When someone says that they're depressed, what exactly does this mean? Do they have major depressive disorder, or are they just feeling sad at that moment because of a breakup or a bad test grade? In this explanation, we will take a look at the difference.

• We'll go over the causes and other risk factors of depression.
• We'll look at the DSM-5 criteria of symptoms in order for someone to be diagnosed with depression.
• We'll review how SSRIs and Cognitive Behavioral Therapy work and why they are effective treatments.

Major Depressive Disorder: Definition

Major depressive disorder is one of the most common mental health disorders. When someone is experiencing symptoms of depression, they have a lower mood and overall negative thoughts about life and themselves. The length of major depressive disorder varies on the person, but it can last anywhere from a couple of months to a year (or longer).

Major Depressive Disorder vs. Depression

So now that we know what major depressive disorder is, what's the difference between major depressive disorder and depression?

For the most part, nothing! The only real difference between these two terms is when and how they're used.

Major depressive disorder is used to describe people who have been clinically diagnosed (typically used more in a doctor's, therapist's, or psychiatrist's office).

Depression, on the other hand, is the colloquial way to talk about feeling sad. When someone's having a bad day and says they're feeling depressed, this would be an accurate way of using that term. It would probably be an exaggeration, but it would be the correct way to use the term.

Because of these differences, someone with major depressive disorder can say that they have depression, and they would be correct. However, someone cannot say that they have major depressive disorder if they have not been clinically diagnosed with it.

Major Depressive Disorder Causes

Depression is most often diagnosed in people in their 20s and 30s, but symptoms can develop at any age. Women are diagnosed with major depressive disorder more often than men; however, is that statistic due to higher rates of depression in women, or is it due to the stigma around men being emotional and not seeking help as a result?

While clinicians are not sure what the exact cause of major depressive disorder is, they are certain that genetics play a role. Experts think the cause of 40 to 50% of depression is genetics. They know there is a higher risk, but there is still insufficient testing to determine how big that risk is exactly.

Along with genetics, clinicians believe that a change in brain chemistry is also a cause of depression. Once again, the research does not have a sufficient number of studies to fully support this claim. However, some believe that those with depression lack certain neurotransmitters in their brains.

Another potential cause of depression is a hormone imbalance. Some researchers have put forth that estrogen and progesterone changes can be linked to depressive symptoms.

Other risk factors

There are also risk factors that will put someone at a higher risk of developing depression.

Personality

People who think less of themselves, are pessimistic, or struggle with being too hard on themselves tend to have a higher chance of developing major depressive disorder.

Being in the LGBTQ+ Community

Oftentimes, people who are in the LGBTQ+ community are at a higher risk of developing major depressive disorder. This is because they exist in a society where people can be unsupportive of their gender identity or sexual orientation. While some families are extremely supportive of LGBTQ+ family members, other families are not, leading to higher rates of depression.

Stressful Life Events

Substance Abuse

Those who struggle with addiction will be a higher likelihood of developing depression.

Alcoholism is a risk factor for depression - rebcenter-moscow, Pixabay.

Major Depressive Disorder Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the tool that psychologists, psychiatrists, and doctors use to diagnose varying mental health problems. Since it was first published, there have been updates, with the most current version being the DSM-5 (fifth edition). The DSM-5 outlines the necessary symptoms required in order to be diagnosed with major depression.

Five or more of the following symptoms have to have been present over a two-week period, with at least one of the symptoms being depressed mood or loss of interest/pleasure:

• Depressed mood for most of the day for nearly every day. This can be reported by the person or by observations made by others.
• Less or lack of interest or pleasure in most or all activities. This has to last for most of the day for nearly every day. This can be reported by the person or by observations made by others.
• Significant weight loss without intentionally dieting, or weight gain
• Insomnia or hypersomnia most days
• Psychomotor agitation or retardation most days. This has to be observable by others.
• Feelings of worthlessness or guilt most days
• Lack of ability to think or focus most days. This can be reported by the person or by observations made by others.
• Thoughts of death, suicidal ideation, a suicide plan, or a suicide attempt

Additionally, these symptoms have to be reported as being the cause of impairment to daily aspects of someone's life, and they must be unattributable to another medical condition or the effects of a substance that has been ingested.

Major Depressive Disorder Treatments

As with most mental health disorders, it has been found that a combination of antidepressants and therapy lead to the most improvement in symptoms of depression.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors, also known as SSRIs, are antidepressants that help reduce symptoms of depression. They are one of the most common forms of antidepressants, but do you know they work?

We all have little chemicals in our brains called neurotransmitters. Neurotransmitters are messengers that carry information between two neurons. They make their journey through the synapse, which is the space between the two neurons. Once a neurotransmitter has been released by one neuron into the synapse, the process of reuptake absorbs that neurotransmitter into the other neuron. But what if we don't want the process of reuptake to happen? That is where SSRIs come into play. As you can tell by the name, Selective Serotonin Reuptake Inhibitors, these drugs hinder the process of reuptake, allowing for more of the neurotransmitter to exist in the synapse.

The neurotransmitters travel from one neuron, through the synapse, to the other neuron, Wikimedia Commons.

If you've heard of the word serotonin, you'll probably know that it is one of the things your brain releases to make you happy. People believe that when someone is depressed, they have lower levels of serotonin than people without depression, leading to the development of SSRIs.

Serotonin is a neurotransmitter. Applying serotonin to the explanation above, when someone takes a Selective Serotonin Reuptake Inhibitor, instead of the serotonin traveling from one neuron to the other, it stays in the synapse. The reuptake process doesn't happen, which causes a build-up of serotonin in the synapse between the two neurons. It is this build-up of serotonin that medical professionals say causes an increase in mood. With more serotonin in our synapses, we must be happier, right?

Yes, for the most part. While SSRIs have been proven to be effective in reducing symptoms of depression, there are still a couple of unanswered questions.

First, why do symptoms not improve until someone has been on SSRIs for a couple of weeks? Studies have shown that there is an immediate increase of serotonin in the synapse after taking an SSRI, but it takes weeks for you to feel an improvement. Does this mean that serotonin is only a component in affecting our mood, rather than the whole explanation?

Additionally, are SSRIs effective for all people diagnosed with major depressive disorder? Studies have shown that SSRIs are effective for people with severe symptoms of depression. However, placebo pills are just as effective as SSRIs in people with milder symptoms of depression.

Therapy

The main form of psychotherapy used to treat people with depression is cognitive behavioral therapy (CBT). CBT focuses on your behaviors and attitudes and tries to change your thought and behavioral processes. CBT teaches problem-solving skills, helps the person understand why they react to situations in certain ways, and then works on changing that.

This form of therapy is mainly focused on helping the patient to react differently to stimuli that, in this case, might make the symptoms of depression worse. By changing these patterns of negative thinking and responses, one can better handle the stressors that were causing their depression in the first place.

While CBT treatment is short-term psychotherapy, usually lasting from five to 20 sessions, it is also a type of therapy you can continue once the formal treatment is over. Since you learn how to restructure thoughts and problem-solving skills, you can still employ those tactics in your life even when treatment has concluded.