Dr. Karthik Ramanan, NMD

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What is Major Depressive Disorder?

Feb 26, 2020

Maybe you've received a diagnosis of major depressive disorder, or you just want to know what it is. Well in this post, I'm going to walk you through the diagnostic criteria so you come away understanding what major depressive disorder is… and what it isn't. And be sure to stick around until the end, as I'll share some insight into how lifestyle choices can positively impact mental health…and some personal words of encouragement.

 

Let's first define major depressive disorder by its diagnostic criteria as per the Diagnostic and Statistical Manual of Mental Disorders.

A. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Before we dive into these, let's just ensure that part settled. There's 9 items in this upcoming list, and five or more have to be met during a two week period, AND, those patterns need to be different from how a person normally is. One of the symptoms also has to be either depressed mood… or loss of interest or pleasure. Got it? So, at least 5 of these 9. Ready? Let's go.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report - e.g., feels sad, empty, hopeless - or observation made by others - e.g., appears tearful

Basically that means someone's experiencing depression most of the time, almost daily. And that depression is determined either by the person themselves or by someone else making the observation.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day - as indicated by either subjective account or observation.

This is a significant characteristic. If you've experienced depression or been around someone going through it, you know what we're talking about here. The desire to do seemingly anything is greatly reduced or non-existent.

3. Significant weight loss when not dieting or weight gain - e.g., a change of more than 5% of body weight in a month- or decrease or increase in appetite nearly every day.

Fairly self-explanatory, but basically we're talking about unintended weight change or appetite change.

4. Insomnia or hypersomnia nearly every day.

This is basically referring to a significant change in sleep patterns. Insomnia, as you know, lack of sleep. Hypersomnia is excessive sleep. Often times when someone is depressed, sleep feels like a great escape.

5. Psychomotor agitation or retardation nearly every day - observable by others, not merely subjective feelings of restlessness or being slowed down.

Psychomotor movement is movement that is consciously made. So we're not talking about digestion and things that happen automatically. We're talking about voluntary movements. Agitation or retardation refers to excessively increased or decreased motion patterns. And specifically, this has to be noticed by other people either in the form of agitation or slowness.

6. Fatigue or loss of energy nearly every day.

Obviously, very common symptom of depression. Everything feels like a drag and it's difficult to sometimes do even basic life activities.

7. Feelings of worthlessness, or excessive or inappropriate guilt - which may be delusional - nearly every day; not merely self-reproach or guilt about being sick.

This gets a little subjective. We can all feel worthless at times, emotionally speaking. We can all feel guilt. Here we're talking about a level of worthlessness or guilt that far exceeds what might be considered normal. This is significant.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day

This can be as per the assessment of the individual or others who have observed this lack of concentration.

9. Recurrent thoughts of death - not just fear of dying-, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

This covers a bit of ground here. The distinguishing factor is that the fear of dying is considered normal, and this criterion doesn't cover that fear. This refers to either repeatedly thinking about death, contemplating suicide with no plan, or actually making an attempt or establishing a plan to commit suicide.

Those are the 9 criterion, and 5 or more of those have to be met in order to be able to call the condition Major Depressive Disorder. And there's more. But first…

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

When we talk about clinically significant distress or impairment, this is a subjective measure but really indicates intensity, duration, and frequency.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

This is important. If the depressive episode relates to another medical condition or a substance, it's not major depressive disorder. This is why it's important to work with a licensed naturopathic physician or functional medicine doctor to look at your entire symptom picture, comprehensive lab work, etc.

If criteria A, B, and C are met, then this is considered a major depressive episode. And we have more.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

This would need to be determined by the mental health professional doing the diagnosis.

E. There has never been a manic episode or a hypomanic episode.

A manic episode is an emotional state characterized by a period of at least one week with an elevated, expansive, or unusually irritable mood. A hypomanic episode is similar symptom-wise, but they don't necessarily impair a person's daily function, and there are no psychotic symptoms.

Anyhow, with major depressive disorder, there's no manic or hypomanic episode. If there is, we might consider looking at a form of bipolar disorder.

So there you have it. Major Depressive Disorder.

Does that mean if your symptoms don't qualify for major depressive disorder that your depression is all in your head? NO! Not at all! The diagnostic criteria is just a framework for clinicians and insurance companies to be able to put a definition on a set of symptoms. Remember, you are not your symptoms. You are a person, and whatever you are going through, there is hope.

If you're dealing with depression, I get it. People around you don't understand. They want you to just cheer up because "it's not that bad". All you want to do is step away. Here's something I wish I knew years ago. Depression is often a result of your construct of reality or your sense of self being completely shattered. When you just want to pull away and be by yourself, that's actually your brain engaging in an extremely high state of neuroplasticity. That means you're actually breaking and reforming neurological connections… lessons, meanings… at a rate that's FAR greater than we normally would. It's a physiological process of self-healing that once it takes place leads to incredible strength and purpose. There is hope. There is always hope.

In the world of integrative mental health, there's a lot of options, and it's worth seeing someone locally who can look at your lab work, your lifestyle factors, and recommend solutions that can absolutely help you feel better. Now, nothing I'm about to say here is a substitute for individualized medical care or counseling. Please be smart and consult a medical professional or counselor before undergoing any sort of treatment plan. This is just for your information.

I have done a few episodes of the Dr. K Show on how exercise and nutrition affect depression. The importance of taking care of your gut microbiome, which are the trillions of bacteria that live in your gut, is extremely important. These bacteria are responsible for 90% of the neurotransmitters in your body, so it makes sense to get the bad bacteria out of there and foster the helpful strains. We're learning more every day about how our precious gut microbiome is effected from everything from foods to medications.

I'd also love to know what other questions you have about depression in the comments.

Always remember, I believe in your greatness!

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