What Is a Major Depressive Episode?

Major depression is a serious mental illness. It is classified as a mood disorder, which means that it is characterized by negative patterns in thoughts and emotions that don’t line up with a person’s actual circumstances. It is also a chronic mental illness. This means it is not curable and that it can come and go, sometimes for a person’s entire life. Someone diagnosed with depression may feel fine for a long period of time and then have symptoms. The period during which someone experiences the symptoms is called a depressive episode.

Most people with major depression live with it as a chronic illness. Episodes come and go, although they may be made less severe and less frequent with good treatment. In some cases, though, a person may experience a singular episode of depression, just once in a lifetime. Often these episodes of depression are triggered by a situational event: a death in the family, the loss of a job or relationship, or some kind of trauma, like a physical assault. This single depressive episode may be just as serious as those experienced by someone with recurrent major depression, with all the same symptoms and persistence.

The diagnostic criteria for major depression include nine possible symptoms. To be diagnosed, a person must experience at least five of these symptoms and significant impairment as a result of those symptoms. The symptoms must last for at least two weeks. This is a depressive episode. The nine possible symptoms of major depressive episodes are:

• Depressed mood. A feeling of depression, sadness, and hopelessness that is intense and persistent. This may seem more like irritability in children, teens, and men.
• Loss of interest. A significant loss of interest or pleasure in doing normal activities, including daily activities like chores but also hobbies, work, or school.
• Weight changes. Significant loss of weight or weight gain that is not intentional but is triggered by overeating or loss of appetite.
• Sleep changes. Either excessive sleep or insomnia and difficulty sleeping.
• Agitation or retardation. Agitated and restless expression or slowed down affect that is notable to anyone observing.
• Fatigue. Fatigue and loss of energy that is more than normal and can’t be explained simply by lack of sleep or low quality sleep.
• Excessive guilt. Feelings of deep guilt and shame, a feeling of being worthless.
• Impaired thinking. Difficulty concentrating, making decisions, and focusing on anything, even just watching television.
• Suicidal thoughts. Thoughts of death, suicide, and suicidal planning or suicidal attempts.

A depressive episode lasts at least two weeks, and the symptoms of depression are persistent and occur nearly every day for the duration of the episode. They cannot be explained by another medical condition or by substance abuse. There can be some variation in symptoms by individuals and by certain populations. For instance, men are more likely to express anger and irritability and to make risky choices, while women are more likely to feel sad, guilty, and ashamed.

Bipolar disorder is a different type of mood disorder that is characterized by a cycle of depressive episodes and manic episodes. Manic episodes are essentially the opposite of depression, during which a person feels euphoric, energized, and sleeps little and acts recklessly. The depressive episodes that precede or follow manic episodes can feel a lot like an episode of major depression.

Certain symptoms are more common in episodes of bipolar depression than major depression. Someone going through bipolar depression is more likely to feel irritable and guilty, to be restless and agitated, and to have unpredictable mood swings. Bipolar depression is also more likely to cause psychotic symptoms, such as hallucinations, delusions, and paranoia. Another important difference is that antidepressants may not help treat someone with bipolar disorder. In fact, these drugs may make periods of mania more likely. Instead, bipolar disorder is more often treated with mood stabilizing drugs.

It is very common for a person with depression to be unaware that they are entering a depressive episode. Recognizing the signs in oneself is challenging, but it helps to be able to see an episode coming. By being more aware of the return of depression, an individual can better deal with it: asking for help, reaching out to socialize, taking self-care measures, practicing stress-relief strategies, or making extra therapy appointments. Being aware of a coming depressive episode isn’t easy, but there are practices that can help:

• Journal or chart mood and symptoms. Self-awareness takes practice, so it can be useful to keep a record of moods, feelings, reactions, and other circumstances on a daily or semi-daily basis. This kind of record, whether it is in a journal or a chart or calendar, can help a patient find patterns and build awareness of signs of an impending depressive episode.
• Find and recognize triggers. It also helps to determine any factors that trigger or worsen depression symptoms and episodes. These may be found in the patterns in a journal, or they may be more obvious, like a fight with a spouse or partner. When a patient knows the triggers, it is easier to recognize when an episode is forthcoming.
• Ask friends and family to speak up. Because it is hard to be self-aware, it is important to involve close family and friends. These people are often the ones most likely to recognize the beginning of an episode, and they can tell the person that all the signs are there.
• Communicate with therapists or doctors. Doctors and therapists treating someone with depression are also useful in helping determine when an episode of depression is imminent. It is important for patients to communicate fully with their therapists and doctors and to trust that these professionals will help them learn to recognize the beginning of a depressive episode.

At the onset of a major depressive episode, it can feel hopeless, as if there is nothing that can be done. An individual facing this may feel like there is no point in trying to do anything to lessen the severity of the episode or turn it around. There are things that can be done, though. It is important to take these steps to cope with a depressive episode, because they can limit the symptoms and even reduce the duration of the episode:

• Schedule a therapy session. Just like a car, sometimes people need tune-ups. When there are signs of depression, it is important to talk to a professional and to schedule additional therapy sessions or to go back to regular sessions after a break.
• Keep up with medications. Antidepressants should never be discontinued without a doctor’s guidance, as quick cessation can cause harmful withdrawal. Patients should always be consistent with medications, even as they start to feel better.
• Reach out for support. During an episode of major depression, reaching out may be the last thing a person wants to do, but it does help. More time spent with those who are supportive is beneficial.
• Practice self-care. Extra attention to self-care is so important as a depressive episode begins. This may include attending therapy or support groups, avoiding alcohol, practicing meditation or yoga, actively challenging negative thoughts, or simply doing activities that are relaxing or enjoyable.
• Practice good health habits. Self-care should always include good physical health habits, but these are especially important during a depressive episode. Eat a healthy diet, try to get enough sleep, get plenty of exercise, and avoid drugs and alcohol.
• Get outside. Sunlight and being outside in nature are proven mood boosters. While this won’t cure depression, it can help a little. A quick walk in a park can make a big difference, especially if taken with a good friend or someone willing to listen.

Major depressive episodes are most often part of a recurring, chronic mental illness. Some people may only ever experience one episode in their lives, but most people have multiple episodes. Understanding what it feels like to go through one of these episodes, as well as what may trigger one, is important. Being more aware allows an individual to take steps to check back in with a therapist, seek out support from family, and to engage in proper self-care to mitigate the severity of an episode.

Depression Treatment at Bridges