Major Depression DisorderMajor depressive disorder is also known as major depression or clinical depression is characterized by a combination of symptoms that interfere with a person’s ability to study, work, eat, sleep, and enjoy once-pleasurable activities. Medical professionals refer to this illness as “Clinical Depression”. In many instances, this is also referred to as “Unipolar Depression”. This particular form of depression is characterized by a mood that is considered to be “low”.

In the 1980 release of the manual known as the “Diagnostic and Statistical Manual of Mental Disorders” the organization known as the American Psychiatric Association included the term of “major depressive disorder” as one of the most common mood based disorders. In this depression guide, you will be introduced to several facts pertaining to this prevalent and potentially disabling psychiatric condition.

Different people are affected in different ways by major depression. Some people have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still, others can function reasonably well at work and put on a “happy face” in front of others, while deep down they feel quite depressed and disinterested in life. There is no one way that people look and behave when they have major depression. However, most people will either have depressed mood or a general loss of interest in activities they once enjoyed, or a combination of both. In addition, they will have other physical and mental symptoms that may include fatigue, difficulty with concentration and memory, feelings of hopelessness and helplessness, headaches and body aches.

Clinical depression is a serious illness. It’s important to know which form/type you’re dealing with. Depression can last for weeks, months and even years. In addition, it can be remittent. The severity can range from not wanting, or being able, to eat, function, or work at optimal capacity, to contemplating suicide.

The most common types of depression are Major Depression, Dysthymia, and Bipolar.

  • Major Depression

Major depression is serious and disabling. It may be remittent; you can get it once, or it may repeat itself on and off throughout your life. This depression affects your ability to eat, sleep, work, and enjoy yourself. Its symptoms include agitation, difficulty concentrating, fatigue, hopelessness, withdrawal, and thoughts of suicide.

  • Dysthymia

Dysthymia is also known as chronic depression and is also a serious disorder. It is characterized by long-term symptoms, which means having symptoms at least two years. While the symptoms may be similar to, but not as severe as major depression, it can still affect the sufferer’s ability to function properly or feel well. Those who suffer from dysthymia may also have episodes of major depression during their lifetime.

  • Bipolar Disorder

This form of depression is also called manic-depressive illness. It is s serious mental illness. The major characteristic of this disorder is the sufferer may go from being very energetic and in a high mood, to being irritable and/or sad and hopeless. Their mood swings are like a see-saw, up and down. Unlike major depression and dysthymia, bipolar disorder affords the sufferer normal moods in between the highs and lows.

While in the up or manic mood the sufferer will feel wired, jumpy, and talk fast, jumping from topic to topic. He will be irritable, have trouble relaxing and sleeping, be more active, and possibly do dangerous things. He may feel like he can do anything like he is invincible.

While in the down or depressive mood the sufferer will feel sad, worried and tired. He will have trouble concentrating, forget things, lose interest in enjoyable activities, have trouble sleeping, and even think about suicide.

Other Less Common Types of Depression are:

  • Postpartum Depression is a type of depression that occurs in a new mother usually within a month of having a baby.
  • Psychotic Depression is a severe form of depression accompanied by psychosis, such as delusions or hallucinations.
  • Seasonal Affective Disorder is a type of depression is related to changes in seasons and a lack of exposure to sunlight.

Causes

There are a number of causes for depression, which can be caused by stressful situations, major traumatic events, chemical imbalances in the brain, or other problems. It may be related to genetic makeup, since people who are depressed also tend to have family members who are depressed, even if these people are not in contact. No matter what its cause, depression causes significant emotional pain and is a disruption to many people’s lives. It affects their friends and family, makes them less productive at work and more likely to call in sick or even lose their jobs, and it can cause many other problems, as well.

To be listed as someone suffering from the major depressive disorder, at least five symptoms from the following list have to have been present during a two-week period. They must represent a change from earlier functioning. People with fewer symptoms or those who haven’t had a change may still be depressed or suffering from a mood disorder, but that disorder will be classed differently. Possible symptoms include a depressed mood, lack of pleasure and interested in activities formerly enjoyed, a significant change in appetite or weight, greatly increased or decreased sleep, excess guilt or feelings of low worth, trouble concentrating and thinking, and recurrent thoughts about death.

Medical professionals have yet to determine one specific cause for the major depressive disorder. Instead, they have established that there are several causes for this condition. One of the main areas of interest when it comes to the causes of this particular form of depression is the common chemical imbalances that may occur within the brain.

There are certain neurotransmitters within the brain that have a large impact on our ability to experience feelings such as pleasure. They also play a large role in the moods that we experience. These neurotransmitters are identified as serotonin, dopamine, and norepinephrine. It is believed that one of the main causes of major depressive disorder is an imbalance within these chemicals in the brain.

Medical professionals also believe that the family history plays a role in the development of the major depressive disorder. Genetic predisposition may account for many cases of major depressive disorder according to many doctors. In many cases of this mental health condition, it has been established that another person in the family history also experienced depression.

The last cause that many medical professionals consider that could lead to this form of depression is the psychosocial based environment that a person lives in. As you can see, there are many different factors that could contribute to this form of depression among individuals.

Symptoms

There are many symptoms associated with the major depressive disorder. In order for an individual to be considered one that suffers from this condition, they must experience symptoms for at least two weeks. The mood that is reflected in the individual must be significantly different than that which is typically experienced by the individual. The change that is experienced must affect an individual negatively in at least one of the following ways:

  • Occupational
  • Social
  • Educational

Major Depressive Disorder Symptoms:

  • A deep feeling of sadness, emptiness or becoming extremely anxious
  • Trouble sleeping or excessive sleeping
  • Extreme difficulty concentrating
  • Feelings of hopelessness and helplessness
  • Agitation, restlessness, and irritability
  • Fatigue and lack of energy. Etc.

Depressive illnesses are highly responsive to treatment. In fact, 80 percent of people with depression report feeling better within a few weeks of starting treatment. There is still some stigma, or reluctance, associated with seeking help for emotional and mental problems, including depression. Unfortunately, feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. The fact is that people with depression can not simply ‘snap out of it’ and feel better spontaneously.

Almost anyone can suffer from depression, and most people who are diagnosed with this problem are treated successfully. Major depressive disorder may come from just one trauma, or from a series of disappointments, problems, or stresses. Some people only go through one major depressive episode in their lives. Others will deal with many episodes. This illness is not selective and affects people of all ages, races, and other descriptors. About three percent of people in the US and Europe are depressed at any one time, rising to seven percent over the course of a year. Between ten and fifteen percent of us will suffer from a major depressive episode at some time in our lives.

Treatment of Major Depression

Although major depression can even troll a life, it is certainly treatable. A majority of the population can be effectively treated and can be successfully returned back to normal lives following a treatment. The treatment plan exclusively depends on the severity of the problem and individual preference. Medications, psychotherapy and electroconvulsive therapy are the three primary types of treatments typically used for treating this.

Typically four groups of antidepressants are administered for treating major depression. They are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), bupropion (Wellbutrin), mirtazapine (Remeron), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and non-antidepressant adjunctive agents.

Psychotherapy, especially in combination with medication, is found to be effective in treating major depression. Cognitive behavioral therapy and interpersonal therapy can be used to treat mild to moderate form of major depression. By using cognitive behavioral therapy, the practitioners can be able to modify the negative thinking patterns and dissatisfying behavior in an individual. On the other hand, interpersonal therapy aids in understanding the personal relationship and helps in forming a new insight for playing new life roles.

Electroconvulsive therapy (ECT) is particularly used for treating the severe form of the disorder. It is specifically considered in such circumstances where medications or psychotherapy could not be able to show any effective results or offer very slow improvement than actually expected. ECT is beneficial for people who are suffering from psychosis or have attempted suicide several times.

Treating major depression can be done in a number of different ways, of which medication is only one, though many people aren’t aware of other options. Psychotherapy, behavioral and cognitive therapy, herbal treatments, and many other methods can also be used to improve symptoms and make the sufferer’s life easier. If you believe you’re dealing with major depressive disorder, it’s important to take control and seek help. There are lots of options, and something is likely to be of help to you.

On an internal level, all forms of depression including major depressive disorder are thought to be due to a low level of any one of three different neurotransmitters. These transmitters are serotonin, dopamine, and norepinephrine. Because of this finding, most treatment regimens for major depressive disorder includes medications which either stop the breakdown of these neurotransmitters or they enhance the activity of them.

No one seems to know why for sure but major depressive disorder seems to affect women almost three times as much as men. It is entirely possible that since women are the major child caregivers, “being stuck in the home” and “not getting any work done” might be causative factors that lead to the depression that is so characteristic of this disease state.

Treatment goals attempt to help the patient get back into mainstream society. Remission of symptoms, restoring a feeling a self-worth and just getting back into a “normal” lifestyle are all on the list of goals that clinicians try to accomplish. For some individuals, this is a formidable task. For others, it is a journey that they embrace with the hope of a full recovery. One of the biggest obstacles to recovery is the fact that there are many different medications available that have only minor differences between them. As such, treatment often involves a lot of trial and error in an attempt to find the right medicine for the patient.

Patients also need to know some of the “behind the scenes” facts about this group of medications. Unlike pain killers which work right away, anti-depressant medication takes a while before any good results are seen. One to two weeks or more is not uncommon before a patient will start to feel better. If they are not told this, it could add unnecessary anxiety to an already agitated person. Finally, a person with major depressive disorder also needs to know to watch out for serotonin syndrome. This could happen because of interactions with similar medications or because of being over-medicated. This syndrome includes a whole host of unwanted side effects such as diarrhea, mental confusion, tremor, flushing, sweating and more.

Major Depression Disorder and Occupational Disability

Definition of Disability

Long Term Disability Insurance definitions vary. Here are some typical ones:

you are disabled when the Insurance Company determines that:

    • you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and – you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

After 36 months of payments, you are disabled the Insurance Company determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

Note how the definition changes after 36 months.

Here is another

Total Disability or Totally Disabled means during your Elimination Period and the next Own Occupation Period (shown in the Benefit Highlights), you, because of your Injury or Sickness, are unable to perform the Material and Substantial Duties of your Own Occupation.  After Total or’ Partial Disability benefits combined have been paid to you for Own Occupation Period (shown in the Benefit Highlights), you will continue to be considered Totally Disabled if you are unable to perform, with reasonable continuity, any Gainful Occupation for which you are or become reasonably qualified for by education, training or experience.

And another

you will be considered totally disabled if all these conditions are met:

  1. you are unable to do the substantial and material duties of your regular occupation.  your regular occupation is your usual work when total disability starts.  If you are retired and not working when total disability starts, your regular occupation will be the normal activities of a retired person of like age; and
  2. your total disability starts while this policy is in force; and
  3. your total disability results from sickness or injury; and
  4. you are receiving medical care from a doctor which is appropriate for the injury or sickness.  When in the opinion of the doctor future care would be of no benefit to you, then the requirement of receiving medical care will be considered to be met.  Doctor means all providers of medical care other than yourself, when such services are within the scope of the provider’s licensed authority.

And California has its own common law definition

California law requires courts to deviate from total disability definitions in some instances Hangarter v. Provident Life and Acc. Ins. Co, 373 F.3d 998, 1006 (9th Cir. 2004). Sometimes, it’s called the Erreca standard. California requires when coverage for “any occupation” is too narrow, the Court must read a common sense definition into the policy based on two cases.  Erreca v. Western States Life Insurance Company, 19 Cal. 2d 388 (Cal. 1942), and Moore v. American United Life Insurance Company, 150 Cal. App. 3d 610 (Cal. Ct. App. 1984). These two cases, when read together define total disability “does not signify an absolute state of helplessness but means such a disability as renders the insured unable to perform the substantial and material acts necessary to the prosecution of a business or occupation in the usual or customary way.”