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Major Depressive Episodes are More Common than Previously Believed

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Major depression is a serious, often chronic mental health issue that may come and go throughout a person’s entire life. It causes a persistent feeling of sadness and loss of interest. It can change how a person feels, thinks, and even behaves. Severe depression – known as major depressive disorder (MDD) – is a potentially debilitating disorder that can significantly degrade the quality of life and increase the risk of suicide. Luckily, there are many treatment pathways to help those with depressive disorder once it has been detected and diagnosed.

Clinically Speaking: What is Depression?

Although most people experience sadness or times of “feeling blue,” major depressive disorder (MDD) is different than a typical bad mood. People with MDD feel depressed most of the time for most days of the week. A major depressive episode (MDE) is defined as a period of two weeks or longer during which a person experiences two or more of the following symptoms:

  • Feelings of intense sadness and hopelessness
  • Fatigue
  • Feeling restless and agitated
  • Feeling sluggish and physically or mentally slow
  • Trouble concentrating or making decisions
  • Weight gain or weight loss
  • Changes in sleeping habits
  • Loss of interest in activities
  • Thoughts of suicide or attempts at suicide

People who have episodes of major depression may also experience periods of persistent but milder depressed mood. But during an MDE, symptoms last for most of the day, nearly every day. They’re usually severe enough to cause noticeable problems in everyday activities. A major depressive episode may occur just once in a person’s life or may return repeatedly.

Depression: Statistics

In 2017, the National Institute of Mental Health (NIH) reported that an estimated 17.3 million adults in the United States had at least one major depressive episode. At that time, the number represented 7.1 percent of all U.S. adults. But a recent study suggests that this number is actually much higher: closer to 30 percent of women and 17 percent of men. The authors attribute some of the differences to “recall error.” Recall error is the tendency of people to forget or misreport their health histories when taking a survey. Think about all those pages you have to fill out every time you see a new doctor. It’s hard to remember all the dates and numbers accurately.

Depression is Under-Reported

Another factor that the researchers found that contributes to falsely low reports of MDEs is that older adults are especially likely to under-report their history of having depressive symptoms. They found that among adults 65 years and older, underreporting for depression was as high as 60 percent. Although this age group often may experience symptoms of minor depression and still report significant depressive symptoms, they may not meet clinical requirements for major depression. This is often due to their own tendency to downplay negative experiences and emotions from when they were younger.

Depression in Children: Problems in Diagnosis

Clinicians can often misdiagnose or misidentify major depressive episodes in children, too. All children will likely experience event-appropriate sadness throughout their life. Early beliefs regarding depression in children and adolescents were that juveniles were unable to experience clinical depression. Consequently, depression in this population was considered to be rare. The numbers of children diagnosed with depression were low. Many individuals never received treatment.

However, we now understand that depression can affect anyone, and can start in early childhood or during the teenage years. In 2018, the Centers for Disease Control and Prevention (CDC) reported that 3.2% of children between the ages of 2 and 17 were diagnosed with depression. However, this number may not accurately reflect the actual number of children who are clinically depressed. This is mainly because parents may not recognize the symptoms and seek treatment. Young children (<13) often display complaints like headaches and stomachaches, agitation, and separation anxiety. Adolescents tend to display more sleep and appetite disturbance. Parents and professionals alike often misidentify these complaints as growing pains or typical moody adolescence and ignore them.

What We Can Do

Overall, the study shows that mental health programs that screen for, prevent, and treat depression could benefit a much larger segment of the population than previously thought. The lead author compares the situation to other chronic health conditions, like heart disease:

“If you think about chronic health conditions like heart disease, we do a lot to identify people who might be at risk for additional health events like heart attacks because that group would benefit from maintenance treatment and clinical monitoring. We don’t do such a great job when it comes to mental health conditions. So, if we’re able to assess how many people actually have histories of depression, that also tells us that more people are at risk of experiencing more depressive episodes.”

While there is no way to prevent major depression, therapy, and certain medications can reduce symptoms and help prevent them from returning. Because treatment is critical to alleviating the burden of depressive disorder and MDEs, early detection and diagnosis are essential. However, we may, unfortunately, be missing opportunities to help a significant number of people who experience major depressive episodes. Many people with histories of depression either don’t have access to treatment or support. Or they choose not to seek help due to the social stigma surrounding depression. Increasing acceptance, recognition, and reporting of major depressive disorder and major depressive episodes is a key step in getting help to those who need it.

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