Major depression: symptoms, causes and treatment

Throughout our lives, it is possible to feel sad for any reason or to go through a bad emotional streak. And if no one likes to go through these potholes, the truth is that suffering can even make you grow as a person, And ultimately be positive for your personal development.

However, we need to be aware that in some cases what we might think of as simple sadness or emotional slowing down is in fact a depressive process; that is to say pathological. There are different types of depression, and in this article we will talk about most serious depressive disorder: major depression. Let’s see what this psychopathological phenomenon consists of.

  • Related Text: “Are There Different Types of Depression?”

Major depression: what is it?

Major depression, also known as unipolar depression, is a mood disorder characterized by the onset of one or more depressive episodes lasting at least two weeks, and presents a set of predominantly affective symptoms (pathological sadness, apathy, anhedonia, hopelessness, tooth decay, irritability, etc.). However, cognitive, voluntary and somatic symptoms are also often present during its course.

Thus, people with major depression are not just “sad”, but tend to show an extreme lack of initiative in doing anything, as well as an inability to be happy and to feel pleasure, a phenomenon. known as anhedonia. They also experience other physical and psychological problems that significantly affect their quality of life.

On the other hand, major depression also affects the way we think and reason. In general, the total or partial lack of motivation makes people who have entered a crisis of this type appear absent and do not want to do anything, even not to think much (which does not mean that they have a mental handicap).

Major depressive disorder can be divided into mild, moderate or severe and it usually appears during young adulthood, although it can occur at almost any stage of life. The individual suffering from this condition may experience normal mood phases between depressive phases which can last for months or years.

On the other hand, major depression is a type of unipolar depression, that is, it does not have phases of mania (which makes the difference between bipolarity), and the patient may have very serious problems if he does not receive the right treatment.

Is this a unique psychopathological phenomenon?

While major depression is one of the most important concepts in the world of psychiatry and clinical and health psychology, many researchers wonder that it is not just about a set of disorders similar to each other and that they do not share the causes or the logic of operation. This is because people who suffer from depression can manifest symptoms in a variety of ways and respond to treatment in a variety of ways as well.

It is likely that as more research is done on the subject, new ways of classifying these symptoms will emerge. However, for now, the psychological construction of “major depression” it helps treat many people who need professional treatment and may benefit from therapySomething important considering that this deterioration in mental health is linked to the risk of suicide and also usually causes great suffering.

frequent symptoms

According to the fifth edition of the Statistical Diagnostic Manual of Mental Disorders (DSM-V), for the diagnosis of major depression, the subject must exhibit five (or more) of the following symptoms during the depressive period (at least two weeks).

These should represent a change from the patient’s previous activity; and one of the symptoms should be (1) depressed mood or (2) loss of interest or the ability to feel pleasure (anhedonia).

  • Depressed mood most of the day, Almost every day (1)
  • Loss of interest in activities that were previously rewarding (2)
  • Weight loss or gain
  • Insomnia or hypersomnia

  • low self-esteem

  • Concentration issues and decision making issues
  • Feelings of guilt
  • suicidal thoughts

  • Restlessness or psychomotor retardation almost every day
  • Fatigue or loss of energy almost every day

It is important not to confuse major depression with other similar mood disorders, such as dysthymia. This psychological disorder is also associated with many symptoms of major depression, but has some differences. Primarily, what distinguishes dysthymia from major depression is that the former develops over longer cycles (at least two years), the intensity of symptoms is lower, and anhedonia does not develop. generally not produced.

    Types of major depression

    In addition, the DSM-V specifies that symptoms should cause clinically significant discomfort or impairment in social, occupational, or other important area functioning. The episode cannot be attributed to the physiological effects of a substance or other medical condition, and the episode of major depression is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified spectrum disorder of schizophrenia and other psychotic disorders.

    There are two types of major depression:

    • Major depression with a single episode: There is only one depressive event in the patient’s life.
    • Recurrent major depression: Depressive symptoms appear during two or more episodes in the patient’s life. The separation between depressive episodes should be at least 2 months without showing symptoms

    Causes of this mood disorder

    Major depression is a multifactorial phenomenon, So that different factors could be at the origin of this psychopathology: genetic factors, childhood experiences and current psychosocial adversities (social context and personality aspects).

    In addition, difficulties in social relations, cognitive dysfunctions or socio-economic status could be risk factors for the development of this disorder. However, the interaction of biological, psychological and social factors probably favors the development of major depression.

    too much major depression has been linked to a lack of dopamine in the brain’s reward system, so the person has no goals. This fact can be the trigger for a sedentary and monotonous lifestyle and the serious self-esteem issues that usually appear in these cases.


    Major depression is a serious but fortunately treatable illness. Treatment options often vary depending on the severity of the symptoms, and in severe cases the administration of psychotropic drugs (such as antidepressants) combined with psychotherapy appears to be the most appropriate treatment.

    However, in recent years, the effectiveness of other treatments has been demonstrated, for example that of electroconvulsive therapy (ECT), Which is typically used when depressive symptoms are severe or when drug therapy is not working. Of course, this therapy is not comparable to the old electroshock, since the intensity of the discharges is much lower and is painless, since it is carried out under anesthesia.

    During psychotherapy sessions, patients with depression are trained to develop habits that allow them to actively participate in daily activities. These types of behavioral activation interventions make discover new ways of self-motivation in the person. As we will also see improves self-awareness and recognition of emotions and challenges dysfunctional beliefs through cognitive restructuring.

    On the other hand, while mindfulness has shown some effectiveness in intervening in cases of mild depression, with major depression it does not seem to work more than to prevent relapses. People diagnosed with major depression they can easily fall into this type of crisis, The treatment is therefore considered a lifelong (but not necessarily weekly) aid. Additionally, the methods used to prevent relapses are different from those used when the patient is going through an attack of depression.

    Treatment with psychotherapy

    Psychological therapy has proven to be an effective tool in treating depression, Especially cognitive behavioral therapy. This type of therapy views the patient as a system that processes information from the carrier before issuing a response. In other words, the individual classifies, evaluates and makes sense of the stimulus according to their set of experiences of interacting with the environment and their beliefs, assumptions, attitudes, worldviews and self-evaluations.

    Different techniques are used in cognitive behavioral therapy which aim to have a positive effect on low self-esteem, negative problem-solving styles or the way of thinking and evaluating events that occur around the patient. Here are some of the most common cognitive-behavioral techniques:

    • self-observation, Roadmaps or the setting of realistic technical objectives are techniques commonly used and which have demonstrated their effectiveness.
    • Cognitive restructuring: Cognitive restructuring is used so that the patient can have knowledge about their own emotions or thoughts and can detect irrational thoughts and replace them with more adaptive ideas or beliefs. Among the most well-known programs for the treatment of depression are: the cognitive restructuring program of Aaron Beck or Albert Ellis.
    • Developing problem-solving skills: Problem solving deficits are linked to depression, so problem solving training is a good treatment strategy. In addition, social skills training and assertive training are also helpful treatments for this condition.

    Other forms of psychological therapy have also been shown to be effective in treating depression. For example: interpersonal psychotherapy, which treats depression as a disease associated with dysfunctional personal relationships; or Mindfulness Based Cognitive Therapy or MBCT (Mindfulness Based Cognitive Therapy).

    pharmacological treatment

    Although the application of psychotropic drugs is not always necessary in less severe cases of depression or in other types of depression, in severe cases of depressive disorder, it is advisable to administer different drugs over a period of time.

    The most commonly used antidepressants are:

    • Tricyclic antidepressants (TCAs): They are known as first generation antidepressants, although they are rarely used as a first pharmacological alternative due to their side effects. Common side effects caused by these medications include dry mouth, blurred vision, constipation, difficulty urinating, worsening glaucoma, thinking disturbances, and fatigue. These drugs can also affect blood pressure and heart rate, so they are not recommended for the elderly. Some examples are: Amitriptyline, Clomipramine or Nortriptyline.
    • Monoamine oxidase inhibitors (MAOIs): MAOIs are antidepressants that work by blocking the action of the enzyme monoamine oxidase. As above, they are used less because of their severe side effects: weakness, dizziness, headache, and tremors. Tranilciprominao or Iproniazida are some examples of this drug.
    • Selective Serotonin Reuptake Inhibitors (SSRIs): They are the most widely used and are generally the first choice in the pharmacological treatment of depression. These drugs tend to have fewer side effects than other antidepressants, although they can also cause dry mouth, nausea, nervousness, insomnia, sexual problems, and headaches. Fluoxetine (Prozac) is the best known SSRI, although other drugs in this group are also commonly used, such as citalopram, paroxetine, or sertraline.

    Serotonin excess and serotonin syndrome

    Although it is also possible to find other types of antidepressants such as selective norepinephrine reuptake inhibitors (SNRIs), selective norepinephrine and dopamine reuptake inhibitors (ISRND) or atypical antidepressants, when consuming antidepressants that have the ability to increase the release of serotonin should be careful with its overdose or interaction with other drugs.

    Excessive stimulation of serotonin on postsynaptic 5-HT1A and 5-HT2A receptors at the central and peripheral level has negative effects on the body which can be very serious or even fatal due to serotonin syndrome.

    • You can read more about this syndrome in our article: “Serotonin Syndrome: Causes, Symptoms and Treatment”

    Bibliographical references:

    • Belloch, A .; Sandín, B. and Ramos, F. (2010). Manual of psychopathology. Volumes I and II. Madrid: McGraw-Hill.
    • Blazer, DG, Kessler, RC, McGonagle, KA and Swartz, MS (1994). The prevalence and distribution of major depression in a national community sample: the national co-morbidity survey. I am J. Psychiat.
    • Drake RE, Cimpean D, Torrey WC. (2009). Shared Decision Making in Mental Health: Perspectives on Personalized Medicine. Dialogues Clin Neurosci.
    • Kramer, Peter D. (2006). Against depression. Barcelona: Seix Barral.
    • World Health Organization. CIE 10. (1992). Tenth revision of the international classification of diseases. Mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Madrid: Meditor.
    • Perestelo Pérez L, González Lorenzo M, Rivero Santana AJ, Pérez Ramos J. (2007). Decision support tools for patients with depression. Quality plan for the MSPS SNS. SESCS; 2010. ETS Reports.

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