Home Psychology Major Depressive Disorder (MDD) Is Not a Choice, It’s A Form of...

Major Depressive Disorder (MDD) Is Not a Choice, It’s A Form of Brain Damage

Major Depressive Disorder

Most people can feel anxious or depressed at times. This feeling can be caused by various situations, such as getting fired, losing a loved one, going through a divorce, you name it. Such difficult situations can lead you to feel scared, sad, lonely, nervous, or anxious.

These feelings are a normal response to such stressful situations, and while you may feel depressed because of those situations, this is something that will eventually pass and you will be able to function normally.

However, there are those people who feel like this all the time, for no particular reason. This feeling disables them from functioning normally. It’s very difficult for these people to carry on with a normal life, as the feeling is just overwhelming.

When a person feels discouraged, hopeless, sad, unmotivated, or disinterested in life in general for more than two weeks, and when those feelings start to interfere with the daily activities – it’s likely that this person is having a major depressive episode.

This disorder is called Major Depressive Disorder (MDD), and according to the Anxiety and Depression Association of America, it’s the leading cause of disability in the United States. It affects people of all ages, including young children and teens.

Major Depressive Disorder Causes

Depression is a wide spectrum shifting between grey and dark phases. It can occur or get triggered whenever a person is undergoing a transition in their life, some kind of crisis, loss or trauma.

Some people are naturally melancholic and therefore more prone to depression, while others have a family history.

Depression is hard to pin down and even harder to cure, as things get further complicated when the person is dealing with clinical depression. So, what are the possible reasons for major depressive disorder? Can knowing what causes it, help in the treatment of the condition?

Yes and no. This depends entirely on the factors included in the unique situation of the patient.

Below are the major factors that contribute to MDD:

Biological factors

A decreased activity in the left frontal lobe during depression and a rise in activity following stabilization of mood suggests a  large discrepancy between over-active and under-active areas of the brain, which indicates that MDD occurs as result of biological causes.

Hormonal imbalance

The hippocampus, a small part of the brain in charge of storing long-term memories, is smaller in some people with a major depressive disorder. A smaller hippocampus has fewer serotonin receptors.

Now, the release of serotonin, norepinephrine and dopamine in the brain influence and control our mood. The disbalance of these hormones influences a person’s mood and adds up to a feeling of numbness and absence of joy and happiness in the person, which can lead to depression and over time, to major depressive disorder.

Childhood trauma

All our adult problems and challenges are rooted in our childhoods. Sexual, physical, or psychological abuse, illness, isolation, neglect, or a traumatic event can lead to major depressive disorder later on in adulthood as the result of a traumatic childhood experience.

Chronic illness

Severe or autoimmune illnesses, disorders, and health  conditions can push a person to the abyss of clinical depression. Just like the chronic condition of the person, the depression itself becomes chronic as well.

This, however, can be often reversed with a lifestyle change, regular exercise, and channeled discipline when following a dietary regime.

Major life events

Losing a loved one, having a stressful job, financial crisis, or major life changes, can also lead to depression. If the person does not learn how to channel, manage or cope with stressful situations, that depression can again turn into a major depressive disorder with a looming feeling of doom and misery.

The patient may lose will and energy for life if they don’t learn how to deal with major life changes or if they don’t talk about them with friends and family.


Many different genes when combined, can contribute to a higher MDD risk, rather than one single, isolated gene, which is why people with a family history of depression have a higher risk for MDD. There really isn’t a depression gene or one defective gene that boosts the MDD risk.

As Psychiatry and Behavioral Sciences expert Douglas F. Levinson puts it: No one simply “inherits” depression from their mother or father.  Each person inherits a unique combination of genes from their mother and father, and certain combinations can predispose to a particular illness.

Substance abuse

Anticholinergic drugs for intestines’ slowing down,  beta-blockers for the treatment of high blood pressure, benzodiazepines used to fight insomnia and anxiety, corticosteroids for the treatment of skin conditions or lupus, Parkinson’s drugs, stimulants, drugs that reinforce hormonal balance, anticonvulsants for seizure treatment, proton pump inhibitors and H2 blockers for GERD and gastritis treatment, cholesterol-lowering drugs, have been linked to depression and major depressive disorder.

Major Depressive Disorder Symptoms

Depressive Disorder

MDD is diagnosed when at least 5 of these symptoms persist for a two-week period:

  • Persistently feeling empty or sad;
  • Feeling hopeless, pessimistic;
  • Feeling worthless, helpless, or feeling guilt;
  • Losing interest or pleasure in hobbies and activities, including sex;
  • Lacking energy; feeling fatigued or “slowed down”;
  • Having a hard time concentrating, making decisions, remembering;
  • Experiencing insomnia, waking up early in the morning, or oversleeping;
  • Losing appetite and weight, or overeating and gaining weight;
  • Suicidal thoughts, or attempts to commit suicide;
  • Feeling restless and irritable;
  • Persistent physical symptoms that don’t respond to treatment, such as digestive disorders, headaches, or pain for which no other cause can be established.

Major Depressive Disorder Criteria

In addition to the above MDD symptoms, there are other markers that point out to major depressive disorder and they should not be disregarded. 

Criteria For Major Depressive Disorder Include:

  • Depressive episodes/Low mood that lasts two or more weeks
  • Episodes that cause distress and anxiety or impact and disrupt the person’s social and work life.
  • Not meeting the criteria for another mental disorder such as mania, bipolar disorder, or schizophrenia

Major Depressive Disorder With Psychotic Features

Psychotic major depression is a mental disorder wherein the person has depression along with a loss of touch with reality (psychosis).

This condition is characterized by having delusions, which are false ideas and beliefs about the person’s environment and the self, and hallucinations wherein the person is hearing or seeing things that to not exist.

Scientists believe that people with a family history of depression are more likely to develop MDD with psychotic features in their life.

Major Depressive Disorder In Children

Depressive Disorder In Children

Unfortunately, children are not immune to depressive episodes or major depressive disorder. In fact, research indicates that the onset of depression now appears in earlier stages of life than it used in past times.

If your child is displaying the following symptoms:

  • decreased concentration or energy
  • academic decline
  • troubled sleep (either insomnia or hypersomnia)
  • lethargy
  • loss of appetite or weight changes
  • an increased sense of guilt or low self-esteem

Or if you notice that they persistently feel down, sad, or angry, or have even tried to hurt themselves, an MDD might be lurking around.

Given your family history, your child’s age, and the extent of their symptoms, treatment may vary from therapy (cognitive-behavioral or interpersonal therapy) to antidepressant medications that will reverse your child’s condition.

If your child is diagnosed with major depressive disorder, your role as a parent is vital. Parents’ support and reassurance that everything is going to be well is an inextricable part of your child’s well-being.

School can be a major trigger for depressive episodes, so to prevent it from happening, talking to the child’s school is also advisable.

Treatment For Major Depressive Disorder

Treatment for MDD is never straightforward and simple. Patients will often have to try different approaches at once or even revisit them years after they are feeling better so MDD does not come back again.

It’s a complex and strenuous process, but it CAN be reversed.

MDD can be reversed through following a dietary regime i.e., eating healthy food, exercising, and getting rid of bad habits such as smoking, alcohol or drug abuse.

Eating well and being physically active will help you take control of your sleep because good sleep also plays a huge role in climbing the mountain.

For proper day-to-day function, we need 7-9 hours of sleep every day and healthy habits and routines promote sleep quality.

It is worth mentioning that a change of lifestyle functions as supplementary, and isn’t the only aspect of the treatment process, i.e., major depressive disorder therapy is used.

The cognitive-behavioral therapy (a type of psychotherapy wherein negative patterns of thought about the self and the surroundings are altered and redefined to prevent mood disorders and unwanted patterns of behavior) and interpersonal therapy (a type of psychotherapy that deals with the past and present social roles and interpersonal interactions of the patient) are used to fight MDD.

Medication For Major Depressive Disorder

In cases when major depressive disorder therapy is not enough, more invasive treatment such as MDD medications are used to aid the patient’s condition.

Patients diagnosed with major depressive episodes usually are prescribed:

  • Selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine, citalopram, paroxetine, sertraline, escitalopram).
  • Serotonin-norepinephrine reuptake inhibitors (venlafaxine, duloxetine, desvenlafaxine).
  • Tricyclic antidepressants (amitriptyline, doxepin, imipramine, clomipramine, trimipramine).
  • Norepinephrine and dopamine reuptake inhibitors (bupropion).
  • Monoamine oxidase inhibitors (isocarboxazid, phenelzine, selegiline, tranylcypromine).

NOTE: These medicaments are doctor-prescribed, so patients should not be taking them without prior consultation with their doctor/psychiatrist.

Is Major Depressive Disorder A Disability?

Disability can be mental or physical and in the case of MDD, we are talking about mental disability.

However, most people will rush to make assumptions just because they’ve been sad or down for a few days. That’s normal – we’ve all felt depressed sometime in our life, but when those symptoms accelerate and linger for longer periods of time, it means a more serious condition is threatening that person’s well-being.

Recurring depression is a common occurrence. However, when the patient is struggling with a treatment-resistant MDD that’s crippling all their aspects in life, it means the major depressive disorder has turned into a disability. 

The Brain And MDD

In a study conducted by the ENIGMA MDD Working Group, it has been established that MDD affects the brain by causing physiological damage to it.

The study examined an unprecedented number of almost 9,000 people, 7,199 of which were healthy, while 1728 were diagnosed MDD. The research team compared the MRI brain scans of the participants and found a pattern that showed a striking difference.

It turns out that the true cause of MDD lies in the size of the hippocampus, which was discovered to be smaller in those suffering from MDD. Although this theory has existed as such, no research sample was large enough to establish it as fact.

Now, the ENIGMA MDD Work Group has finally gathered a sample large enough to prove that MDD indeed comes in correlation with the size of the hippocampus. The patients diagnosed with MDD showed a shrinkage in the hippocampal volume by up to 1,24%.

The hippocampus is in charge of the creation of new memories, the processing of long-term memories, emotional responses, and spatial navigation. It’s located in the medial temporal lobe, or the center of the lower middle part of the brain.

The fact that it’s reduced in size in patients diagnosed with MDD explains as to why these people are experiencing depression in such way.

As professor Ian Hickie, the co-author of the study, explains, memory is not only about knowing how to do Sudoku, or remembering a password. “It’s the whole concept we hold of ourselves.”

He explains that a lot of other animal experiments have shown that the shrinkage of the hippocampus doesn’t affect only the memory, but also an array of other behaviors that associate with it.

The shrinkage of the hippocampus is associated with a loss of function, he concludes. This explains why people suffering from depression are having a tough time coping with the daily activities.

The good news is…

The brain damage done by MDD is reversible. This means that with proper treatment, the brain function can be returned to normal. Modern methods of treatment like TMS (transcranial magnetic stimulation) can easily make a huge difference, even without the need for medicating.

This is important to note, and if you think that you are suffering from MDD, you should visit a healthcare professional and start the recovery process as soon as possible.