Northeast Health Services is dedicated to supporting your mental health. If you are experiencing suicidal thoughts, we encourage you to reach out for immediate support through your local crisis services by dialing 988, contacting your local emergency services, or visiting your local emergency room.

Major depressive disorder (MDD) is the clinical term for what most people think of as depression. It’s marked by persistent sadness, loss of interest in activities someone used to enjoy, fatigue, and physical symptoms like sleep issues.

Thankfully, if you’re experiencing these symptoms, there is hope. Depression is highly treatable, usually with a combination of therapy and medication. If medication isn’t alleviating symptoms, there are still options through innovative treatments like TMS and Spravato® which can work quickly to help you feel better.

What Is Major Depressive Disorder?

Major depressive disorder is a serious mental health condition that affects how someone thinks, feels, and functions. Beyond occasional sadness or a rough day, MDD is a long-lasting condition that can impact every area of life, from relationships to work to physical health. It involves having episodes of low mood that last for at least two weeks at a time.

In 2021, more than 21 million adults in the United States, representing more than 8% of the adult population, experienced at least one major depressive episode, according to the National Institute of Mental Health (NIMH).¹

Depression vs. Sadness

Sadness is an emotion that tends to be tied to a specific event or trigger, and it’s typically temporary. Depression is a mental health condition that could be set off by a situation or event, or it could also occur out of the blue. Sadness can be one symptom of depression, and if consistent low mood sticks around for more than two weeks, this could be a sign of sadness turning into a deeper level of depression.

MDD vs. PDD & Other Disorders

Major depressive disorder and persistent depressive disorder (PDD), formerly called dysthymia, are both forms of depression, but while MDD is marked by periods of depression that could be months or even years apart, PDD involves persistent low mood for at least two years. Treatment is similar for both disorders, with a combination of therapy and medication being the typical care plan.

Recognizing MDD Symptoms

Symptoms of major depressive disorder can vary, but typically involve low mood and hopelessness, loss of interest in previously enjoyed activities, low energy, and changes in sleeping and eating patterns. For someone to receive an MDD diagnosis, they must have at least five of the symptoms listed below.

MDD symptoms can include:

• Persistent feelings of sadness, emptiness, or hopelessness
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite or weight
• Changes in sleep patterns, could be either insomnia or oversleeping
• Reduction in cognitive function or slowed body movement
• Fatigue or low energy, even after rest
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating, making decisions, or remembering things
• Thoughts of death or suicide

If you’ve been experiencing any combination of these symptoms for more than two weeks, it might be time to talk with a mental health professional.

Signs & Symptoms of Clinical Depression in Children

Symptoms of MDD in children and teens are similar to those in adults, involving a lower mood and lack of energy for at least two weeks. Symptoms could be somewhat difficult to pinpoint, or may show up with your child complaining of physical ailments, like more aches or pains than usual. Children may have difficulty understanding and expressing their emotions, so they may experience somatic, physical symptoms for mental health concerns like depression. A depressed teen may isolate or distance themselves from family and friends, or may use the excuse of being “tired” instead of talking about their symptoms.

Signs of depression in a child could include:

• A consistent low, sad, or grouchy mood
• Being overly self-critical, saying things like “I can’t do this,” “that’s too hard,” or “I don’t have any friends”
• Seeming extra tired, or putting less effort into school or activities
• Not enjoying the things they used to, like games or playing with friends
• Changes to their eating and sleeping habits, either over- or under-eating, and sleeping too much or too little
• Some children may express having a stomachache or other aches or pains, potentially even skipping school even though they aren’t “sick”

Causes & Risk Factors for MDD

There’s no single cause of MDD. Instead, it usually results from a combination of biological, psychological, and environmental factors. Those with a family history of depression are more likely to develop it themselves, and it can also be “triggered” by situational factors, like the death of a loved one, divorce, or job loss.

Some common causes and risk factors for developing clinical depression include:

• Genetics: Having a family history of depression increases your risk.
• Brain chemistry: Difficulty producing and processing neurotransmitters like serotonin and dopamine can play a role.
• Hormones: Changes in hormone production, such as pregnancy, menopause, or thyroid issues can trigger depression.
• Trauma or stress: Childhood adversity, loss of a loved one, or chronic stress may increase vulnerability.
• Medical conditions: Chronic illnesses like diabetes, cancer, and chronic pain can often trigger depression.

How is MDD diagnosed?

Diagnosing clinical depression involves a careful assessment by a qualified mental health provider, like a therapist or psychiatrist. Your primary care doctor could also diagnose depression. A clinician will talk with you about your symptoms, how long you’ve been experiencing them, and how they affect your daily life. Someone must have at least five of the symptoms listed above, lasting for at least two weeks, to receive a diagnosis of MDD.

Northeast Health Services takes a compassionate and individualized approach to care. Our providers are here to listen without judgment and help you find a path forward that reflects your needs and goals.

Other Specifiers That Could Be Part of an MDD Diagnosis

When you receive a diagnosis of MDD, there could be other terms added on to describe additional aspects of the disorder. These could be situational or delineate other mental or emotional factors that aren’t always part of MDD.

Other specifiers that could be included in an MDD diagnosis include:

• Atypical depression, involving more mood reactivity, increased appetite, excessive sleeping, and hypersensitivity to criticism
• Seasonal pattern, like seasonal affective disorder: symptoms worsen and improve consistently with the changing of the seasons
• Peripartum onset, meaning that the symptoms emerged during pregnancy or postpartum
• Anxious distress, added to an MDD diagnosis when someone also has heightened anxiety symptoms during their depressive episodes
• Psychotic features, like delusional thinking or hallucinations

What Are the Treatment Options for MDD?

The good news is that major depressive disorder is treatable, and treatment works. MDD treatment usually includes a combination of therapy and medication. For those who have tried multiple medications and haven’t seen improvements (which we call difficult-to-treat depression), other treatments like TMS or esketamine could be the next step in treatment.

Your care team may also suggest supportive strategies such as lifestyle changes, stress management, or mindfulness practices.

Here are some of the most common options for treating clinical depression:

Therapy for MDD

Talking with a licensed therapist can be a powerful part of healing. Therapy modalities like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy (IPT) can help reduce depressive symptoms. Most therapists will use an “eclectic” approach, using tools from different modalities to tailor each therapy session and overall care plan to the client’s needs.

Antidepressants for MDD

Antidepressants, namely SSRIs and SNRIs, help balance the brain chemicals involved in mood regulation. Your doctor or psychiatric providers work closely with you to find the proper medication and dosage, monitoring for side effects and efficacy.

Transcranial magnetic stimulation therapy (TMS)

For those who haven’t had success with medication, TMS may offer hope. This noninvasive treatment uses magnetic pulses to stimulate areas of the brain involved in mood. It’s approved by the U.S. Food and Drug Administration (FDA) and backed by research for its effectiveness in treating depression.

Spravato® treatment (Esketamine)

Spravato® is an esketamine nasal spray administered under the supervision of a healthcare provider. It’s the first of its kind to be approved by the FDA for treating difficult-to-treat depression when other medications haven’t alleviated symptoms, working quickly and with few side effects. Unlike other antidepressants which target serotonin and norepinephrine, Spravato® works to stimulate glutamate in the brain, upping overall activity and mood.

How Long Will Depression Treatment Take Before I Feel Better?

Everyone responds differently to depression treatment. Some people will start to feel better a few weeks after starting medication and/or therapy, while others may not see improvements for a couple of months.

Here are some signs that your depression treatments have started working:

• You’re reconnecting with family and friends
• You’re able to get more done at work or school
• You start to feel more hopeful and grounded
• Your mood is generally more stable

Healing from major depressive disorder doesn’t always mean the symptoms disappear completely. Instead, treatment helps you manage symptoms, regain energy and motivation, and reconnect with what matters most to you. Many people living with MDD go on to lead fulfilling, purpose-driven lives.

When Should You Consider TMS or Spravato®?

If symptoms don’t improve after trying multiple medications, you may have difficult-to-treat depression. In this case, another form of treatment like TMS or Spravato® might be added to your care plan. Talk to your psychiatrist or other mental healthcare provider about whether either of these treatment options could be a good fit for your situation.

You may benefit from either TMS or Spravato® if:

• You’ve tried two or more antidepressants without significant improvement
• You experience unpleasant side effects with medications
• Your depressive symptoms make it difficult to function day-to-day

How to Support a Loved One With MDD

Supporting someone with clinical depression can feel challenging, especially when you’re unsure what to say or do. However, your presence matters more than you might realize. Just showing up consistently and being a good listener can go a long way in helping someone with MDD feel supported by you.

Here are some ways to offer support to someone with depression:

• Listen without trying to fix: Sometimes the best thing you can do is simply be there.
• Encourage treatment: Offer to help them find a therapist or go with them to an appointment.
• Educate yourself: Learning about MDD helps reduce stigma and improves communication.
• Offer practical support: Provide nourishing meals, offer transportation to and from appointments, or do a bit of housework.
• Be patient: Recovery can take time, and progress may not always be linear.
• Take care of yourself: Supporting someone else is easier when your own needs are met, which could include seeking your own mental health support.

Get MDD Treatment in Massachusetts with Northeast Health Services

Whether you’re newly diagnosed or seeking a fresh start, Northeast Health Services offers comprehensive treatment to people of all ages and life stages across Massachusetts. Our experienced providers offer therapy, medication management, and interventional treatments like Spravato® and TMS therapy in a warm, welcoming environment.

Call Northeast Health Services at 508.794.8711 today to learn more or schedule your first appointment. For existing clients, please find your office location to contact your office directly.

 

Footnote:

1. National Institute of Mental Health. “Major Depression.”