Everyone becomes “depressed” at one time or another. When we say, “I am depressed,” what we really mean is that we are sad because of some situation. Experiencing transient sadness is a normal part of life.
The clinical disorder of major depression, or as it is more formally called major depressive disorder, represents a clinical syndrome where the major feature is the experience of depression that is far in excess of the normal transient mood variations that everyone experiences.
It is important to understand that there is a difference between normal reactions to events and a clinical disorder. People reading this article who believe that they or someone else may have a major depressive disorder should seek the assistance of a licensed mental health professional. This disorder can only be diagnosed by a trained professional.
Major Depressive Disorder
Major depressive disorder (MDD), also known as major depression or clinical depression, is a clinical syndrome where the individual experiences extreme sadness and/or loss of the ability to experience pleasure as major symptoms of a clinical syndrome (a group of symptoms that occur together and can be identified as a formal illness or disorder). These major symptoms are accompanied by other symptoms that must occur consistently over a two-week period before the syndrome can be diagnosed.
The American Psychiatric Association lists the major diagnostic criteria for MDD in its diagnostic manual the DSM-5. While those diagnostic criteria will not be presented here, some of the behaviors associated with individuals who have MDD include the following:
- The person has a depressed mood most of the day almost every day, the person displays significantly diminished interest in things or events that previously were interesting to them, or the person displays an inability to experience pleasure nearly every day.
- The person experiences difficulties with sleeping nearly every day. These difficulties are either not being able to get the sleep (insomnia), or the person could experience difficulties with sleeping excessively (hypersomnia).
- There is a significant loss of weight that has occurred over a two-week period without any attempts to diet or lose weight.
- Significant feelings of fatigue, being bogged down, or having no energy nearly every day for a two-week period.
- The person appears to move in slow motion, or the person is highly irritable and restless nearly every day.
- The person experiences marked difficulty concentrating and thinking nearly every day.
- The person has feelings of worthlessness or extreme guilt nearly every day.
- The person has recurrent thoughts of death or self-harm, such as committing suicide, nearly every day.
Individuals who express suicidal thoughts should be evaluated immediately by a professional mental health worker.
Having MDD and a Substance Use Disorder
Anyone diagnosed with any formal psychiatric/psychological disorder is at an increased risk to also have or develop a substance use disorder. When an individual has a psychological disorder, such as MDD, and a co-occurring substance use disorder, the situation is now referred to as a dual diagnosis, dual disorders, or co-occurring disorders. This situation is so common that it is generally accepted that at least one-third of individuals diagnosed with MDD will also be diagnosed with a comorbid (co-occurring) substance use disorder.
While a person with MDD can also be diagnosed with any type of substance use disorder, there are several types of substance use disorders that are commonly diagnosed with individuals who have clinical depression. These include:
- Alcohol use disorders
- A substance use disorder to prescription medications, such as benzodiazepines (anti-anxiety medications) or narcotic painkillers (e.g., Vicodin, OxyContin, etc.)
- Cannabis use disorders
- Cocaine use disorders
Individuals diagnosed with MDD and a substance use disorder are at greater risk for the development of severe symptoms, such as psychosis (a loss of reality) and potential suicide attempts.
Despite a large body of research investigating the relationships between psychological/psychiatric disorders and substance use disorders, it is virtually impossible to develop any consensus as to whether having one type of disorder causes another, or whether individuals consistently “self-medicate” psychological issues with drugs and alcohol. None of these hypotheses are consistently demonstrated, and each individual case is different. In some cases, individuals with depression may turn to drugs as a means to dampen the symptoms of their depression, whereas in other cases, individuals with substance use disorders develop depression as a reaction to their situation and to the effects of substance abuse.
Who Is at Risk to Develop MDD?
The research on MDD has identified a number of risk factors that are associated with an increased probability to develop this disorder. It is important to understand that risk factors are not causal factors; they simply increase the probability that an individual may develop a specific condition. Having more than one risk factor increases this probability even further. That being said, many individuals with numerous risk factors never develop psychiatric/psychological disorders, such as MDD.
- Certain genetic factors are associated with a risk to develop MDD. For instance, having a first-degree relative who is diagnosed with MDD increases the risk for developing this disorder.
- Females are more prone to develop MDD than males. Females are diagnosed with MDD 1.5-2 times more often than males.
- Adverse childhood experiences, such as abuse, poor parenting practices, loss of a parent, and other major stressors, are linked with an increased risk to develop MDD.
- Individuals with serious and chronic medical conditions are at increased risk to develop MDD.
- Being diagnosed with another psychiatric/psychological disorder increases the risk to develop MDD.
- Having a substance use disorder increases the risk to develop MDD.
- Experiencing stressful or traumatic life events increases the risk to develop MDD.
When a person has co-occurring disorders, such as MDD and a substance use disorder, it is important to treat both disorders at the same time. The research and clinical literature is clear that attempting to treat just one of the disorders and trying to hold the other in check will result in both disorders getting worse. A number of treatment options exist, including:
- Medications: There are a number of medications used in the treatment of MDD and to assist the treatment process for substance use disorders. Antidepressant medications, and medications targeted at specific types of withdrawal symptoms from substance use or to control cravings, can only be administered under the supervision of a physician.
- Therapy: The therapy of choice for both substance use disorders and MDD is a type of therapy known as Cognitive Behavioral Therapy (CBT). This therapy addresses the person’s patterns of thinking, attitudes, and beliefs first. Then, CBT attempts to help the person recognize irrational thoughts and beliefs, and change them to more functional beliefs that are in line with reality. CBT is a family of therapies, and a number of different types of CBT can be used to treat both MDD and substance use disorders.
- Support groups: Support groups are not run by mental health professionals, such as physicians or therapists. They are run by individuals who have struggled with the same types of issues. These include such familiar groups as Alcoholics Anonymous, Narcotics Anonymous, and a group known as Depressed Anonymous for individuals with depression. Often, individuals participating in these groups find them extremely helpful and supportive. Though popular, 12-Step groups are not the only types of support groups. Interested individuals can check with local hospitals, community service centers, and mental health clinics for different types of support groups in their area.
- Other types of interventions: These include vocational counseling, case management services, peer involvement, and family therapy, among others.
The empirical evidence indicates that treatment for MDD and comorbid substance use disorders can be very effective. The sooner people get into treatment, the better their chances of recovery are.