Major depressive disorder

You don’t just ‘snap out of it’

Karen Miller | 9/18/2015, 6 a.m.
Depression is one of the most harmful mental health disorders.
Albert S. Yeung, M.D., Director of Primary Care Studies Depression Clinical and Research Program, Massachusetts General Hospital

People tend to use the word "depressed" rather loosely. They often mistake depression for grief or sadness. Although the conditions share some traits, they are actually quite different.

Types of depression

Major depressive disorder: This disorder, often just referred to as depression, is marked by severe symptoms that interfere with your daily life. The symptoms must be at least two weeks in duration. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

Persistent depressive disorder: This form of depression has less severe symptoms than major depressive disorder and lasts usually two years or more. It also can interfere with normal functioning.

Bipolar disorder: Also called manic-depression, bipolar disorder is characterized by mood changes that cycle from extreme highs (mania) to extreme lows (depression).

Depressions that develop under unique circumstances:

  1. Psychotic depression: Occurs when a person has severe depression plus some form of psychosis, such as having delusions or hallucinations.
  2. Postpartum depression: Occurs in 10 to 15 percent of women after giving birth.
  3. Seasonal affective disorder (SAD): Characterized by the onset of depression during the winter months, when there is less natural sunlight.

It is normal to experience grief or sadness in response to a loss or something unpleasant in life. Sadness, however, is not constant and is interspersed by lighter moods. It also tends not to affect a person’s functioning. Sadness and grief eventually subside. Depression does not.

The disorder can affect anyone. It knows no bounds. Both genders, all ages and all races are targets. Celebrities are not exempt. Halle Berry, Alicia Keys and Kanye West have all been victims. Even Serena Williams, who is ranked number one in women's singles tennis, admitted that she at one time had been afflicted.

The medical term is major depressive disorder. Its diagnosis involves a detailed examination of symptoms that have interfered with one’s normal functioning at work and at home for at least two weeks. The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) is the standard classification of mental disorders and the bible of mental health practitioners. It serves as a universal authority for psychiatric diagnosis.

According to the DSM-V, there are nine distinct symptoms of major depressive disorder — changes in appetite and sleeping, loss of energy and difficulty in making decisions, for example. An individual who experiences at least five of the nine symptoms is diagnosed with depression, according to Dr. Albert S. Yeung, a psychiatrist at Massachusetts General Hospital. In addition, according to Yeung, one of the five symptoms must be depressed mood or loss of interest in activities one usually enjoyed.

Depression is one of the most common types of mental illness. The National Institute of Mental Health reports that approximately 15 million people suffer the condition every year. It takes a toll on the economy. In a study published recently in the Journal of Clinical Psychiatry, depression costs $211 billion a year, which comprises direct costs, reduced productivity (workplace) costs and suicide-related costs, which include loss of earning.