Major Depression: What is it? And what are its signs and causes?
Major depressive disorder or major depression, also called clinical depression or unipolar depression, or major depressive disorder is characterised by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat and enjoy once-pleasurable activities.
Major depression prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes. This is the most common type of diagnosed depression. The DSM IV classifies major depressive disorder as a depressed mood or loss of interest in daily activities lasting more than two weeks with negative and noticeable impact on daily functioning.
The University of Oxford has released an excellent Podcast series under creative commons which enables How I Beat Depression to freely share this podcast on depression. We highly encourage you to listen to this as it underscores so much of this article nicely:
Below is summary of how symptoms often manifest in daily life.
At How I Beat Depression we do not diagnose people or offer medical advice. If you are concerned about yourself or loved one please seek medical assistance.The good news is that according to statistics 70-80% of people with major depression disorder experience a significant reduction in symptoms when treated.
Symptoms of major depression
Fatigue or loss of energy almost every day
Feeling constantly exhausted, even when little exertion or work is done. See our article on tiredness, which remains one of our most popular posts to date.
Feelings of worthlessness or guilt almost every day
Body and verbal language makes this obvious sometimes, although depressed people are often capable of masking troubled feelings quite well. Bodily postural withdrawal such as drooping shoulders, deflated head and neck carriage, looking down frequently and avoiding eye contact with others. Verbally, statements like “I don’t deserve my family/loved ones or they don’t deserve me”; “They may be better off without me”; “I am not adding or contributing anything to this person/team”. Believing that people can see right though you to an ugly self inside and don’t love and appreciate you and will ultimately reject you, or that no one really understands and appreciates you.
Feeling hopeless and helpless
I feel like nothing will ever change (hopeless) and even if I tried to do anything it would not make once difference (helpless). Really believing there’s no silver lining ever in sight and that misery, blackness, darkness and despair is a lifelong companion.
Impaired concentration, indecisiveness
Depressed people may feel stupid or thick. Basic and ordinary tasks become very difficult to compute, information doesn’t register properly, the lack of concentration makes connecting bits of information and forming clear perspective difficult. Making a decision, even a menial or trivial one, becomes hard to make. The mental fog produces an inability to process information
Thoughtless acts and forgetfulness would be part of this: losing wallets, leaving belongings, forgetting to do basic tasks around the house. This often causes irritation for loved ones and families around the sufferer. It also results in reduced performance at work or educational studies.
Insomnia or hypersomnia (excessive sleeping) almost every day
It’s very common for depressed people to have trouble getting to sleep and then waking up early in the morning and being unable to sleep again; early morning rising is one of the key signs of depression and is no way connected to getting up early because of motivation or intention. Sleep deprivation builds over time because of this and adds to the fatigue felt during the day. It’s also common for anxious states to be more pronounced when trying to fall asleep like a rapid heartbeat and ruminating thoughts. Nightmares often reoccur about previous traumatic and stressful events: school, workplace, finished relationships.
Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others)
A frightening symptom especially when something so dear like a hobby or enjoyment, such as classical music or car repair, becomes worthless and meaningless for someone who loved and enjoyed this previously. Loved ones can notice this change. Pulling away from regular hobbies and structures will accompany anhedonia fuelling the depressive fire of isolation, rumination and emotional introspection.
Restlessness or feeling slowed down
Feeling mentally slowed down is common; again this contributes to indecisiveness and fatigue. The brain struggles to process and the build up of troubling rumination and thoughts. Or the person may have trouble settling down with fidgeting and being restless, the agitated and ruminating mind feeds into this behaviour, not content and accepting the present, wanting to flee and be somewhere else, but not really knowing where.
Recurring thoughts of death or suicide
Sometimes the person will try and do everything to not think these thoughts and try everything to ameliorate them such as meditation, but sometimes these thoughts just can’t be blacked out, changed or dissolved. They may feel that life is not worth living. If you are thinking of suicide contact a professional or crisis hotline immediately. In Australia, call Lifeline on 13 11 14.
In spite of outward appearances of slowness and lethargy, the mind is racing furiously, constantly going between reflecting and fixating of past events, hurts, reactions and possibilities, fixating on current symptoms, worrying about increased strain in current relationships and why it seems that other circles of friends are growing distant and separate from them. The chorus of inner voices is unbearably incessant and often continues when the person is sleeping resulting in interrupted, shallow and poor sleep.
Reduced sex drive
Depression wreaks havoc on normal cycles of life such as eating, sleep and sex, disallowing the person from a sense of replenishment and reward and further exacerbating feelings of being different, disconnected and alone. Further to this the decreased sex drive may cause further strain with loved ones and increase feelings of guilt and worthlessness and a sense of failure.
Significant weight loss or gain (a change of more than 5% of body weight in a month)
May be more noticeable by others and again cause for more concern and rumination for the sufferer. The anxious type will lose weight and have trouble putting down meals, all the cycle interruptions could reduce appetite and desire for food. The oversleeper is likely to comfort eat and not care about appearance or repercussions of overeating.
Can be expressed in anger or discouragement rather than sadness
Depression doesn’t necessarily mean feeling down or morose, it cam come out in anger or discouragement too. It’s important to note this as people may disqualify themselves if it their depression doesn’t manifest with obvious gloom and melancholy. It can be expressed in irritability and anger, especially in response to reasonable requests, lashing out at others making even slight demands at them is common.
In terms of functional impact major depression has been likened to diabetes. It’s a condition that significantly interferes with the normal running of daily life and significantly puts strains on all form of relationships.