“I Have Crippling Depression” - Addressing Severe Major Depressive Disorder

Major depressive disorder (MDD), which is also known as clinical depression, is one of the most common mental health disorders worldwide. In the United States alone, it is estimated that, in 2017, 17.3 million adults and 3.2 million adolescents were struggling with depression. Despite being so prevalent, depression symptoms can be impairing and, sometimes, life-threatening, which is why it needs to be cared for immediately. In this article, we’ll explore what treatment options are available to help manage symptoms of depression.

Avoiding the term ‘crippling depression’ 

Severe depression is a serious mental health condition that can affect several different aspects of an individual’s life. However, use of the term “crippling” to describe a medical or mental health condition is considered offensive to people with disabilities.    

‘Debilitating depression’ and other alternative terms for ‘crippling depression’

There are several ways you can describe severe symptoms of clinical depression without using the word “crippling”. “Debilitating depression”, “severe depression”, “serious depression”, and “extreme depression” are alternatives that can help you express the challenges of major depressive disorder without using a potentially objectionable term.

How is major depressive disorder (MDD) diagnosed?

It is important to discuss how major depressive disorder (MDD) is diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association. These are a set of standards put in place for doctors and mental health professionals used to diagnose mental health conditions in patients accurately.

According to the DSM-5, an episode of major depression is defined as follows:

Five or more of the following A Criteria (at least one includes A1 or A2):

A1. Depressed mood-indicated by subjective report or observation by others (in children and adolescents, can be irritable mood).

A2. Loss of interest or pleasure in almost all activities-indicated by subjective report or observation by others.

A3. Significant (more than 5 percent in a month) unintentional weight loss/gain or decrease/increase in appetite (in children, failure to make expected weight gains).

A4 Sleep disturbance (insomnia or hypersomnia).

A5 Psychomotor changes (agitation or retardation) severe enough to be observable by others.

A6 Tiredness, fatigue, or low energy, or decreased efficiency with which routine tasks are completed.

A7 A sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick).

A8 Impaired ability to think, concentrate or make decisions-indicated by subjective report or observation by others.

A9 Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.

If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255, and is available 24/7.

1. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
2. The symptoms are not due to the direct physiological effects of a substance (e.g., drug abuse, a prescribed medication's side effects) or a medical condition (e.g., hypothyroidism).
3. There has never been a manic episode or hypomanic episode.
4. MDE is not better explained by schizophrenia spectrum or other psychotic disorders.

All of these symptoms must be new or have worsened over time, and have lasted for at least two weeks and persisted every day for most of the day. The reason why the last two are so important, especially D, is because that would warrant a different diagnosis and medication.

For example, if an episode of major depression is also coupled with manic or hypomanic symptoms, this could indicate bipolar disorder, not just depression. Individuals who have been diagnosed with bipolar disorder may require mood stabilizers and possibly antipsychotics, whereas if a person has depression by itself, an antidepressant will typically be prescribed. Please do not consume any medications without first seeking the advice and help of a trained professional.

Nonetheless, if this criterion matches what you are feeling, it advised that you make an appointment with your doctor so you can get help for your depression.

Causes of major depressive disorder

Depression can be the response to the various circumstances such as the death of a loved one, the end of a relationship, and being terminated from a job; however, in many individuals who are dealing with major depressive disorder, their feelings may feel unexplainable, and there may be no particular external event for how they feel.

For these individuals, brain chemistry may be to blame, and specific neurotransmitters, or a lack thereof, can cause people to become severely depressed without being heavily impacted by something troubling that has happened. 

The role of serotonin in clinical depression

One of the most prominent neurotransmitters that are associated with mood and well-being is serotonin. For example, a lack of serotonin could be the reason why someone stops enjoying activities that they once loved.

This is also why people may lose their appetite and sex drive when becoming depressed. It is also connected with sleep, which is something that can be compromised in a major depressive episode.

The impact of norepinephrine on depressed mood and reduced attention

Another significant neurotransmitter that can be involved in depression is norepinephrine, and like serotonin, it can also be targeted with medication. Norepinephrine is associated with arousal and attention, which is why medication that increases its levels can help uplift a person's mood. In cases of major depressive disorder, norepinephrine imbalances may contribute to difficulties in concentration and persistent fatigue.

The influence of dopamine on loss of interest and pleasure

Low dopamine levels can also contribute to symptoms of depression; however, it is not typically targeted as a first-line treatment, like the previous two neurotransmitters. Because dopamine is essential to mental health, its deficiency can lead to motivation issues and decreased pleasure in daily activities.

In the next section, you will learn more about these specific types of prescription medications designed for these neurotransmitters, which can help improve symptoms of depression.

Medication for depression

Since neurotransmitters like serotonin, norepinephrine, and dopamine can have a major role in how we feel, severe depression is often correlated with a deficiency in one or more of these chemicals, which will need to be addressed through antidepressants.

Commonly prescribed medications for major depressive disorder

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Tricyclic Antidepressants (TCAs)
• Atypical Antidepressants

The majority of medications prescribed to those with major depression will belong to the classes of SSRIs and SSNRIs. SSRIs are quite diverse in their uses and are frequently recommended for people who have anxiety disorders and obsessive-compulsive disorder (OCD).

Many people may feel hesitant to try medication, either due to side-effects and other personal beliefs, but great strides have been made to make these drugs as safe as possible and to minimize side effects. This is especially true with SSRIs and SNRIs, and these are considered to be less burdensome than TCAs and MAOIs in terms of side-effects. Therefore, currently, the pros of using antidepressants outweigh the potential cons.

Note: Prescription medication should not be sought after without the guidance of a health professional. Before taking any prescription medication, consult with your doctor to determine the best course of action for you.

Non-pharmacological forms of mental health treatment 

Medication can be an effective treatment for major depressive disorder, especially if you combine it with other methods like talk therapy, medication-free treatments, and lifestyle changes. In fact, people who choose to take advantage of both aspects can have significant improvements and positive outcomes.    

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation, also called TMS, is a noninvasive depression treatment that uses magnetic pulses to electrically stimulate certain areas of the brain associated with mood disorders, like depression. TMS is indicated for treating depression symptoms that don’t respond to medication, referred to as treatment-resistant depression. 

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment that involves direct electrical stimulation to the brain, while the patient is under general anesthesia. Electroconvulsive therapy is considered a more intensive treatment, compared to TMS, and is recommended when other treatments, like medication and TMS don’t relieve depression symptoms. 

Talk therapy 

Therapy can be an excellent outlet for those with depression because it can allow a person to talk about what is on their mind to a non-judgmental professional who can give advice, like talk therapy and counseling, and other methods can actively try to change how you feel and think about issues, like cognitive behavioral therapy (CBT).

CBT is designed to potentially change a person's negative thinking patterns into ones that are positive and productive.

Exercise

Exercise is also another practical way to address depression because studies show that it may be essential to a person physical and mental health, and it can aid in improving appetite, sleep habits, and overall mood. You may even find that you enjoy having some physical activity in your life, which can make it much easier to stick to a routine and stay consistent with it. For individuals facing debilitating depression, regular exercise can serve as a valuable tool to regain energy and reduce severe symptoms.

While medication can help you, especially if there is a chemical imbalance, it is things like exercise and therapy that can truly benefit you in the long-term because they can give you the skills to overcome depression and how you think about your life instead of just controlling the symptoms.

Benefits of mental health treatment through online therapy

Multiple studies have found that online CBT therapy is just as effective (and, in some cases, even more effective) than in-person therapy in treating major depressive disorder. Online therapy also tends to be more affordable than traditional therapy, and it can treat other disorders that tend to be comorbid with depression, like anxiety, for example. 

Takeaway

If you are experiencing debilitating depression or crippling depression and you have a hard time performing everyday tasks and activities, seek help with a mental health provider. 

If you are unsure where to find a counselor or therapist who specializes in depression, or don't know where to begin to look, ReGain offers online sessions that are convenient and affordable and have helped countless individuals overcome their issues with depression, anxiety, and other mental conditions.