Major Depressive Disorder (MDD) is commonly known as just “Depression”. MDD is one of three depressive disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).

MDD is characterized by the presence of a cluster of symptoms known as a Major Depressive Episode (MDE), that represents a change from previous functioning and has persisted for at least a couple of weeks.

The primary symptoms of an MDE are the pervasive feelings of being down, sad, or blue (“depressed mood”) and the significant loss of interest or pleasure. Secondary symptoms that typically accompany either primary symptom are: significant changes in appetite or weight, decreased sleep or over-sleeping, physical agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to concentrate or indecisiveness, and recurrent thoughts of death or suicidal ideation.

Most people experience some, if not all, of these symptoms at some point in their life, either as the result of significant life events such as the loss of a loved one or getting laid off from work or in response to daily life stressors. What distinguishes a major depressive episode from a transient state of sadness is the extent to which the symptoms persist and affect functioning. Someone who has been experiencing many of the symptoms previously listed on a daily basis, most of the day for the past month with a consequent loss of productivity at work is most likely truly ill, whereas someone who occasionally feels down only for a few minutes of the day with some tiredness may be just over-worked and in need of good rest. However, since it can be difficult for someone to gauge their own state objectively, it is highly recommended that one see a physician when in doubt about their symptoms.

Untreated depression can worsen or it can go away without any intervention. The latter is always favorable. However, it may also be a mistake to wait too long to seek professional help and allow the depression to deteriorate. In a way, depression is a vicious cycle of hopelessness and helplessness. People who are depressed have little motivation or energy to seek treatment, so they feel worse, further preventing them from taking any action, etc. It is also a costly illness in terms of decreased productivity - some people feel unable to work or perform their usual household activities including caring for dependent children. An unfortunate possible consequence of untreated severe depression is suicide. This is another very important reason to seek help.

There are several modes of treatment available.
The more common means used today are therapy or counseling, and medication. There are several types of anti-depressants available today - SSRI’s such as Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), and Zoloft (sertraline); Tri-cyclic antidepressants such as Elavil (amitryptiline), Sinequan (doxepin), and Tofranil (imipramine); MAOI’s such as Nardil (phenelzine); and anti-depressants with unique mechanisms of action such as Effexor (venlafaxine), Wellbutrin (buproprion) and Serzone (nefazodone). These are all prescription medications and should be taken under the supervision of a doctor to ensure your safety and comfort. As with other medications, the dosage taken may have to be adjusted for proper effect.

Depression Self-Assessment Questionnaire
Complete this short questionnaire to help you gauge if you are suffering Depression. Answer the following questions in relation to the past two weeks:

1. I don't enjoy the things I used to		Yes		No
2. I feel hopeless about the future		Yes		No
3. I feel worthless and not needed		Yes		No
4. My appetite has decreased or increased		Yes		No
5. I get tired very easily		Yes		No
6. I am sleeping too little or too much		Yes		No
7. I feel down-hearted, blue, or sad		Yes		No
8. I think life is empty or not worth living		Yes		No
9. I have difficulty concentrating		Yes		No
10. I feel irritable more than usual		Yes		No
11. I feel slowed down or agitated		Yes		No
12. My symptoms have interfered with my       usual functioning (home, work, social)		Yes		No

If you answered “Yes” to six or more questions, and have had these symptoms most of the days for at least the past two weeks, you may be suffering from depression.

If you answered “Yes” to question number 8, you should seek medical help immediately, regardless of your other answers.

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