What is major depressive disorder?
In: 88
It’s a mood disorder in which the symptoms of depression (there are criteria for a major depressive episode) persist for most of the day, nearly every day, for at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning.
There is a distinct difference between general sadness and depression. Sadness is situational and generally has external causes beyond the control of the person (i.e. loss of a loved one). Depression is the cause of a chemical imbalance in the brain, so it is internal. Think of it like emotions. Sadness is anger at something, but there isn’t a direct target for the anger. Because of this lack of a target to focus the anger, there is a feeling of hopelessness, and one will “feel” sad. Therapy can help with sadness because there is an external source that can be addressed. Depression is basically anger turned inward as there is no external source. Therapy alone generally doesn’t work with major depressive disorder because the chemical imbalance remains. This is why a combination of therapy and medication is the best course of action.
One thing to note. Sometimes you feel sick and go to the doctor, and if it’s a common virus, they might say take some Tylenol, drink plenty of fluids, and let it run it’s course. BUT, if symptoms continue after a certain time or become worse, go to the emergency room. Sadness is like this. After the loss of a loved one a person will be sad, but if that sadness lasts a long time or isn’t adressed in therapy, the brain will become used to this feeling, leading to a chemical imbalance, aka major depressive disorder. If something is making you sad and you are struggling to get over it, seek help!
The brain makes you feel emotions by passing signals between the brain cells, called neurotransmitters. In some people, for some reason they can’t discern, their brain’s neurotransmitters stop functioning properly, and when the ones that tell them to feel contentment and joy are the ones that stop working, it makes the person start feeling sad and helpless. Because the neurotransmitters aren’t working right, it makes it hard to do things, because while the person is aware that things that would normally make them feel better (like having a clean home and body) or happy (like hobbies), are happening, they don’t feel very different.
Psychologist here! Let me see if I can explain it the way I sort of wrapped my head around it in grad school.
So peoples moods go up and down, think of it like a wave; sometimes it’s up and you’re feeling good, sometimes it’s down and you’re not feeling good. For most people this is a pretty regular thing, you have good days when the wave is up, and bad days when the wave is down. Everyone gets a little depressed and a little down sometimes, especially in relation to stuff that happens in our lives.
When you have Major Depressive Disorder, the wave goes WAY down, way lower than it should, and it stays there for a bit before coming back up. When it’s down, you just can’t do anything. It’s like your body loses the will to act. This is what we call a “Depressive Episode.” Now a single episode isn’t a big deal, especially if something in your life made it happen; losing a love one, facing death, yeah these things suck. But with this disorder, that deep wave keeps happening, which really sucks and makes it hard to function. This repeated, super deep dips of the wave is what we call Major Depressive Disorder.
Now what’s cool is you can use this wave analogy for other mood disorders too. For example, what happens when the wave goes way up? You have way too much energy, act impulsively, can’t control yourself, and so on. This is what we call a “Manic Episode.”
Ever heard of Bipolar disorder? That’s what your wave is going *Crazy*! high waves and low dips. This is really disruptive to peoples lives and why we often medicate to manage it!
So people with Major Depressive Disorder aren’t always depressed. Sometimes the wave is up! But sometimes the wave is way way down, and it’s hard to get out of bed or even function.
Hope that helps!
MDD tends to be cyclic, where a person suffering from it has periods where they want to do little (anhedonia), feel extremely sad outside of a direct cause and potentially actually move and interact with the world slowly. It tends to recur, and in the time between episodes, they might not be happy per-se, but are less affected. MDD is just one of a large number of depressive and mood disorders, and while it tends to be what people think of when referring to “depression,” there are things like dysthimia that are less periodic.
Have you ever been devastated? Just utterly heartbroken to the point where you feel numb and empty and it feels physically difficult to move? It feels basically impossible to get out of bed, and when you find the strength to force yourself to do even that much, you have trouble doing anything else, like showering or brushing your teeth or getting dressed. You don’t want to be around anyone. Your favorite comedy fails to cheer you up or make you laugh. You feel like you’re falling apart and breaking.
Most people only feel this way once or twice in their lives when they experience a devastating loss. Someone suffering from Major Depressive Disorder feels some or all of these things most of the time for no explainable reason. There’s no huge loss that they’re going through. Their life might seem pretty nice (comfortable income, standard of living, family, etc), but they feel empty and numb or can’t find joy in things that used to make them happy. They might feel like they’re falling apart or find it physically hard to move or impossible to get out of bed or take care of their personal hygiene in the same way that someone who’s experiencing extreme loss might go through.
Everyone experiences these things in normal amounts and at appropriate times, in response to normal stressors. What makes this a disorder is that depressed people experience this all or most of the time in response to seemingly insignificant stressors.
Another thing a depressed person might experience is negative self talk, where, in addition to the above, they feel that no one likes them or that they are a huge burden to everyone around them. As someone whose suffered from MDD for years, I often find myself starting to think suicidal thoughts because someone I care about snapped at me. Through years of therapy and medicine, I can quickly stop myself from spiraling into becoming suicidal, but before, my thought process would be something like (very simplified) “I care about this person and they snapped at me. They must hate me so much. I’m such a burden to them and I make their life so difficult. I love them so much and I hate that I make their life worse. It would be better for them if I didn’t exist. If I really loved them, I wouldn’t be in their life and things would be easier for them. I love them so much and they hate me because I make life worse for them. I’m being selfish by being alive. I need to kill myself because I love them and want to make their life easier and I just make things worse for everyone around me.”
Depression is horrible and it’s taken a huge amount of therapy and a lot of trial and error with medication to find a combination that works for me. Everyone’s depression is different, but a lot of mine is feeling like how I described.
Have you ever had a stomach ache when something bad happened or you knew you did something bad? What if you felt that all the time, even if everything was okay?
Have you ever just been watching the water going down the sink and forget what else your doing? My Dad would shout, “hey stop wasting my water and time! Get out here!” I really thought that whirlpool cool. I’m like Grandma old now, and I’ll still watch it sometimes since it’s now MY water no one can yell.
MDD is like falling into that whirlpool you’re watching, not realizing you fell in, and getting stuck there. Now I know there’s a whole bathroom around me with a wonderful shower with lots of nozzles, the walls are my favorite colors, I got fluffy towels, a beautiful view out the window, and even a door I could use to get out. But what I can see, feel, hear is just that little bit of space that’s
inside that swirl of water going into the drain. My walls are made of tough feelings,mostly about me. and not good thoughts, mostly about me, instead of water, but you get the idea.
MDD also means you get stuck in the little
whirlpool for a very long time. So long that you forget or no longer believe the rest of the room is there. Real things you can see in the bathroom with the sink aren’t real to me, and my big ‘problem’ things don’t seem like a big deal to you. I say, “why can’t you else see the water walls are going to suck us away?” And you say, “You can just walk out the door and not look at the whirlpool.” Then I say, “What the heck are you talking about, there’s no door in the water? “
Now I feel extra lonely cuz my friends can’t help, and that makes it even sadder for me in my little world
My MDD reoccurs, so I keep falling in the sink water! Sometimes I fall because of things that would hurt anyone’s heart, like missing someone I love who’s not around anymore. Other times I can’t tell you what happened, but I’m back in the water! The good news, my five year old friend, there are things that help people like me.
Meds help me stay higher in the water when I happen to end up there, like a floaty in a pool. It’s dangerous to be that far down in the water sinking. By keeping me higher my meds let me do all the important things everyone needs to do when in danger. I can still breathe, see what’s around, hear who’s there, not panic, and call for help.
Therapy, talking to a person about my thoughts and feels, helps me see when I’m getting into the bowl and getting close to that danger spot. Then I can avoid it! I mean wants to get stuck in a sink, right?
I also learned ways from my doctor to get out fast. My first get-out-early trick is Distraction, make a phone call or google something weird but fun (come on we all take our phones to the bathroom). My next is to Use my Five Senses to know what’s really around me; I get in the shower feel the water hitting my skin, taste the spray of water, hear the drops hitting the walls And my last choice,for some stupid reason I don’t know, is get up and go somewhere else. I hit the door and get to a place where that neat but dangerous for me water whirlpool isn’t. Kinda feels like that should be first, right?
Kiddo I hope that makes sense, but if look at other responses for more help. That’s the way to make most problems better, ask for help when you need it and don’t feel bad for asking.
I have double depression, which is chronic dysthymia with bouts of major depression. I describe dysthymia as a chronic low-grade fever, metaphorically speaking. When the major depressive episodes hit, I call this double whammy a full-on bout of the flu, also metaphorically speaking. I hope that helps. 🙂
I have depression, I don’t know if it’s major depressive disorder or not but it is a pain so this is how I like to see it.
Imagine you’re walking in a forest and you’re on a dirt path. Like dirt paths tend to do there are natural pits formed. Some people can see these pits and avoid them, some people will trip a bit but recover quickly. Now I’m a little clumsy so if there’s a pit for me I trip into it so hard I fall into a different deep hole. For a while when I would fall into a deep hole my solutions were “oh I can dig tunnels in the hole and get out that way” or “if I can figure out to fill the hole with water I can swim out of the hole.” Someone who isn’t me can clearly knows if you dig tunnels in a deep hole you get lost and when fill the hole with water you can drown. After getting lost and almost drowning a few times I learned that digging gives you rocks and water will strengthen the roots and turn the dirt into mud. I learned how to turn the rocks and mud into a stronger foundation and how to climb roots. After I’m out of that hole, because I am clumsy, I will fall into more holes. But eventually I learned how to build fires and collect food so if I fell into another hole I could handle being in the hole better. I learned how to make rope when I’m in the forest and I fall into another hole I can get out easier. I learned not all holes are created equal and what might have worked in the past won’t work for this hole. And still as a get older I’m learning how to take different paths to handle the pits better, but I know that when there is a pit and I trip, how to get out of the hole.
In our lives we are faced with so much uncertainty, stress and anxiety. For some people they know how to handle these things and for some of us they cause us to spiral and get stuck. Being depressed, for me at least, feels like I’m trapped in my own brain. I feel stuck and feeling stuck makes me sad, and being sad will turn to feeling empty. When I have empty in the past in cause me to go to very dark places, making me lost in my own thoughts, which when you’re depressed, are self destructive. Through lots of trial and error, I’ve learned how to navigate the emptiness and how to work through that to get myself back where I want to be. Sometimes I just need to find a way to get out and sometimes I need to survive the emptiness until I know how I’m supposed to get out. Depression is about learning strength, forgiving yourself, and about surviving through the pain. But most importantly it’s about learning how to not make it worse for myself.
I will trip, and I will fall into holes. Being in the hole is the hard part. But being out to see the forest, is why I keep trying to get better at getting out.
Latest Answers