MAJOR DEPRESSIVE

DISORDER
Term Paper – Jillian Hanna
 Major depression is a mood disorder. The Merriam-Webster dictionary defines it as

having a clinical course involving one or more episodes of serious psychological depression

lasting two or more weeks, each with no intervening episodes of mania. Across age groups,

symptoms accompanying major depression are constant fatigue, changes in appetite,

thoughts/attempts of self-harm or suicide, fluctuation in appetite, loss of interest, thoughts of

guilt and/or hopelessness, and a general feeling of sadness. Children and adolescents, ages 3-18,

may also present as being bored or overly aggressive, and may frequently miss school, abuse

substances, and have frequent, vague physical complaints (DSM V). Each person experiences

depression in a different way, and not all symptoms are prevalent for every person suffering from

depression.

In 2015, the Substance Abuse and Mental Health Services Administration found that

approximately 12.5% of adolescents ranging from ages 12-17 suffered from major depression.

The Anxiety and Depression Association of America states that in younger children, ages 6-12,

there was a 2-3% rate of depression. Research has found that rates of depression vary greatly

with race and ethnicity in the United States. The Nation Institute for Mental Health states that

56.5% of African Americans, 56% of Caribbean people of color, and 38.6% of Caucasian people

experience chronic depression. Note that this is chronic depression – when it comes to instances

of depression that do not continue for years, White Americans report higher statistics. Across the

board, Native Americans/American Indians have among some of the highest rates of mental

illness, suicide and substance abuse in the nation. A factor to consider in the racial and ethnic

disparities that accompany depression is access to healthcare and other resources, level of

education, and income. More cases of non-chronic, major depression are reported in White
Americans, but, perhaps, this is because they have the tools necessary to seek help and be

diagnosed by a professional. Minority groups often do not have this at their fingertips.

The Washington Post noted that is more common in the United States as opposed to other

well-to-do countries, but the Middle East, North African countries, the Netherlands, Eritrea,

Rwanda, Botswana, Gabon, Croatia and Honduras have the highest rates of depression. The rates

of depression in younger children and adolescents in these countries, and in others, are not as

clearly defined due to a lack of diagnoses by professionals, lower rates of report, and low-quality

mental health treatment. Notice that many of these countries are conflict-stricken. High instances

of war and political conflict raise depression rates. Another explanation for the high rates of

depression are unemployment, low incomes and high levels of inequality. Depression in other

countries typically presents in similar ways as it does in the United States.

Like many others, this disorder can occur at any time in one’s life. But the average age of

onset in the United States, according to Johns Hopkins Medical School, is the mid-20s

Truthfully, the onset of depression can be either acute or insidious – it is very subjective. If a

child or adolescent with a genetic predisposition for the illness were to face a traumatic event,

such as the loss of a parent, the onset of depression would very likely be acute. If an adolescent

sustained a leg injury and needed to take a large leave of absence from the sport that they love,

the onset might be insidious as they discontinue their passion for some time. Women are twice as

likely as men to be diagnosed with major depressive disorder. But, ironically, men are four times

more likely to commit suicide than are women. In fact, Johns Hopkins Medical School found

that the highest rates of suicide in the United States are in Caucasian men over the age of 85.

It is a known fact that depression is caused by a combination of biological, genetic and

environmental features. At the base, we know that depressed individuals have a decreased
amount of the neurotransmitter, serotonin. The hippocampus of depressed individuals is also

smaller as compared to non-depressed individuals, and this is the area of the brain that controls

memory and emotion. When medications such as Selective-Seratonin Reuptake Inhibitors

(SSRIs) are administered, the growth of new neurons in the hippocampus is encouraged (all

same article, medical daily.) We have the science down, but knowing exactly how much of

depression is science-based and how much is environmental is still in the works. Per Stanford’s

department of medicine, individuals with a parent or sibling with depression have a 2 to 3 times

greater risk of developing the illness. Identical twins, who share 100% of their genetic make-up,

have a 60%-80% chance of developing a mood disorder if their twin has it. In younger children,

depression has much more of an environmental basis. The American Academy of Child and

Adolescent Psychiatry states that children who experience loss, have anxiety or learning

disorders, or are under major stress are at a higher risk for depression. Typical stressors are the

divorce of parents, living with a depressed parent, neglect, abuse, physical illness, etc. Since

depression in children often presents as insidious, nearly 70% of children with the illness go

without diagnoses or treatment. Children may simply appear bored, cranky or not personable to

other children.

There are different forms of depression, each with a different timeline. Initial diagnoses

of major depressive disorder occurs after at least two weeks of persistent and life-influencing

depressive symptoms. The DSM-V states that major depression lasts at least two weeks, but has

an average duration of about 20 weeks. Once major depression lasts much longer, patients will

often be diagnosed with chronic depression. That being said, major depression is typically not a

chronic illness.

If the treatment of major depression works well, patients will probably not see symptoms
in their older years. That being said, patients on medication have a larger hill to climb. Many

medications, such as Paxil can cause withdrawal or discontinuation symptoms. These symptoms

can mimic regular symptoms of depression, or can cause more physical symptoms such as

nausea, vomiting, and sweating. The Harvard Medicine Department states that when patients

want to halt treatment via medications, they must ween off them, allowing approximately two to

six weeks in between each decrease in dosage. It is also recommended that patients continue

therapy even after symptoms are gone.

Currently, the most effective treatment for major depressive disorder in younger children

is a combination of cognitive-behavioral therapy (CBT) and family therapy. Medication is not

typically safe on younger children, and is used sparsely. For adolescents, a combination of

medication and therapy showed the highest levels of improvement. CBT focuses on the treatment

of cognitive, behavioral and physiological causes of depression. It focuses on correcting

erroneous, negative ways of thinking about oneself. It also aims to positively shift social

behaviors, and promotes breathing and meditation techniques. Family therapy is useful in

younger children. This is essentially getting the parents involved, teaching them ways to aid their

child, and breaking down parental behaviors that increase stress on the child. A major tactic that

could be employed in the therapy of younger children and adolescents is art therapy – mainly,

drama therapy. The North American Association of Drama Therapy defines it as the intentional

use of drama and/or theater processes to achieve therapeutic goals. In his book, Acting for Real,

Renee Emunah, one of the leaders of drama therapy, states that processes such as puppetry,

storytelling, improvisation and role taking are used in the field. Such processes allow children to

unknowingly express internal conflicts, practice for real-life events, develop a sense of identity,

and release pent up emotions.

 There are a plethora of forms of depression. While major depressive disorder has a time

cap about a year or two, other forms come and go according to the time of year, or last much

longer. Seasonal Affective Disorder, or SAD, often begins in the autumn and persists throughout

the winter for many patients. It is not as common in the warmer seasons. In the fall and winter,

patients often exhibit hypersensitivity in social situations, a heavy feeling in the arms and legs,

and other symptoms not commonly found in major depressive disorder.

Dysthimia is another form of depression – also known as persistent depressive disorder.

This is going back to the idea of chronic depression. Dysthymia can persist for years. There is

also bipolar disorder, which is formerly known as manic-depressive disorder. This is categorized

by episodes of mania – extreme highs, and depression – extreme lows. The different forms of

depression are endless.

 References

A stunning map of depression rates around the world. (n.d.). Retrieved October 31, 2016, from
https://www.washingtonpost.com/news/worldviews/wp/2013/11/07/a-stunning-map-of-
depression-rates-around-the-world/

Anxiety and Depression in Children. (n.d.). Retrieved October 30, 2016, from
https://www.adaa.org/living-with-anxiety/children/anxiety-and-depression

Englisch-Deutsch Übersetzung für: Depressive. (n.d.). Retrieved October 31, 2016, from
https://dict.leo.org/englisch-deutsch/depressive.html

Major Depression and Genetics. (n.d.). Retrieved October 30, 2016, from
http://depressiongenetics.stanford.edu/mddandgenes.html

Mental Health Disorder Statistics. (n.d.). Retrieved October 30, 2016, from
http://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/mental_healt
h_disorder_statistics_85,P00753/

NIMH » African Americans, Black Caribbeans, and Whites Differ in Depression Risk,
Treatment. (n.d.). Retrieved October 31, 2016, from https://www.nimh.nih.gov/news/science-
news/2007/african-americans-black-caribbeans-and-whites-differ-in-depression-risk-
treatment.shtml

NIMH » Major Depression Among Adolescents. (n.d.). Retrieved October 30, 2016, from
https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-
adolescents.shtml

Olson, S., & Samantha Olson Samantha Olson is a writer-reader-runner cliché with a passion for
nutrition and health management. The Science Of Depression: The Biology Behind A Darker
Mind [VIDEO]. October 30, 2016, from http://www.medicaldaily.com/science-depression-
biology-behind-darker-mind-299078

Publications, H. H. (n.d.). Managing chronic depression - Harvard Health. Retrieved October 30,
2016, from http://www.health.harvard.edu/newsletter_article/managing-chronic-depression

What is Drama Therapy? (n.d.). Retrieved October 30, 2016, from http://www.nadta.org/what-is-
drama-therapy.html