Mr. Hershel Wertheimer

Executive Director of Hamaspik Kings County

“I had an awful day at work. I’m so depressed.” 

We say these kinds of statements all the time, but they don’t accurately capture the experience of clinical depression. Someone who had a difficult day at work or got a low  grade on a test is sad, upset, or disappointed. That’s a temporary emotional state, not actual depression. 

Clinical depression encompasses far more than simply feeling down; it’s a comprehensive emotional, physical, and cognitive state that impedes normal functioning, making even simple tasks feel insurmountable.

Moreover, depression isn’t a single condition; it’s a term that covers several specific disorders, each with its unique criteria, manifestations, and implications.

Understanding the nuances of these disorders is crucial for recognizing the seriousness of clinical depression and the importance of seeking appropriate care and support. Let's delve into each of these disorders to uncover their distinct characteristics, discover what it’s like for those who live with them, and learn ways to cope with depression.

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Major Depressive Disorder (MDD)

This is the most common form of depression. MDD is a diagnosable medical condition that requires specific criteria in order to qualify for a diagnosis:

1. Several symptoms: To be diagnosed with MDD, individuals must experience at least five of the following nine symptoms for most of the day, nearly every day, for at least two weeks:some text
   • Persistent sad, anxious, or “empty” mood
   • Diminished interest or pleasure in all or most activities
   • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
   • Insomnia or hypersomnia (excessive sleep)
   • Physical agitation (restlessness) or slowed movements and speech
   • Fatigue or loss of energy
   • Feelings of worthlessness or excessive, inappropriate guilt
   • Diminished ability to concentrate or indecisiveness
   • Recurrent thoughts of death or suicide
2. Impact on daily life: The symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning.
3. Not attributable to substances or medical conditions: The symptoms cannot be due to the physiological effects of a substance (e.g., drug abuse, medication) or another medical condition.
4. Distinct from other mental health conditions: The symptoms are not due to another mental disorder, such as schizophrenia or bipolar disorder.
5. Exclusion of manic episodes: The individual hasn’t experienced a manic or hypomanic episode.

An estimated 7% of the U.S. population experiences MDD, making it one of the most common mental health diagnoses. The severity of MDD can vary widely among individuals, ranging from mild to severe.

Treatment options for MDD are diverse and often highly effective. Cognitive therapy for major depressive disorder is usually helpful, as are anti-depressant medications such as SSRIs (selective serotonin reuptake inhibitors). Evaluating depression and seeking treatment can significantly improve the quality of life for those affected.

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Persistent Depressive Disorder (PDD)

Persistent Depressive Disorder, also known as dysthymia, is a long-term form of depression that, while generally milder than Major Depressive Disorder (MDD), significantly impacts an individual's daily life. Often perceived as the "chronic" form of depression, dysthymia is characterized by a persistent low mood that lasts for years but doesn’t reach the intense severity of major depression. 

Individuals with PDD might be able to maintain their day-to-day activities, such as work and home responsibilities, yet they live under the weight of perpetual low spirits. 

This condition is more persistent, defined by symptoms lasting at least two years in adults or one year in children and adolescents. During this period, depression may fluctuate in intensity but is present more often than not, requiring symptoms to persist for at least two months when it does appear.

To be diagnosed with PDD, one would need to experience two or more of the following six symptoms:

1. Decreased appetite or overeating, affecting physical health and well-being.
2. Experiencing insomnia or sleeping excessively, impacting energy levels and mood.
3. Persistent low energy or feelings of exhaustion, making it challenging to manage daily tasks.
4. Ongoing negative perceptions of oneself.
5. Difficulty focusing or making decisions, impairing personal and professional life.
6. A persistent feeling of pessimism about the future.

As with MDD, to be diagnosed with this disorder, symptoms must significantly disrupt daily functioning and not result from substances or other medical conditions. They can't be explained by another mental health diagnosis, and the individual must not have had a manic or hypomanic episode.

Ways to cope with depression include psychotherapy to provide valuable strategies for managing symptoms, improving self-esteem, and changing negative thought patterns, while medications, such as antidepressants, can help regulate mood and alleviate some of the disorder's physical symptoms. 

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Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is a form of depression that emerges at specific times of the year, usually during the less sunny fall and winter months. 

The onset of SAD typically occurs in adulthood, with the prevalence increasing as one ages; it’s uncommon in individuals younger than 20. Women are more frequently diagnosed with SAD than men. 

The condition is thought to stem from a chemical imbalance in the brain induced by reduced exposure to sunlight, alongside an increase in melatonin production during darker periods, which affects sleep patterns and mood.

Symptoms of Seasonal Affective Disorder are diverse, generally including:

1. A noticeable increase in sleep and daytime drowsiness.
2. A loss of interest and pleasure in previously enjoyable activities.
3. Tendency towards social withdrawal and an increased sensitivity to rejection.
4. Irritability and anxiety.
5. Persistent feelings of guilt and hopelessness.
6. Chronic fatigue or a consistently low energy level.
7. Reduced ability to focus or concentrate.
8. Difficulty thinking clearly.
9. An increased appetite for sweets and carbohydrates, often leading to weight gain.
10. Physical symptoms, such as headaches.

These symptoms are cyclical, typically appearing at the same time each year and improving with the change of seasons.

Effective treatment of SAD may involve a combination of strategies aimed at alleviating symptoms and improving overall well-being. Tips for overcoming depression include maximizing exposure to natural sunlight by spending time outdoors or sitting near windows, and utilizing light therapy through special light boxes to simulate sunlight. 

Psychotherapy, such as cognitive-behavioral or interpersonal therapy, can help adjust negative thought patterns and enhance coping mechanisms, and antidepressant medication can correct the underlying chemical imbalances. 

Together, these tips for overcoming depression can significantly mitigate SAD's impact, helping individuals lead more balanced and fulfilling lives during challenging seasons.