue, sleeplessness, and feelings of guilt.

Physical exam

The psychiatric exam consists of general physical exam and neurological exam which are critical component of the evaluation process. The objective of the exams is the exclusion of physical illnesses, for example neurological problems on the central nervous system, which might be associated with depression.

Laboratory test

Laboratory tests are necessary to detect possible health problems before starting treatment. They also serve as a benchmark for later controls to rule out the side effects of the prescribed medication.

Electrocardiogram (ECG)

Similarly, the ECG has the objective of excluding problems on your heart before commencing the treatment and creating a point of reference for the follow-up controls.

Psychological evaluation

Additionally, a psychological evaluation may be necessary in some cases to secure a diagnosis and gain further insight into your psychological status. This evaluation can involve the use of standardized interviews or psychometric tests.

Securing diagnosis

A thorough anamnesis and investigation are necessary to diagnose and treat depression effectively. This comprehensive approach helps to develop a personalized treatment plan that addresses your unique needs. Based on the collected data your psychiatrist will establish a diagnosis using international statistical manuals such as ICD 10 or DSM 5.

Cure and risk factors

• The first step prior to treatment is the correct diagnosis distinguishing depression from other mental disorders.
• Recognizing correctly depression is the “bottle neck” in the diagnostic and treatment process. Only half of the depressive disorders are diagnosed properly
• From those accurately diagnosed only half are treated. This means that only every fourth person suffering from depression receives treatment.
• Among the sufferers 10% -15% commit suicide
• Men are three times more likely to commit suicide than women.
• Depression is a genuine illness and not a sign of a “personality weakness.”
• A professional team consisting of a psychiatrist and psychologist can cure depression.

Famous people diagnosed with clinical depression:

• Abraham Lincoln
• Georgia O’Keeffe
• Theodore Roosevelt
• Robert Schumann
• Emily Dickinson
• Ludwig van Beethoven
• Edgar Allan Poe
• Marie Curie
• Mark Twain
• Vincent van Gogh
• Virginia Woolf