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In a major depression, a greater number of the symptoms of depression are present, and they are usually more intense or severe. A major depression can result from a single traumatic event in your life,
or may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop the symptoms of a major depression without any obvious life crisis causing it. Other
individuals have had less severe symptoms of depression for a long time (such as dysthymic disorder), and a life crisis results in increased symptom intensity.
Major depression can occur once, as a result of a significant psychological trauma, respond to treatment, and never occur again within your lifetime. This would be a single episode depression. Some people tend to
have recurring depression, with episodes of depression followed by periods of several years without depression, followed by another episode, usually in response to another trauma. This would be a recurrent
depression. In general, the treatment is similar, except that treatment usually is over a longer time period for recurrent depression.
Professional debate continues about the existence of "endogenous depression"
which occurs without any identified psychological causes. An endogenous depression is a biologically caused depression, due presumably to either genetic causes or a malfunction in the brain chemistry. But, all depression involves some changes in brain chemistry, even when the cause is clearly a psychological trauma. After psychological treatment and recovery from depression, the brain chemistry returns to normal, even without medication. To date, there is no hard research evidence to support the notion of endogenous depression. Sometimes this term is used to describe people who do not respond well to treatment, and sometimes it is a rationale to prescribe medication alone, and not to offer any psychological treatment for the depression.
In general, most depressed people, who require antidepressant medication, respond better when psychotherapy, particularly cognitive-behavioral psychotherapy, is provided in addition to the medication.
Medication treats the symptoms, not the problems that caused the depression.
Research has shown that cognitive therapy is the best treatment for depression, as compared to medication and other forms of psychotherapy. Some people do respond better to a combination of medication and
cognitive therapy, but it just does not make sense to only prescribe medication, without offering psychotherapy as well. There are some people who respond positively to psychotherapy, but plateau at a mild level of
depression without complete recovery from all of the symptoms. Often, these individuals are maintained on anti-depressant medication after they have completed psychological treatment.
If you need to be evaluated for medication, your psychologist will refer you to either your primary care physician, or to a psychiatrist, for a medication evaluation.
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Symptoms of Depression
Major Depression is identified by a combination of symptoms that occur together, and last for at least two weeks without
significant improvement. Symptoms from at least five of the following categories must be present for a major depression,
although even a few of the symptom clusters are indicators of depression, but perhaps not a major depression.
- Persistent depressed, sad, anxious, or empty mood
- Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
- Hopeless about the future, excessive pessimistic feelings
- Loss of interest and pleasure in your usual activities
- Decreased energy and chronic fatigue
- Loss of memory, difficulty making decisions or concentrating
- Irritability or restlessness or agitation
- Sleep disturbances, either difficulty sleeping, or sleeping too much
- Loss of appetite and interest in food, or overeating, with weight gain
- Recurring thoughts of death, or suicidal thoughts or actions
This list is a guide to help you understand depression. It is not offered for you to diagnose yourself. If you have some of
these symptoms, don't focus on how many symptoms you have. Instead, talk to a psychologist about how you have been feeling, to see if he/she can help.
Major Depression versus other Depressions
The differences between Major Depression and other depressions, such as bipolar depression, dysthymia, or reactive
depression, are more important for psychologists planning treatment, and are of less concern to the average person. When
you review the list of symptoms for major depression, and you have four symptom clusters, instead of five, you should not
ignore it or forget about it. Moderate Depression is not a separate diagnosis, so if the symptoms do not fit a specific
category, the depression is simply called "unspecified." Ask yourself this question: "Does the depression interfere with my
life, my relationships, my productivity or my happiness?" If depression is interfering with your life, then don't wait, talk to a psychologist soon.
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