Major Depressive Disorder (MDD)

Overview

Major Depressive Disorder (MDD) is a common and serious mood disorder that significantly impacts how individuals feel, think, and function in their daily lives. It is characterized by persistent sadness, a loss of interest or pleasure in previously enjoyed activities, low energy, difficulty sleeping or oversleeping, and feelings of hopelessness or worthlessness. When left untreated, MDD can interfere with work, relationships, and overall quality of life. Fortunately, effective treatments are available, including innovative therapies such as Transcranial Magnetic Stimulation (TMS).

Types

MDD can present in different forms depending on symptom patterns and duration:

• Single Episode: A first occurrence of depressive symptoms lasting at least two weeks.
• Recurrent Depression: Multiple episodes of depression over time, separated by periods of wellness.
• Melancholic Depression: Severe depression with loss of pleasure, physical symptoms, and mood worse in the morning.
• Atypical Depression: Mood reactivity with symptoms like increased appetite, sleep, and sensitivity to rejection.
• Seasonal Affective Disorder (SAD): Depression linked to seasonal changes, most commonly in winter months.

Understanding the type of depression helps determine the most effective treatment approach.

Symptoms

Common symptoms of Major Depressive Disorder include:

• Persistent sadness or low mood
• Loss of interest in hobbies or daily activities
• Changes in appetite or weight
• Insomnia or excessive sleep
• Fatigue or lack of energy
• Difficulty concentrating or making decisions
• Feelings of guilt, worthlessness, or hopelessness
• Thoughts of death or suicide

Symptoms must last for at least two weeks to meet the criteria for diagnosis and can vary in intensity and duration from person to person.

Diagnosis

Diagnosing MDD involves several key steps:

1. Clinical Interview: A comprehensive discussion of symptoms, duration, and functional impact.
2. Psychiatric and Medical History: Includes past treatments, family history, and co-occurring conditions.
3. Standardized Questionnaires: Tools like the PHQ-9 help assess severity and track progress.
4. Physical Examination: To rule out medical causes such as thyroid issues or vitamin deficiencies.
5. Collaboration with Providers: Communication with therapists or referring physicians for coordinated care.

Early and accurate diagnosis is essential for initiating timely and effective treatment.

Treatment

Treatment for MDD focuses on relieving symptoms and restoring functioning. Treatment plans are individualized based on the patient’s symptoms, history, and response to previous interventions. TMS is especially beneficial for those seeking alternatives to medication or those who have experienced limited success with traditional therapies.

TMS is a non-invasive, drug-free option for patients who have not responded to medications. TMS works by targeting underactive areas of the brain, particularly the left dorsolateral prefrontal cortex, with magnetic pulses. Many patients report significant relief or full remission following a full course of treatment.