A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.
Although the exact origin of depression is unclear, it is believed to involve biological, psychological, and social aspects. Socioeconomic status, life experience, genetics, and personality traits are believed to be factors in the development of depression and may represent an increased risk of developing a major depressive episode.
In the United States and Canada, the costs associated with major depression are comparable to those related to heart disease, diabetes, and back problems and are greater than the costs of hypertension. According to the Nordic Journal of Psychiatry, there is a direct correlation between a major depressive episode and unemployment.
Treatments for a major depressive episode include psychotherapy and antidepressants, although in more severe cases, hospitalization or intensive outpatient treatment may be required.
Signs and symptoms
Depressed mood is the most common symptom of a major depressive episode. Either a depressive mood or a loss of interest or pleasure in everyday activities for most of the day or every day must be present for a diagnosis of a major depressive episode. In addition, the person may experience one or more of the following emotions: sadness, emptiness, hopelessness, indifference, anxiety, tearfulness, pessimism, emotional numbness, or irritability. In children and adolescents, a depressed mood often presents as irritability. Withdrawal from social settings and neglect of personal relationships often accompany depressed mood, and may be noticed by those close to the person.
Major depressive episodes are known to cause sleep disturbances such as insomnia or, less frequently, hypersomnia. Symptoms of insomnia include trouble falling asleep, trouble staying asleep, or waking up too early in the morning. Hypersomnia may include sleeping for prolonged periods at night or increased sleeping during the daytime. Sleep may not be restful, and the person may feel sluggish despite many hours of sleep, which may be a factor in the worsening of their depressive symptoms, which interfere with other aspects of their lives. This type of sleep disorder may make it harder to fall and stay asleep at night than during the day. Hypersomnia is often associated with atypical depression as well as seasonal affective disorder.
A general lack of energy, fatigue, and tiredness that cannot be otherwise explained is also a symptom of a major depressive episode. A person may feel tired without engaging in any physical activity, which may cause day-to-day tasks, such as showering, to become unmanageable. This may also lead to difficulties with everyday decisions or trouble thinking or concentrating. This criterion requires this difficulty to cause significant difficulty in functioning for those involved in intellectually demanding activities, such as school and work, especially in difficult fields. Individuals with depression often describe a slowing of thought, an inability to concentrate and make decisions, and being easily distracted. In the elderly, the decreased concentration caused by a major depressive episode may present as deficits in memory. This is referred to as pseudodementia and often goes away with treatment. Decreased concentration may be reported by the patient or observed by others.
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. People with depression may be overly active (psychomotor agitation) or very lethargic (psychomotor retardation). 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. Psychomotor retardation results in a decrease in body activity. In this case, a depressed person may demonstrate a slowing of thinking, speaking, or body movement. They may speak more softly or say less than usual. To meet diagnostic criteria, changes in motor activity must be so abnormal that it can be observed by others. Personal reports of feeling restless or slow do not count towards the diagnostic criteria.