Major Depressive Disorder: Diagnosis and Treatment

Major Depressive Disorder (MDD) is a mood disorder marked by detrimental changes to a person’s well-being on a number of levels. It includes feelings of emptiness, sadness, and a lack of hope or pleasure, in addition to thoughts and actions that significantly impair an individual’s functioning.

Careful consideration is given to the differences between Major Depressive Disorder and normal “everyday” sadness, or grief.

Sadness—an emotional pain marked by a lacking or longing sensation—is part of the emotional spectrum and the human experience. As opposed to MDD, sadness can affect an individual’s well-being without significantly harming their ability to function in life for an extended period of time.

Grief—the emotional destabilization process of bereavement that centers around emptiness, due to the loss of a loved one, ability, object or even idea—also occurs normally, and is not considered a disorder. Though MDD can stem from grief or appear with it simultaneously, MDD tends to be more severe. Additionally, while grief involves a preoccupation with what has been lost, MDD turns the focus to the individual experiencing it, causing them a great deal of self-criticism.

Both sadness and grief typically arise in reaction to a known event or experience, with the individual ultimately able to recover without these feelings becoming a near-constant factor. MDD, on the other hand, can develop without a recognizable source and is typically recurrent; as such, an individual can find themselves drawn into repeated bouts of depression, without understanding why. Depression can also occur in conjunction with other psychiatric disorders. For example, many patients suffering from Obsessive-Compulsive Disorder (OCD) or Post Traumatic Stress Disorder (PTSD) also cope with symptoms of depression.

MDD is marked by extended periods of sorrow, anhedonia (lack of happiness), or a lack of hope that things will improve through lasting relief. Drastic weight change when not dieting, erratic sleep schedule, diminished self-confidence, suicidal ideation, excessive guilt and a loss of energy are also signs of this disorder.

The various symptoms of MDD result in significant impairment in different areas of life, such as social, occupational, personal hygiene and in terms of self-worth.

Major Depressive Disorder: Diagnosis and Treatment

It should be noted that MDD can be considered when the symptoms associated with the disorder are not the result of a medical condition or substance abuse (e.g. weight loss resulting from cancer treatment).

Additionally, an individual who has undergone a manic or hypomanic episode cannot typically receive an MDD diagnosis.

Symptom Severity and Episode Recurrence

The level of severity and single vs. recurring episodes are also considered when assessing MDD. This severity spectrum ranges from mild to severe, and also looks at possible psychotic features that may arise.

Risk Factors

There are several factors that have been shown to increase the chances of developing MDD. These include a temperamental inclination, childhood environment, life events, genetics, and the existence of other mental disorders or medical conditions.

MDD Treatment

Major Depressive Disorder can be treated through several treatment options:

Deep TMS: Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive treatment that utilizes a magnetic field to safely regulate the neural activity of brain structures clinically shown to be associated with MDD. Deep TMS does not require anesthesia and can be incorporated into an individual’s daily routine.

Deep TMS has repeatedly been shown to successfully alleviate MDD symptoms. Due to the treatment’s effectiveness, dTMS was granted FDA clearance status in 2013 for treating this disorder.

Deep TMS has not only been shown to effectively alleviate symptoms of MDD, but can also be combined with any form of medication, due to its non-invasive treatment process. A 2019 study published in the Journal of Psychiatric Research highlighted these advantages: when applied over the left dorsolateral prefrontal cortex (DLPFC), Deep TMS was found to result in significantly higher remission rates when combined with pharmacotherapy, as opposed to pharmacotherapy alone.

Psychotherapy: Psychotherapy is often suggested as first-line therapy for MDD. Discussing what may have led to your depression with a caring and trained professional has been shown to offer relief to many patients. As patients begin to unpack the contributing factors that continue to affect their well-being, psychotherapy has the added advantage of offering them a safe space, where they can come to terms and even grow from painful aspects of their life story.

Major Depressive Disorder: Diagnosis and Treatment

Medication: There are several types of medication normally prescribed to treat MDD, which affect different neural pathways to achieve symptom relief. Though many find them to be helpful, all antidepressants may cause some side effects, and require time before the right kind or combination of medication is discovered.

ECT: Electroconvulsive Therapy is a medical treatment that uses brief electric pulses to stimulate the brain, inducing a brief seizure. The treatment is performed while the patient is under anesthesia, with potential side effects including short-term memory loss. Its proven efficacy is therefore counterbalanced for many by its more complicated preparation process and adverse possible side effects.

Consult your doctor if a question arises regarding the status of your mental health, the possibility of Major Depressive Disorder, and whether Deep TMS may be right for you.