Major depressive disorder: clinical features

Major depressive disorder: the use of the term ‘depressed’ is often used out of context with respect to a framework that is necessary in daily clinical practice

The distinction between a transitory state of mind and a genuine depression must be assessed by a specialist.

What are the characteristics of depression?

Depression can manifest itself with both mental and physical symptoms, the main symptom being depression of mood.

The essential characteristic for diagnosing mood depression is that the mood must be low in all aspects of the person’s life, and for almost the entire day, for a period of time of at least two weeks, although not necessarily to the same extent.

The person suffering from depression loses pleasure in the things he or she used to enjoy, manifesting a state that is referred to as anhedonia.

Attempts to bring the person back to his previous state of pleasure or to stimulate him to ‘make it on his own’ are counterproductive and make the situation worse.

The diagnosis of depression is not only based on symptoms of hostility, irritability or anger, but symptoms relating to mood, a negative view of oneself and of the future must also be present.

Depressive experiences differ from individual to individual

During depressive episodes, the reading of reality may appear distorted as depressive thoughts take over from positive thoughts.

The reading of the past is also distorted by the present depressive thoughts, so that a ‘parallel reality’ is reconstructed in which all positive thoughts, feelings of love and joy, and happiness are regarded as not experienced or as falsely experienced, thus reinforcing the depressive symptoms.

The variation of the view of reality makes everything in contrast to this view as unbelievable.

During a depressive episode, intellectual functions such as attention, memory, information processing and decision-making abilities may be impaired.

Cognitive flexibility and executive functioning are also impaired.

The ability to concentrate is also impaired and work difficulties are encountered.

The very common complaint of not remembering anything is an expression of concentration difficulties.

Often patients are focused on brooding and negative thoughts causing a real attention deficit.

Very often cognitive symptoms persist even after the depressive episode has resolved.

The loss of hope and of being without a way out is a common symptom of people suffering from major depression.

This can trigger suicidal thoughts or actions.

Everything that happened before the depressive episode, even if right, becomes wrong.

The entire outside world completely changes its previous status so that everything takes on a worse character than it had.

The pain of major depression is intense, but mental.

People are considered insincere or uninterested in the state of the depressed person.

Feelings of shame also appear because of the behaviour dictated by the depression.

Those suffering from major depression lose interest in their hobbies.

The change is often sudden and is an important sign of the change in a pathological direction that is taking place.

This signal should not be overlooked by the family members of a depressed person.

Feelings of shame, guilt or the feeling of being abandoned are very common phenomena that are described by patients all the time.

These feelings are pervasive in persons suffering from major depression and everything that previously had meaning loses its intrinsic meaning.

Manifestations can be varied: from muteness to sudden, unmotivated anger.

Such manifestations can be a way of showing one’s state of mind, which tends towards general sadness.

Convincing people to look on the bright side or minimising the issue is not helpful and leads to further estrangement.

Talks such as ‘when I am dead’ or wondering how things will be when I am gone are phenomena related to the desire to end one’s life.

Often, thoughts focus on destruction and death and one may come to make rash decisions.

It is useful to seek help for the treatment of major depression as it is a serious mental health problem.


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Kupfer DJ, Frank E, Phillips ML. Disturbo depressivo maggiore: nuove prospettive cliniche, neurobiologiche e di trattamento. Lancet. 2012;379(9820):1045-55.

Pan Z, Park C, Brietzke E, Zuckerman H, Rong C, Mansur RB, Fus D, Subramaniapillai M, Lee Y, McIntyre RS. Compromissione cognitiva nel disturbo depressivo maggiore. CNS Spectr. 2019;24(1):22-29.

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