When you’re looking for treatment for major depressive disorder (MDD), it’s important to understand the latest treatment approaches available. This is true whether your diagnosis is for mild, moderate, or severe depression. Many people don’t understand having clinical depression is far different than being sad or moody or having a bad day. The symptoms of major depressive disorder can dominate daily life and make the most basic activities seem impossible.
When MDD goes untreated, disruption can be severe. In this article, we’ll talk about the consequences of untreated MDD, i.e. why getting treatment is important, and describe both traditional and new/innovative new treatments for MDD. We’ll also list the primary signs and symptoms of MDD, and share the latest prevalence rates for diagnosis and treatment of major depressive disorder (MDD).
The Consequences of Delayed Treatment for Major Depressive Disorder
First, to ensure we’re on the same page, let’s review a basic definition of depression as published by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines major depressive disorder as:
“…an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”
We’ll review the detailed list of symptoms below, but first, we’ll review the reasons why it’s important for people who receive a diagnosis for depression to seek professional support as soon as possible. The most important reason is also the easiest to understand. In most cases, when someone with depression – whether they have a clinical diagnosis or not – does not seek professional support the symptoms get worse over time.
Therefore, the level of disruption they cause often increases, as well. Research released in 2018 shows depression – when untreated – gets worse over time because of long-term changes in the structure and function of the brain. Results of this large-scale meta-analysis show:
- Long-term untreated depression can cause damage to the hippocampus
- Damage includes measurable decrease in hippocampal volume
- Damage to the hippocampus can have a negative impact on:
- Memory formation
- Memory organization
- Connection of memory to physical senses
- Connection of memory to emotions
- Increased symptom severity can cause increased damage to the hippocampus
- Longer time between symptom onset and treatment can result in increases damage to hippocampus
- Longer time between symptom onset of and treatment for depression can lead to:
- Less favorable clinical outcomes
- Longer time for treatment effect/symptom reduction
- Longer time until symptom remission
This data explains why mental health professionals urge people to seek treatment as soon as possible when they experience the symptoms of depression. Like the life disruption caused by the symptoms of depression, the damage to the brain caused by depression can get worse over time.
Treatment for Major Depressive Disorder (MDD)
Typical treatment for major depressive disorder most often includes mixture of therapy, medication (if needed), lifestyle changes, and group/community support.
Individual counseling and/or psychotherapy therapy:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Acceptance and commitment therapy (ACT)
- Motivational interviewing (MI)
Medication, if indicated:
- Selective serotonin reuptake inhibitors (SSRIs): Prozac, Paxil, Zoloft, Lexapro, Celeaxa
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): Cymbalta, Effexor
- Atypical antidepressants: Remoron, Buproprion
- Tricyclic antidepressants: Pamelor, Norpramin
- Monoamine oxidase inhibitors (MAOIs)
Lifestyle changes:
- Increased activity/exercise
- Improved diet and eating habits
- Improved sleep hygiene
- Mindfulness/meditation/stress reduction
Community support:
- Local support groups for people with mental health issues
- Support groups specifically for people with depression
- Activity groups for people with/without mental health diagnoses
However, research shows that about thirty percent of people with MDD don’t respond to initial treatment, and some don’t respond well to two or more attempts at treatment with a combination of medication and therapy. These patients receive a diagnosis for treatment-resistant depression (TRD), and are eligible for two new and innovative approaches evidence shows are effective for treatment-resistant depression: transcranial magnetic stimulation (TMS) and SPRAVATO®.
Transcranial Magnetic stimulation (TMS): What You Need to Know
Transcranial magnetic stimulation (TMS) is a safe, effective, non-invasive treatment for TRD. It works by directing electromagnetic pulses to the brain area involved in regulating mood and emotion. This technique has no systemic side effects and doesn’t require anesthesia or sedation.Treatment with TMS follows this general pattern, after a patient meets the criteria for TRD:
- Patients receive treatment in an outpatient office setting.
- Sessions last about 20 minutes each
- Patients relax in a comfortable chair
- A clinician places a coil or cap on the patient’s head
- The TMS device delivers therapeutic pulses
A full course of treatment with TMS involves 1-2 sessions per week over 4-6 weeks. Because there’s no sedation or anesthesia involved, patients can drive themselves to and from TMS sessions. To learn more about TMS, please read our TMS treatment page:
Transcranial Magnetic Stimulation (TMS) at Crownview
SPRAVATO®: What You Need to Know
SPRAVATO® is a medication for depression approved in 2019 for patients with treatment-resistant depression (TRD). Like TMS, SPRAVATO® is designed to help patients with depression who’ve already tried at least two courses of treatment with standard antidepressants and psychotherapy.
Also, like treatment with TMS, treatment with SPRAVATO® typically occurs in an outpatient office setting. Under the direct supervision of qualified clinicians, patients administer SPRAVATO® themselves via nasal powder, delivered in a spray bottle exactly like a nasal spray for seasonal allergies.
However, unlike treatment with TMS, the side effects of SPRAVATO® can include dizziness, drowsiness, and/or sedation. Patients remain under observation by clinical staff for at least two hours after self-administering SPRAVATO®. Because of these potential side effects, treatment centers require patients in treatment SPRAVATO® to arrange transportation to and from treatment sessions.
More details on SPRAVATO® treatment:
- Patients typically start with two sessions a week for a month
- Next, they transition to one session a week for a month
- Then they move to sessions every other week
- Total duration of treatment depends on patient progress and clinician input
To learn more about SPRAVATO®, please read our SPRAVATO® treatment page:
SPRAVATO® Treatment at Crownview Psychiatric Institute
Now we’ll discuss the primary symptoms of depression, review the current prevalence rates of depression in the U.S., and end with tips on how to get through the day when managing major depressive disorder.
The Symptoms of Major Depressive Disorder
The most common symptoms of depression include:
- Constant feelings of sadness
- Persistent feelings of hopelessness/pessimism
- Irritability/anger
- Persistent sense of guilt/feeling worthless
- Decreased interest in favorite activities/hobbies
- Withdrawal from family
- Withdrawal from social contact
- Decreased motivation
- Persistent fatigue
- Agitation/restlessness
- Problems with memory/concentration
- Problems making decisions
- Altered/poor sleeping and eating habits
- Suicidal ideation
It’s important to remember we all experience virtually everything on this list at some point or another. What makes these symptoms of clinical depression is their frequency, duration, and severity. People who experience any of the symptoms above every day – and they disrupt typical daily activity – would benefit from a full psychiatric evaluation delivered by a mental health professional.
If you do experience the symptoms above, you’re not alone. Data from the 2023 National Survey on Drug Use and Health (2022 NSDUH) shows millions of people in the use experience the symptoms of MDD every year. In the data below, MDE is a metric that indicates the presence of major depressive disorder (MDD).
Depression Among Adults in 2023
Major Depressive Episode (MDE):
- Adults (18+): 8.5% (21.8 million) total
- 10.4% (13.6 million) among females
- 6.3% (7.9 million) among males
- 66.7% received treatment
MDE With Severe Impairment:
- Adults (18+): 5.9% (15.2 million) total
- 7.4% (9.7 million) among females
- 4.4% (5.5 million) among males
- 70.1% received treatment
What this data leaves out is the number of people with TRD, and the number of people with MDD or TRD who’ve tried treatment in the past, but discontinued treatment because of unsatisfactory results. That’s why the information we share below is important. Whether a patient with MDD has TRD or not, or whether they have MDD/TRD and are in treatment, they need practical tips to help them get through the day, in addition to the medication or therapeutic techniques they receive and/or their weekly therapy sessions.
What this data leaves out is the number of people with TRD, and the number of people with MDD or TRD who’ve tried treatment in the past, but discontinued treatment because of unsatisfactory results. That’s why the information we share below is important. Whether a patient with MDD has TRD or not, or whether they have MDD/TRD and are in treatment, they need practical tips to help them get through the day, in addition to the medication or therapeutic techniques they receive and/or their weekly therapy sessions.
To read our top five tips for managing depression on a daily basis, please read this article:
How to Get Through the Day with MDD: Our Top Five Tips
Gianna Melendez
Jodie Dahl, CpHT