Severe Depression

Severe Depression

Severe Depression is an umbrella term often used in everyday language loosely to describe negative emotional states. Sometimes it is accompanied by a descriptive term, an adjective, such as severe or major depression, to underline its severity. But too few people really understand these terms and what they mean clinically.

From a psychiatric point of view, the informal term depression can refer to a number of clinical entities:

• major depressive disorder;
• dysthymia(persistent depressive disorder);
• postpartum depression;
• depressive episodes in bipolar disorder;
• premenstrual dysphoric disorder;
• seasonal affective disorder (SAD).

It is extremely important to have ownership of terms when discussing mental illness. We should not use words without understanding their meaning or without having a diagnosis from a doctor. Thus we perpetuate the ignorance and lack of credibility that mental illness has for the general public. So, in this article we will clarify two of the most commonly used and confused expressions, namely severe depression and major depression.

At first glance, the terms “severe depression” and “major depression” seem similar, denoting a severe case of Severe Depression. As a result, many people use them as synonyms, without paying much attention to their respective meanings. In reality, the difference is significant, because major depression is short for major depressive disorder. This is a diagnosis from the Diagnostic Manual of Mental Disorders (DSM). The DSM is developed by the American Psychiatric Association, and is the main diagnostic tool for psychiatrists in the US and around the world. While other doctors have sophisticated equipment to examine our bodies and do blood tests, psychiatrists often have only this manual at their disposal. With its help, they can identify a patient’s suffering so they can treat it. That’s why the DSM is also called the psychiatrists’ Bible, and why what it says is considered holy.

So major depression is an official DSM diagnosis. This expression should only be used when we receive this diagnosis from a psychiatrist. Severe depression, on the other hand, is part of a classification of major depression adopted in the 4th edition of the DSM, but no longer in the latest edition of the DSM, published in 2015. Depression, like many other mental illnesses, exists on a continuum: from mild to severe.

Depression manifests itself differently and to varying degrees in different people. Those who receive this diagnosis because they have symptoms of depression will not suffer the same degree of distress. Just as cancer has several stages, or hypertension has several classes, depending on severity, so depression has been divided into 3 degrees of impairment: mild depression, moderate depression and severe depression.

As ‘major depression’ is an official diagnosis, it has a number of diagnostic criteria. Based on them, it can be identified by specialists. To qualify for a diagnosis of major depression, a person must have at least 5 of the following symptoms within 2 weeks:

1. a depressive state most of the day, almost every day. Depressive state means: sadness; feeling of inner emptiness; hopelessness. In children or adolescents, irritability may predominate, not sadness.
2. marked decrease in enjoyment or interest in all or most activities. In other words: we don’t like going to school/work anymore; we don’t like the hobbies we used to have; going out; we don’t have the concerns we used to have.
3. significant weight loss without making an effort to do so, or on the contrary, weight gain (weight change of more than 5% in one month). Decreased or increased appetite may also occur.
4. sleep problems: insomnia or hypersomnia (excessive sleeping);
5. locomotor impairment: we have a permanent state of agitation, or on the contrary, we move extremely slowly and clumsily. This is also noticed by others (colleagues, friends, family);
6. fatigue, lack of energy;
7. feeling that we are good for nothing or an exaggerated sense of guilt over small, insignificant things;
8. decreased ability to concentrate: (we can no longer read, we don’t pay attention to what we see on TV, to conversations with others); inability to make decisions (we can’t decide what to wear or what to buy at the supermarket);
9. recurring thoughts of death (not just fear of death, but the hope of dying, the desire to die); suicidal thoughts, with a plan to take one’s own life; suicide attempts.

Severe depression – symptoms

The symptoms of severe depression are identical to those of major depression, listed above. As we have established, “severe depression” is a subtype of major depression. According to DSM IV, major depression was divided according to the number of symptoms present in a person into the following categories:

• mild depression – 5 symptoms, which is the minimum required to receive this diagnosis;
• mild depression – somewhere between mild and severe, around 5-6 symptoms;
• severe depression – more symptoms than the minimum required, going as far as cases where all of the above symptoms are present in a single patient.

So, when we talk about severe depression, it is the most severe cases, with the highest number of symptoms.

About 30% of people with depression can be classified in this category, while the majority, 50%, have moderate depression.

This classification of depression into mild, moderate and severe has been removed in the latest edition of the DSM because it poses more problems in practice. Although the number of symptoms generally correlates with severity, it is by no means the only factor. But doctors used to consider only the number of symptoms when classifying depression. It also happens not to consider other important aspects, which leads to many errors in classification.

Other factors that have a crucial influence on the prognosis and course of depression are the person’s disability, impaired functioning or age of symptoms. Also, this classification suggests that symptoms are equivalent, but in fact there are more severe symptoms than others. For example, suicide attempts are a more severe symptom than overeating. As a result, the classification is no longer used by doctors when making a diagnosis of major depression, but the terminology has remained in use.

Major depression cures

When we hear the words “major depression” from a doctor, it can sound like a death sentence. “Major” suggests something insurmountable, an incurable condition, something we will never overcome. And depression itself feels like this: we have no hope; we have no joy; we don’t even remember what it was like to be happy, and we are convinced that we never will. But this is just depression talking, not reality.

Even if you have major depression it can be cured, or kept under control. And paradoxically, the most severe cases of severe depression are the ones that respond best to treatment.

1. Medication for severe depression

Antidepressant drugs, as the name suggests, are designed specifically for the treatment of this condition. There are several different classes of antidepressants, but they all regulate the amount of serotonin in the brain. Some also have effects on other neurotransmitters, such as adrenaline and noradrenaline.

There is no recipe for success in treating depression.

Everyone responds differently to treatment. So it is very important to monitor the progress and go for regular medical check-ups. Only this way can the doctor adjust the dose or change the medicine, depending on the specific needs of each of us.

2. Psychotherapy for severe depression

Similar to medicines, there are also many different types of psychotherapy, each acting differently. There are certain schools of psychotherapy that are proven effective in treating depression, such as cognitive-behavioural therapy, or dialectical-behavioural therapy.
Ultimately, however, we have to find what suits each of us.

Studies show that the most important predictor of success in therapy is the relationship with the psychotherapist. So it’s important to choose a person with whom we feel comfortable, who we feel listens to us without judging us and helps us. Sometimes finding the right therapist is as hard as finding a good friend or life partner. Definitely worth the effort. To make our search easier, we can ask for recommendations from people we know, our psychiatrist or online.

Although medication and psychotherapy are also effective on their own, they work best together. It is recommended that you benefit from both forms of treatment.

3. Lifestyle changes

These usually come after the institution of medication and/or psychotherapy. A person with major depression will have great difficulty following these tips before treatment. However, once treatment has started and a steady state has been reached, the following changes can bring major improvements in general condition and may have a preventive role for future episodes.
Here are some tips for overcoming depression:

Physical activity

It reduces inflammation in the body, gives us energy and makes us feel better. One of the impediments, however, is that we see it as a chore. Humans were not made to run like hamsters on a wheel. We need objectives, goals we can achieve and challenges. Find something you like to do that involves exercise and try to include it in your schedule 3 times a week. Some ideas are: dancing (classes or in a club); climbing (outdoors or in the gym); walking (in the park, in the woods, with the dog, with friends); preparing for a marathon; yoga.

Healthy diet

It affects both our physical and mental health. Severe Depression makes us crave carbohydrates and other unhealthy foods. As we treat depression, we can also replace the unhealthy habits we have picked up as a result. Healthy dieting is not about starvation or counting calories. Rather, it is the care we take of our body, in gratitude for what it does for us. An extremely tasty and healthy diet with a proven role in protecting against depression and cardiovascular disease is the Mediterranean diet. This includes lean meat (fish, chicken); seeds and nuts; salad and vegetables; olive oil; fruit.

Meditation

It is a practice thousands of years old, which has only recently reached the Western world. It consists of concentrating on the present moment, on the breath or on a mantra, in order to clear the mind and achieve a state of calm. Although it may seem impossible or frustrating at first, by persevering, we will notice an evolution and changes in everyday life. Meditation can be practiced anywhere and anytime. It helps us care for and protect our mental health. Just as we brush our teeth every day to protect our dental health, we can practice meditation daily as a kind of mental hygiene.