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What is the difference between depression and Major Depressive Disorder?

Posted Jul 08 2012 10:09pm

Depression, Mood Disorder or Major Depressive disorder?

Major Depressive Disorder is a specific diagnosable disorder listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders.)  Sometimes we use the term imprecisely to refer to both the common sense feeling of sadness and a series of specific mental disorders that we professionals call mood disorders.

The dictionary definition of depression is essentially sadness. In the mental health field it means so much more.

The differences in mood or depressive disorders are largely a matter of certain specific features that the person has rather than saying anything about the cause. There are also some related conditions that are not currently official “depressive disorders” but for which depression is a feature.

Confused yet? It takes 4 years or more of grad school to make it all this complicated. 

Mood problems often occur in “episodes” so they can come and go with or without treatment. The episodes don’t get specific diagnoses, but they do get used to see if you have all the features of a specific diagnosis.

Now if you are depressed and suicidal, which specific mood disorder you have may not matter to you but it matters a whole lot to the insurance person approving your treatment. Since not everyone agrees which things are severe enough to require treatment, the list fades in and out with time.

What makes depression into a Major Depressive Disorder rather than garden variety depression is a few key factors.

How long you been feeling that way?

To be major depression it should have lasted for more than 2 weeks AND there should be at least 4 other symptoms of impairment. The effort here is to separate normal life problems from an illness that needs treating. 

How has this affected you?

There needs to be some problem in your life over and above just being sad. Being over sad all the time but not quite getting bad enough to be diagnosed with Major Depressive Disorder is called Dysthymic Disorder.

So we look to see can you work? Do you have friends and family? Do you still do some things for fun? These things separate out the sad-moods and the sad-for-a-reason from the sad-way-to-much-and-too-long that characterizes Major Depressive Disorder.

Major Depressive Disorder is also separated into “single episodes” and “recurrent.” The first time someone has Major Depression we look more for causes. If they have repeat performances of depression we look at this as likely to be something produced by the person, either biologically or thinking wise.

Depressive Episodes, hence Major depressive Disorder can also be “graded” into mild, moderate and severe. For the treating professional this helps plan treatment. For the insurance company it helps them known how big a bill they are getting for this treatment.

Sometimes the depression gets so bad that the brain starts making up stores. This looks a lot like the psychosis in Schizophrenia but it only happens to some people and then only when they are severely depressed.  This is called with (or without) psychosis depending on whether you have or do not have psychosis.

People who have Major Depressive Disorder do not all look or act the same. Some people become so depressed they have trouble moving. This is called Catatonia which is also associated with sleep paralysis.

The old fashion name for depression was melancholy. This is typically very severe in the morning but gets better as the day moves forward. People with this variety also wake up early. They don’t feel like eating and they either sit unable to summon up the energy to do anything, or they pace aimlessly about.  Often they also feel guilty about everything and hate to bother people.

People with atypical features are more like bears hibernating for the winter. They are hungry when awake and they sleep day and night but are still tired.  They are likely to feel that people are rejecting them and don’t what them around. People with atypical features can brighten a little for a while if you dangle something they like in front of them, but this improved mood doesn’t last long.

Postpartum depression is also a recognized type. This is easy to understand in women soon after the birth of a child, due to the changes in the hormones in the woman’s body. It can also be seen in men especially after the birth of the first child as there is a change in the primary relationship. The fairy tale is over. Some men become excited about fatherhood, others feel like they have lost a lover.

There is also a seasonal pattern associated with depression. Sometimes this is referred to as Seasonal Affective disorder or “winter blues.”  This pattern can occur in the summer or at the spring and fall changes of weather, but those changes are more likely to be associated with Bipolar Disorder than Major Depressive Disorder.

For more on related conditions check the categories list to the right of the posts or watch for words to turn blue indicating they have been linked to other posts about this topic. My plan is to add links as quickly as I can finish the posts of these other topics.

Feel free to leave comments or email me about your questions. While I can’t provide therapy or counseling over the internet, you need to come see me in the office for that, I will be glad to try to answer questions of general interest.

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