Major Depressive Disorder - Recurrent episode

Major Depressive Disorder - Recurrent Episode

Recurrent Major Depressive Disorder is considered a mood disorder. Individuals that experience Recurrent Major Depressive Disorder have had a depressive episode at least twice in their lives. Millions of people worldwide suffer from depression, which may be caused by a genetic predisposition, current or past stressful situations, and/or other illnesses that increase the risk for depression, such as cancer or diabetes.

Different depression, different treatment

There are three common types of depression, and treatment usually looks different for each kind:

1. Dysthymia: having ongoing, low-level depressive symptoms
2. Major Depression, Single Episode: Having had one period of moderate or severe depression
3. Recurrent Major Depressive Disorder (Recurrent MDD) - Having two or more periods of moderate or severe depression

Another way some doctors characterize someone’s specific case of depression is “Treatment-resistant” depression (TRD) which is when any of the above three diagnoses does not get better after being treated with at least two different categories of antidepressant medications. This is important because there are some forms of treatment that are only approved for TRD.

For Recurrent MDD, a doctor might recommend treating it like a chronic illness, where medication or therapy could be helpful for the long-run rather than just a short duration. Fortunately, there are many effective treatments for Recurrent MDD, including psychotherapy and antidepressant medications. Such treatments usually facilitate a return to normal life.

However, one of the many frustrating aspects of depression is that it might take a long time for a physician to identify the best medication for a given patient. This means that a medication that worked well in the past may be a proper choice again; However, because so much effort is focused on creating new medications that improve depression and new medications are continually introduced, more effective medications may be available now.

Severe depression tends to recur

Some individuals experience a bout of serious depression and, with therapy and/or medication, they recover completely. They eventually taper off their treatment and do not need to restart again. However, many other individuals experience recurrent depression and consequently, require ongoing therapy for depression. Researchers have studied people who have suffered from multiple episodes of depression and found patterns. For example, adults who experienced a depressive episode are at six times greater risk for having a future episode. In addition, individuals with ongoing medical problems are also more likely to suffer a relapse of their depression.

What it looks like

Common symptoms of Recurrent MDD include the following:

• Having a sad mood
• Sleeping much more or much less every day than in the past
• Eating much more or much less than in the past, causing an unintentional weight gain or loss
• Having difficulty meeting the daily requirements of life, such as dealing with work and one's family
• Extreme fatigue much of the time
• Difficulty with concentrating most of the time
• Feeling like a worthless or bad person, although the individual hasn't done anything wrong
• Taking no pleasure in activities that formerly made one happy
• Laughing less often or never
• Thoughts of death or suicide

Some describe depression as feeling like their “tank” is empty. Others report feeling extremely sad, or start to feel insignificant - that other people are looking right through them. Many people with depression stop getting pleasure from the things that used to make them happy, and can’t imagine being happy again. They sometimes wonder “if it’s all worthwhile,” and imagine how life would be if they weren’t around. The depressed mind can play horrible tricks on one’s thinking.

Having depression is nobody's fault

Many people with Recurrent MDD may have blamed themselves for years for not being able to “shake” their feelings. But, depression is no one’s fault. And, most of the time, it is highly treatable. Blaming oneself for depressive symptoms is like blaming oneself for having brown eyes or blonde hair. Depression is not the individual’s fault.

The ongoing management of Recurrent MDD

When a depressed person feels better as a result of medication, therapy, or circumstances, she might assume she is cured, and stop taking her medication. The illusion of being “cured” is enticing, and it is common to feel well when depression is being treated. But, oftentimes ongoing treatment is necessary, even when the depression is managed. Management is different from taking an antibiotic for a week for an infection and achieving a complete recovery. It is important for individuals and their health care providers to distinguish whether signs of improvement are a response to a particular treatment or the elimination of the depressive episode.

In the case of Recurrent MDD, if the medication is working and helping, this is a positive indicator of the medication’s effectiveness rather than a sign that the underlying Recurrent MDD is gone. For that reason, the process of determining if someone suffering from Recurrent MDD is ready to stop treatment must be made in partnership with the individual’s health care provider to avoid stopping too abruptly or too soon.

Outlook

While living with Recurrent MDD can present unique obstacles, and finding the best treatment for such depression can take several tries, the right treatment can dramatically improve an individual’s quality of life. The majority of people who are properly diagnosed and treated for Recurrent MDD often gain transformative results. In fact, people who have received medical treatment for their depression often say that starting an antidepressant was one of their most important decisions. With treatment, people with Recurrent MDD can reclaim their lives.

In good company

Many prominent people reportedly struggle with depression, such as actor Dwayne Johnson (“The Rock”), singer Katy Perry, actress Kristen Bell, and many others. No one should feel alone if feeling this way.

The current thinking on what causes Recurrent MDD

In the past, health care providers have explained conditions such as depression as a “chemical imbalance.” This may make it seem like depression is similar to a vitamin or mineral deficiency, and that just taking the right drug will easily cure someone. Unfortunately, depression, and particularly Recurrent MDD, are more complicated, and it’s unclear whether an imbalance causes depression, depression causes an imbalance, or depression is caused by other factors entirely. And what’s more, there is disagreement over whether an individual is born with an imbalance or an imbalance is triggered by the environment.

Most likely, it is a combination of both. In support of “chemical imbalance” being a cause, medications that act to increase brain chemicals such as serotonin, dopamine, or norepinephrine often make depressed people feel better. In fact, by increasing the levels of neurochemicals in the brain, symptoms of depression can sometimes be quickly resolved.

Substance abuse is a known risk factor for depression, and individuals who are dependent on alcohol or illicit drugs may have an increased risk for developing depression. Sometimes other disorders increase the risk for depression; for example, people who suffer from anxiety often are more likely to be depressed than non-anxious people.

Life situations can lead to depression in some cases, such as getting fired from a valued job, a spouse or partner deciding to leave the relationship, or the person being in a major car accident. Money problems and stress are also crises leading to a depressed state in many individuals.

Depression may also be genetic, and health care providers often say that it “runs in families.” If an individual’s parent or sibling has depression, it puts that individual at increased risk for having an episode. But, it is a complicated issue. Some people have many depressed family members, but they never develop depression. In contrast, some people may report no depressed relatives and yet they develop depression. Researchers are constantly studying the causes and potential ways to mitigate the effects of this common condition.