Major depressive episode
Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities.
[1] Although the exact origin of depression is unclear, it is believed to involve biological, psychological, and social aspects.
In modern times, depression, more often severe cases, is more noted as an absence of pleasure, with feelings of emptiness and flatness.
[3] This type of sleep disorder may make it harder to fall and stay asleep at night than during the day.
[8] A general lack of energy, fatigue, and tiredness that cannot be otherwise explained is also a symptom of a major depressive episode.
[3] A person may feel tired without engaging in any physical activity, which may cause day-to-day tasks, such as showering, to become unmanageable.
[8] Individuals with depression often describe a slowing of thought, an inability to concentrate and make decisions, and being easily distracted.
[3] In the elderly, the decreased concentration caused by a major depressive episode may present as deficits in memory.
[1] Changes in motor activity by individuals in a major depressive episode that is slower or faster than normal levels may be noticed by those around them.
[1] Psychomotor agitation is marked by increased body activity, which may result in restlessness, an inability to sit still, pacing, hand wringing, or fidgeting with clothes or objects.
[8] Many patients in major depressive disorders exhibits distorted thought patterns and may believe they are not worthy of care from those around them, and may feel as though their lives have no meaning or purpose.
[11] Despite its longstanding prominence in pharmaceutical advertising, the idea that low serotonin levels cause depression is not supported by scientific evidence.
[12][13][14] One interpretation is that depression manifests due to an imbalance of neurotransmitters in the brain, resulting in feelings of worthlessness and despair.
[2][18] A major depressive episode can often follow acute stress in someone's life, such as the death of a loved one or being fired from a job.
[11] Other medical conditions, for example hypothyroidism, may cause people to experience similar symptoms as a major depressive episode.
[20] However, according to the DSM-5, this would be considered a mood disorder due to a general medical condition, not a major depressive episode.
[1] These symptoms must be present for at least 2 weeks, represent a change from the patient's normal behavior, and cannot be attributed to another medical condition[22] or substance use.
[1] Symptoms must also cause clinically significant distress in important areas of everyday life (e.g. social or occupational).
Treatments for a major depressive episode may be provided by mental health specialists (e.g. psychologists, psychiatrists, social workers, counselors), mental health centers or organizations, hospitals, outpatient clinics, social service agencies, private clinics, peer support groups, clergy, and employee assistance programs.
[22] Meta-analyses suggest that the combination of psychotherapy and antidepressant medications is more effective in treating mild and moderate forms of depression than either type of treatment alone.
[7] Evidence shows that cognitive behavioral therapy can be as effective as medication in treating a major depressive episode.
[24] Psychotherapy may be the first treatment for mild to moderate depression, especially when psychosocial stressors play a large role.
[7] Some studies have shown that antidepressants may increase short-term suicidal thoughts or actions, especially in children, adolescents, and young adults.
[3] Some of the unique benefits of vagus nerve stimulation include improved neurocognitive function and sustained clinical response.
[3] It is a non-invasive treatment that is easily tolerated and shows an antidepressant effect, especially in people with more typical depression and younger adults.
However, even after the major depressive episode is over 20% to 30% of patients have residual symptoms, which can be distressing and associated with disability.
[36] In a National Institute of Mental Health study, researchers found that more than 40% of people with post-traumatic stress disorder had depression four months after they experienced the traumatic event.
This is referred to as postpartum depression and is a different health condition than the baby blues, a low mood that resolves within 10 days after delivery.
