Clinical depression is a mental disorder characterized by an array of symptoms that, when severe, can affect nearly every aspect of a person’s life. Most people have experienced extreme sadness, but that feeling usually comes from or is affected by the circumstances around them and is usually short-lived. For example, the death of a loved one could cause someone to enter a short-term depressive period. For many people with clinical depression, the symptoms come on without warning and seemingly without cause. To receive a diagnosis of clinical depression, one must experience at least five symptoms for two weeks or longer. According to the National Institute of Mental Health, the most common symptoms include:
- Sadness or anxiety;
- An empty feeling or lack of emotion;
- Feelings of worthlessness, guilt, pessimism, helplessness, or hopelessness;
- Decreased energy and excessive fatigue;
- Talking, walking, or moving more slowly than usual;
- A loss of interest in activities that the person once enjoyed;
- Appetite changes;
- Unexplained weight gain or loss;
- Physical problems, like headaches and digestive issues, that lack a clear cause;
- Sleep problems, like insomnia or oversleeping;
- Memory problems;
- Difficulty concentrating or making decisions;
- Thoughts about self-harm or suicide.
Many of these symptoms are present in other diagnoses. For example, people with anxiety disorders often experience restlessness, insomnia, irritability, and concentration and memory problems. Clinical depression does, however, display a few distinguishing characteristics. People with depression tend to have dulled emotions and reactions. People with anxiety, on the other hand, tend to experience a hypersensitivity to emotions and can sometimes come off as hyperactive in times of distress. There are several types of clinical depression, but a few are more common:
- Major depressive disorder (MDD), also called major depression, is the classic type of depression that receives the most media attention. The bleak mood that accompanies major depression tends to be all-consuming and may resist traditional treatments.
- Seasonal affective disorder (SAD) most often occurs during the fall and winter and most likely results from environmental changes, like the decrease of natural light, which disrupts the body’s melatonin and serotonin production.
- Persistent depressive disorder, formerly called dysthymia, is a form of depression that lasts for at least two years and generally doesn’t reach the intensity of more acute, severe forms of depression.
- Postpartum depression, also known as perinatal depression, appears either during pregnancy or after a woman gives birth and affects one in seven women who give birth.
- Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome.
As with most psychological disorders, depression can coexist with other conditions. The presence of multiple psychiatric diagnoses is known as comorbidity. A U.S. National Comorbidity Survey revealed that “51 percent of patients with a diagnosis of major depression also had at least one anxiety disorder and only 26 percent of them had no other mental disorder.” Comorbidity often causes the symptoms of multiple disorders to intermingle and even feed off each other. For this reason, along with the similarities in symptoms between various mood disorders, clinical depression can be difficult to pinpoint and accurately diagnose. Some disorders are more likely to be present alongside clinical depression:
- Bipolar disorder, formerly called manic depression, is another mood disorder that causes drastic and sometimes rapid shifts between depressive moods and moods that are manic, hyperactive, and sometimes even euphoric.
- Anxiety disorders often accompany depression. The most common ones are generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety disorder, and panic disorder. Although distinct, each of these conditions is characterized by a feeling of impending doom and an inability to fully relax.
- Obsessive-compulsive disorder (OCD), which falls under the wider umbrella of anxiety disorders, is characterized by intrusive thoughts and ritualistic compulsive behavior.
- Substance use disorders are diagnosed when a person’s use of substances like drugs or alcohol escalate enough that they cause significant distress and, often, addiction.
- Personality disorders sometimes coexist with mood disorders. Some examples are borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. According to the American Psychiatric Association, although the term “personality disorders” encompasses a wide range of conditions, most involve “a way of thinking, feeling, and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.”
One of the most common ways to treat clinical depression is with antidepressant medications. SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), and MAOIs (monoamine oxidase inhibitors) are among the most common classes of antidepressants. They work by regulating chemicals in the brain. SSRIs, for example, increase the level of serotonin in the brain by blocking the reabsorption of the chemical. When it’s absorbed more slowly after its initial release, there’s more of it available for the brain to utilize. Serotonin is a neurotransmitter that regulates mood, sleep, and appetite. Although experts still don’t know the exact cause of depression, most agree that a serotonin imbalance can play a role in the development of the condition.
Antidepressants are invaluable aids in the treatment of clinical depression and other mood disorders, but they’re not for everyone. Some may cause persistent digestive problems, agitation, sleep problems, and sexual issues that many users of these medications experience. For many, it’s worth it to weather the potential side effects because the benefits of medication outweigh the downsides. Others, however, continue to seek other options.
Psychotherapy is another common treatment for clinical depression and other mental health concerns. The process is generally quite effective and involves sitting down with a trained professional to work through issues and establish ways to mitigate depressive symptoms. There are many types of psychotherapies, including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). These therapies are often used to treat depression alongside medication.
People with clinical depression often have the option to seek treatment through brain stimulation therapies like electroconvulsive therapy (ECT), which, despite its relative success, may cause side effects like memory loss and physical discomfort.
With all of the side effects associated with antidepressant medications and treatments like electroconvulsive therapy, many people find themselves overwhelmed by the options and at a loss for how to treat their clinical depression. Additionally, some people find that traditional treatments aren’t as effective for them. According to the World Journal of Psychiatry, antidepressants don’t improve symptoms in 10–15 percent of people with depression and only partially improve symptoms in 30–40 percent. There is, however, another treatment option Do tcalled transcranial magnetic stimulation (TMS), which can be more effective in addressing treatment-resistant depression.
According to the National Alliance on Mental Illness, TMS therapy treats depression by sending magnetic fields, through an electromagnetic coil placed on the forehead, into the brain. These magnetic fields stimulate nerve cells in the bilateral prefrontal cortex, which is the area of the brain that controls one’s mood. The FDA permitted marketing of TMS therapy as a treatment for major depression in 2008. Providers often recommend that patients seek TMS treatment in conjunction with psychotherapy, medications, or lifestyle changes. Further advantages of TMS therapy include an outpatient procedure, the absence of hospitalization or anesthesia, and very minimal systemic side effects.
Along with its groundbreaking treatments, Mindful Health Solutions also leads TMS Health Education, a continuing education initiative for doctors to learn the benefits of TMS therapy. The annual “Hands-On for TMS Symposium,” one of the education initiative’s courses, provides practical and current information to physicians and health professionals interested in the clinical use of TMS therapy.