What is the Course of Major Depressive Disorder?
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- Опубліковано 20 сер 2024
- This video describes the course of major depressive disorder over the lifetime. When we talk about major depressive disorder we're really talking about an episodic or cyclical mental disorder. It's not merely excessive sadness or some sort of state that's maintained that's relatively stable over time, but rather the illness cycles. One of the characteristics of major depressive disorder is the major depressive episode. We can think of major depressive disorder as being made up of one or more major depressive episodes. With major depressive disorder, we'd expect to see either depressed mood or a loss of interest or pleasure. At least one of those two symptoms must be present and we'd also expect to see a number of other symptoms including potentially a difficulty with sleep, difficulty concentrating, a change in appetite, feelings of worthlessness, feelings of inappropriate guilt, fatigue, suicidal ideation, and suicidal behavior. If the full criteria for a major depressive episode are met, then an individual would have major depressive disorder. The 12-month prevalence for MDD is 7% and the onset can be at any age. The course of MDD is highly variable. We see a lot of different types of presentations. In order to understand the course, it's important to understand the idea of remission. Remission is a two-month period where there are no symptoms of major depressive disorder or one or two symptoms, but the expression of those symptoms is mild. some individuals will develop a major depressive episode and they'll never have a two-month period when there are no symptoms or a few symptoms. We refer to this as “chronicity.” Major depressive disorder can be chronic and we also see presentations where there are long periods of remission, but then the major depressive episodes come back. We refer to this as “recurrence.” Some individuals will develop major depressive disorder by having a major depressive episode, but they'll only have one episode and they'll never be a recurrence. That episode will end and the remission will just stay in place. Most the time, however, we do see recurrence. If an individual has a single major depressive episode there's a 60% chance that they'll go on to have a second major depressive episode. If they have two major depressive episodes, there's a 70% chance that they'll have three. If they have three, there's a 90^ chance that they'll have a fourth. We also have data available on the likelihood of a recurrence after a major depressive episode. After an MDD ends there's a 40% chance of a recurrence within two years, a 60% chance of a recurrence within five years, and an 85% chance of recurrence within 15 years. The average length of a major depressive episode is about four months, if that MDE is untreated.
When we look at the course overall in terms of major depressive disorder we see that over time major depressive disorder doesn't really change that much. The likelihood of suicide attempts tends to drop and middle-life and later-life, but the likelihood of a completed suicide does not change as people grow older. We also know that a number of people who were initially diagnosed with MDD will eventually be diagnosed with bipolar disorder. Roughly 20% of individuals with MDD will eventually be diagnosed with bipolar disorder, and the risk of that conversion from MDD to bipolar disorder increases with early onset MDD.
This was a really depressing video. I knew all of this already but it still scares me so much that I'll most likely have many more depressive episodes in my life (I'm only 24 yo and have already had about three depressive episodes).
Dr. Grande explained how MDD is a cyclical type of mental disorder, not just an extreme state of sadness. This was a great way to explain this because I feel that the title of the disorder can be misleading. I was unaware that 60% of individuals will likely experience a second major depressive episode after the first episode, and 70% will likely have a third MDE after experiencing the second episode, or 90% of clients will have a fourth MDE.
I understand that staying in treatment even between the MDEs is very important for a person with MDD. It makes me think about the difficulties they might encounter with length of treatment in terms of insurance
If Mdd was a movie it would be The Exorcist. I have it. They nailed it with that film.
DEFINITE YES agreeing with keeping up therapy and interest in psychology and being engaged when feeling better is the way to go. It's a lot of why I'm watching Dr Grande's videos- I intuitively understand at this point it's best to stay engaged. I had a therapist for a very long time, but she really let me down and I had to end our relationship. And then! My psychiatrist retired! Geez! So I've got double whammy and while I figure this all out, I watch videos and read articles and talk about stuff with people. .. Yeah.
It seems to be important for someone with MDD to be in therapy for life.
I never knew that MDD was episodic. I use to think that when people felt better they were no longer depressed. I understand that symptoms may still persist despite improvement because MDD is a lifelong problem it seems like.
That is precisely how my episodes have been. First episode at 20 years lasting a year, second episode at age 43, lasting mostly 8 years with ups and downs. Then again at 54 years for 2 years, but it was linked with PTSD and after that went into remission after 5 years, I had a minor relapse at 61 years, linked to SAD. I am now recovering from that.
With the stated enduring nature of MDD and its recurrence rates of: 40% within 2 years, 60% within 5 years, and 85% in 15 years, it makes me wonder why people don't remain in therapy for the long haul.
Usually due to expense of treatment in my experience.
I seem to cycle between depressed and hopeless with extremely powerful mood swings between anger and sadness. My father was diagnosed with bipolar disorder and I often find myself wishing that there was a component of mania that would develop. I dont know how people live like this for extended periods of time.
I can confirm that I still have episodes and even after episodes, I will still have some symptoms, but to a lesser degree
BloomingFireHeart I have been an episode for 2 1/2 months now. can you please tell me how long it took you to come out of an episode?
Thank you so much for this information. I'm battling this right now for the 3rd time in my life and am glad to know more about the statistics. Thank you.
4CornersGal SST I suggest the book The Mindful Way Through Depression by Jon Kabat-Zen, John Teasdale,Zindel Segal, and Mark Williams. I have given copies to several people who have depression. Please get copy for yourself.
You're welcome!
Hearing the statistics in this video were very shocking to me with the recurrence rate. MDD is a very interesting topic, this video was very helpful in understanding it further.
The statistics definitely helped me to see and understand how MDD is a cyclical disorder with certain patterns.
As someone with MDD, 2 months without episodes seems like an eternity.
I’ve been diagnosed with MDD bipolar with psychotic features schizoaffective every time I see a different psychiatrist they give me a different diagnosis I think the most accurate one is major depression disorder but I don’t seem to have any breaks in my episodes so I’d like to learn more about that , I rarely leave the house due to extreme social anxiety I’ve made doctors appointments and cancel or reschedule them way to Often. My home health care attendant is a great help, and makes me keep my hygiene habits more than I would have if not for her, ( sad I know) . Thank y’all for posting this and other videos like it 🤪👨💻
Very informative! It is also surprising that 20% of individuals with MDD will eventually be diagnosed with bipolar disorder.
Interesting stuff. It's always good to see how professionals view and categorize these things. I was diagnosed with dysthymia which presented from early childhood. I also have chronic major depressive episodes as well. This is sometimes known as double depression. I have constant thoughts of suicide, but it's just something I've learned to deal with.
Unfortunately, this has stopped me from being able to seek professional help. Professionals in my opinion do not know how to deal with suicidal ideation. On the two recent occasions where I had a remission from my major depression, professionals violated my boundaries and pushed me over the edge in to the most suicidal state I have ever been in. I tried my hardest to kill myself, but I just couldn't do it when it came down to it. No thanks to them.
The first that pushed me over the edge was a CBT therapist. The second was my doctor. I've also been abused by every single professional person I have come in to contact with to help me with my problems. I realise this sounds paranoid. But I don't have a persecution complex. It's just the way it has worked out for me. The abuse has been on a spectrum, but I've never been physically or sexually assaulted by them. It's usually in the form of verbal abuse and mind-fucking aka gaslighting.
So I don't deal with professionals any more. They are above the law and are untouchable. And they know this. There's a real culture of abuse by these people. When I do a bit of therapy for other damaged people (I always let everyone know I'm not a professional and I'm just an idiot), very often it comes down to the same two things: first, early childhood trauma, secondly, therapist abuse in one form or another.
It took me a long time to get help. To get strong enough to do it, but every single time I was totally crushed by the experience, to the point of actual suicide. Something is wrong there.
I may be a bit messed up, but I have very good insight. I am not violent or threatening. I'm not a danger to others. I've just never met anyone that was competent. This is not a unique case here in the UK. It's pretty much accepted that there is no professional help unless you pay good money for it.
But it's not all bad. The consequences of this abuse by so called professionals in the NHS led me to seek help and find self-help groups here on youtube, of all places. I also happen to have a couple of friends who are professional psychologists, as well as friends who take a deep interest in psychology and are extremely competent (even though they are laymen).
There are some great resources on youtube when you get through all the charlatans and self-promoters. And the anonymous nature of the medium also helps for people to speak more freely. You can have some great conversations with people sometimes, where you help them or they help you - such as it should be in any kind of therapeutic community where people are making a real effort to heal.
There really is a dearth of professional representation of the professional psych community here on youtube. But I'm glad to have found a couple. Dr. Grande being one of the few of my latest discoveries. I think it's important to touch base and keep score with those who do this professionally for a living. Because this stuff is very deep and complex. And even though we laymen might think we know a lot, it doesn't compare to the knowledge attained by those that have done this far longer and more intently than we ever would wish to.
It's been noted on more than one occasion that rapport is 90 percent of any therapeutic relationship. Sometimes (most the time) you just have to find someone that resonates with you. They needn't even be a professional as such. As long as they do not misrepresent themselves. Some people do this as a passion or/and to help to sort out their own problems. I have no problem with that as long as the cards are on the table.
That isn't to say that there is no place left for the professional therapists, because there is. But good luck finding one. Good luck being able to afford one. Good luck getting one you can have a rapport with.
I've had terrible life-threatening experiences with all the professionals I have come in to contact with, so that is why I have drawn a line in the sand with them now. But that isn't to say that they are all bad. I believe in psychoanalysis and psychiatry as a profession, even though it isn't strictly a hard science. I think they do remarkably well in an arena where hard data is difficult to come by. I don't want to seem as if I am dismissive of it.
Anyway, ramble over. I like Dr. Grande. I feel a rapport with him. I don't feel like he is trying to sell me something. I feel as if has a great passion for this and is trying to help people for all the right reasons. If I had the money, I would happily arrange a few sessions with him just to see what came out of it all.
Please remember that I am in the UK, and we get pushed all kinds of crap from the NHS. The NHS is not in a fit state when it comes to mental health issues. Something to bear in mind. I wouldn't say I am a therapist (because I am not), but I do point people in the right direction with regard to resources. I do this for all types of people from all over the world, sometimes even veterans.
Dr. Grande has been added to my 'approved resources' list, FWIW. That's a pretty short list to be fair. More like a 'Top 10', because when you are sharing a reading list with someone, you don't want to overload them. Unlike what I have done with anyone who managed to read this far with my ramblings. :-)
I would be interested to hear the rate of chronicity with MDD. Though unwanted, individuals without remission are more likely to stay in treatment. Also, though the overall suicidal ideation may not change over time, it is reassuring that actual suicide attempts decrease with age.
I thought that major depression disorder was another name for bipolar but its actually manic depression. Thanks Dr. G
It is very interesting how the percentages of chances to develop recurrences occur and that they keep rising as the length of time gets longer.
You described me to a "T" every morning before I get some coffee in me 😬
Thank You
The correlation to bipolar is interesting.
Would you do a video about the relationship between major depression and OCD? I was recently diagnosed with both and they are apparently highly comorbid.
Love the term comorbid. lol I have them both. i keep trying to find an activity i can enjoy. Only read an entire book maybe 5 times.
what are best ways for an MDD patient? specially those who are not motivated for things that should accomplish or lose the motivation very quick? how about hypnotherapy? please let me know
Is it possible to distinguish MDD comorbid with Complex PTSD, from complex PTSD that has depression as one of the major symptoms ?
highly informative, thanks for the video.
Do you agree with prescribing antipsychotics as an adjunct to antidepressants without dx of psychosis or features therof?
I find it ironic that the facts about major depression is major depressing
Great Video! Why is the remission period considered no symptoms for 2 months. Why couldn't it be 1 month or 3 months without symptoms ?
Can this be comorbid with NPD or ASPD?
Yes, MDD can be comorbid with either or both.