Is Major Depression a Mental Illness?

Major depression, also known as major depressive disorder, is different than a passing feeling of sadness that comes from the loss of a loved one, losing a job, trauma, a medical issue, or other life stressors. It is a mental health illness marked by a persistent sad mood or hopeless feeling. It is considered a mood disorder because mood is substantially disrupted, causing changes in the way a person thinks, feels, and perceives his or her environment and relationships. When a person is suffering from the disorder, all aspects of his or her life are affected, often causing significant difficulty in functioning. The ability to go to work or school or to carry out everyday activities, as well as interpersonal relationships, can be impaired.

Major depression is the most common mental health diagnosis. More than 16 million Americans suffer from the disorder, and it is the leading cause of disability in the United States for people between the ages of 15 and 44. Women are twice as likely as men to suffer from it.

Because major depression is so prevalent, it is well understood by mental health professionals and highly treatable. With treatment, people can experience an improvement their mood, relationships, and ability to function in life.

Signs and symptoms that a person may have major depression can vary among individuals. And, while not everyone will experience all of them, having several of the following symptoms is a strong indicator the disorder may be present:

• A persistent depressed or sad mood, feeling empty or helpless
• Fatigue
• Irritability
• Noticeable loss of enjoyment in activities previously enjoyed
• Sleeping too little or too much
• Feeling worthless, or guilty
• Losing or gaining weight, and unexplained gastrointestinal issues
• Restlessness
• Intrusive thoughts of death or suicide, or suicide attempt(s)

The most common symptoms include a sad or empty feeling, loss of motivation to participate in activities that were previously enjoyable, fatigue, irritability, non-specific aches and pains, and an inability to concentrate. Symptoms of depression can range from mild to severe. But when major depression is present, symptoms are generally severe and cause noticeable problems with interpersonal relationships and carrying out everyday activities.

Men and women tend to experience major depression differently. Men are more apt to express symptoms of depression as tiredness, irritability, and anger. They also tend to engage in risky behavior and substance abuse. Men often don’t recognize their symptoms as being a problem and, thus, do not seek treatment.

On the other hand, women tend to express signs of major depression as sadness, feelings of worthlessness, emptiness, and guilt. Women are more likely to seek treatment than men.

The exact cause of major depression is unknown. But there are many factors that play a role in the development of the disorder.

People with a blood relative with depression are more likely to also develop it. Additionally, physiological and chemical changes in the brain have been found in people who suffer from depression. What those changes mean is still unclear, but research indicates that irregularities in brain chemistry affects the way it regulates mood and emotion, possibly causing instability of both.

Trauma and losses early in life have also been linked to the development of depression and major depressive disorder. Researchers believe that trauma causes subtle changes in brain chemistry and function that are related to symptoms of anxiety as well as depression.

Women also are subject to several physiological issues, such as hormonal changes due to menopause, pregnancy, or postpartum complications that can trigger the development of major depression.

Certain medical issues such as cancer, stroke, hypothyroidism, Cushing’s syndrome, diabetes, and other ailments that affect the endocrine system have also been associated with symptoms of major depression. The endocrine system produces hormones that regulate growth, metabolism, sleep, sexual function, and mood, among other things.

Other mental health disorders or medications for treatment of other disorders could also cause symptoms or lead to the development of major depression.

Symptoms of depression vary in severity and can range from mild to severe. Because most people have felt sad or a mild transient depressed mood, they may find themselves asking, “Is major depression a mental health illness, or simply someone having a few bad days?” The truth is, major depression is a very serious mental health illness. People suffering from the disorder cannot just “snap out of it” and will themselves into “feeling better.” In fact, without treatment, symptoms may only get worse.

A diagnosis of major depression can only come from a trained mental health professional. Generally, a doctor will conduct a physical exam to rule out medical reasons for symptoms, collect a medical history including family history of mental health illness, and discuss the person’s symptoms, feelings, emotions, and patterns of behavior.

In addition to the physical and psychological evaluation, mental health professionals will consider criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 requires that a person experience at least five or more of the nine main symptoms of depression, one of which must be either a depressed mood or a loss of interest in activities that were once pleasurable. Additionally, those symptoms must be present most days over a two week period or longer and cause a change from previous levels of functioning. The depression must not be a result of physiological effects related to a medical illness or substance abuse to garner a diagnosis.

Two-thirds of people suffering from major depressive disorder do not seek treatment. Without treatment, major depression only gets worse and can lead to development of other medical or mental health issues.

Usually, the disorder is treated with a combination of talk therapy—most commonly, cognitive behavioral therapy (CBT)—and medications. The purpose of CBT is to help people diagnosed with major depression to:

• Identify stressors
• Find better ways to cope with life difficulties
• Manage moods and emotions
• Replace negative feelings and beliefs with positive ones
• Regain control and confidence over self
• Improve life functions and interpersonal relationship

If psychotherapy alone is not sufficient, medications may also be prescribed to alleviate symptoms of major depressive disorder. Typically, antidepressants are used to treat depression. They help to change the way chemicals in the brain regulate mood and emotions.

Antidepressants usually take a few weeks to begin working, so it is important to give them a chance to take effect and not stop taking them abruptly.

There are several types of antidepressants that work in different ways to treat symptoms of depression.

• Selective Serotonin Reuptake Inhibitors (SSRIs) decrease symptoms of major depression by increasing the amount of serotonin in the brain. Serotonin is a chemical that transmits signals between brain cells to control mood and emotion. It is “selective” because it only affects serotonin, not other chemicals in the brain. SSRIs have fewer side effects than other antidepressants and are therefore generally used before other medications. Common SSRIs include sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), and escitalopram (Lexapro).
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) work much like SSRIs but affect both serotonin and norepinephrine. SNRIs can also help reduce pain and anxiety in addition to controlling mood and emotion. They also have fewer side effects and are used as a first line of pharmaceutical treatment. Common SNRIs include duloxetine (Cymbalta, and desvenlafaxine (Pristiq).
• Monoamine oxidase inhibitors (MAOIs) are the first antidepressants that were developed. They also work by changing the way chemicals in the brain work to ease symptoms of depression. Although they are very effective, MAOIs have serious side effects, including potentially deadly interactions with certain foods, so are often prescribed only when other antidepressant are ineffective. MAOIs cannot be combined with SSRIs. Common MAOIs are tranylcypromine (Parnate), phenelzine (Nardil), isocarboxazid (Marplan), and Selegiline (Emsam).
• Tricyclic antidepressants are also an early iteration of antidepressant and have serious side effects. Newer medications have fewer side effects, so tricyclic antidepressants are generally used when other options don’t work. They work on serotonin, norepinephrine, and other neurotransmitters to better regulate mood. Common tricyclic antidepressants include imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, and desipramine (Norpramin).
• Atypical antidepressants also affect the way chemicals in the brain interact to ease depression. But the various medications work on different neurotransmitters. For instance, one medication may change dopamine reaction, while another medication affects serotonin, and still another medication works on norepinephrine. Side effects of atypical antidepressants can be serious. Typical medications include bupropion (Wellbutrin XL, Wellbutrin SR), mirtazapine (Remeron), and trazodone.

Residential treatment can be the best option for people experiencing severe symptoms of depression. Therapy can be provided in a safe environment, away from stressors, while mood is stabilized and new coping skills are developed. Residential care may be essential when a person’s symptoms prevent them him or her from properly being able to provide self-care, or when there is risk of harm to oneself or others.