The characteristic symptom of the depressive disorders is a persistently depressed and empty mood.
A period of sadness or melancholy that occurs in reaction to a personal loss or trauma is often referred to as a reactive depression. While in some instances a reactive depression may be severe enough to require treatment, it is normally of short duration and self-correcting. In the depressive disorders, however, the depressed mood arises spontaneously and is long lasting, the symptoms are severe, and the individual is unable to function normally.
MAJOR DEPRESSIVE EPISODE
A major depressive episode is characterized by either a persistent depressed mood or loss of interest or pleasure in daily activities over at least a two-week period. Four or more of the following symptoms must also be present: significant weight change or change in appetite, sleeping too much or not being able to sleep, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, an inability to concentrate or indecisiveness, and recurrent suicidal thoughts.
Types of Depressive Disorders
MAJOR DEPRESSIVE DISORDER
Major Depressive Disorder is characterized by a major depressive episode that lasts at least two weeks and is severe enough to cause marked impairment in the individual’s ability to function in their daily life. A person may experience a major depressive episode only once, but more commonly episodes occur several times in a lifetime.
PERSISTENT DEPRESSIVE DISORDER
Persistent Depressive Disorder (Dysthymia) is a less severe form of depression that is characterized by a chronically depressed mood for at least two years. The symptoms of dysthymia, while not seriously disabling, keep the individual from functioning well or feeling good. Many people with dysthymia experience major depressive episodes during their lives.
Prevalence and Age of Onset
The lifetime prevalence of the depressive disorders in the United States is estimated to be 16.6% for major depressive disorder and 2.5% for persistent depressive disorder. The age of onset for the first major depressive episode is usually late adolescence/early adulthood although the first episode can occur at any age. A family history of depression increases the likelihood that a child will also have a depressive disorder. Major depressive disorder is the leading cause of disability in the United States and the second leading cause of disability worldwide.
Treatment & Support
While depression is a dark and painful disorder, a number of effective treatments have been developed that can bring significant relief to those who are suffering. More than 80% of people with a depressive disorder will show improvement in their symptoms within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. Treatment usually lasts for about a year, and there is a small percentage of individuals who have recurrent depression and require ongoing treatment to maintain recovery.
Antidepressant medications are given to alter the levels of the neurotransmitters serotonin (5-HT) and/or norepinephrine (NE) in the brain. While some improvement in the symptoms of depression may be seen in just a few weeks, antidepressant medications generally have to be taken for three to eight weeks before the full therapeutic effect is realized. Because of the variability of response, a patient may have to try several antidepressants at different doses over a period of time before an effective treatment is found.
Research has found that two psychotherapeutic (talk therapy) approaches are effective in treating the depressive disorders, interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT). IPT puts an emphasis on the way symptoms of depression are related to a person’s relationships. The goals of IPT are symptom reduction, improved interpersonal functioning, and increased social support. The major aim of cognitive-behavioral therapy (CBT) is to help the client eliminate negative beliefs and/or behaviors and replace them with positive ones.
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT, also known as “shock treatment”, may seem frightening, but in recent years, however, the ECT procedure has greatly improved, and clinical research clearly shows it to be an effective treatment for major depression. Prior to the procedure, the patient is given a muscle relaxant, and the procedure itself is performed under mild anesthesia. The electrical stimulation causes a brief seizure in the brain, lasting about thirty seconds. It is not fully understood how ECT is effective in treating depression, although it is theorized that like antidepressants ECT alters the levels of certain neurotransmitters in the brain.
TRANSCRANIAL MAGNETIC STIMULATION
Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. During the procedure, a large electromagnetic coil is placed against the patient’s scalp near the forehead. The electromagnet creates electric currents that stimulate nerve cells in the prefrontal cortex thought to be involved in mood control and depression. The procedure is painless, has no reported side effects, and is usually done as an outpatient procedure in a psychiatrist’s office or clinic. Daily sessions are usually required for four to six weeks to obtain the full therapeutic benefit.
A Spiritual Perspective
The depressive disorders share a core spiritual feature, hopelessness. The Scriptures teach us that “faith is the assurance of things hoped for, the conviction of things not seen” (Hebrews 11:1). If you are ministering to someone with a depressive disorder, a hope that transcends circumstances is what you have to offer them. The Scriptures were written to encourage us and to give us hope. Use God’s Word to rebuild their hope. Remind them that while deep despair and hopelessness can occur in believers, God is faithful. Demonstrate to them how focusing on that single truth brings hope at the lowest points of life: “This I recall to my mind, therefore I have hope. The Lord’s loving kindnesses indeed never cease, for His compassions never fail. They are new every morning; great is Your faithfulness” (Lamentations 3:21–23)