Major depression

Major depression is a serious affective disorder that manifests itself through depressive episodes lasting at least two weeks. During this time, the person experiences a significant change in mood, accompanied by symptoms that affect both their emotional and physical well-being.

This is not a passing sadness, but a clinical condition that causes significant physical and mental exhaustion, interfering with their ability to function in daily life.

This disorder can appear at any stage of life, and while in some cases it has an identifiable cause, in many others it arises without a clear trigger.

The person may feel that they have lost interest or pleasure in activities they once enjoyed, have a constant feeling of emptiness, and experience persistent fatigue even without having made significant efforts.

Basic diagnostic criteria

To diagnose an episode of major depression, the DSM-5 states that at least five specific symptoms must be present for a minimum of two weeks.

One of these symptoms must necessarily be depressed mood or loss of interest or pleasure. The remaining symptoms include:

• Changes in appetite or body weight.

• Insomnia or hypersomnia.

• Psychomotor agitation or retardation.

• Fatigue or loss of energy almost every day.

• Feelings of worthlessness or excessive guilt.

• Difficulty thinking, concentrating, or making decisions.

• Recurrent thoughts of death or suicide.

These symptoms must represent a change from the individual's previous functioning and cause impairment in overall functioning, whether in the social, occupational, or family sphere.

In addition, organic or substance-induced causes are excluded as the primary source of the disorder.

Progression and relapse

One of the most important clinical challenges in major depression is its course. Although many people respond favorably to initial treatment, relapse is common.

It is estimated that between 50% and 85% of those who experience a major depressive episode will have at least one more episode in the future if they do not receive ongoing treatment.

In many cases, relapses can occur between 4 and 9 months after an apparent improvement. This underscores the importance of not discontinuing treatment prematurely.

This is where maintenance therapy comes in, which aims to prevent further crises through a combination of psychotherapy, psychosocial intervention, and, in many cases, sustained drug treatment. It is essential to understand that recovery from major depression is not linear, and that the process may include periods of ups and downs.

Therefore, therapeutic follow-up should not cease when the patient “feels better,” but should be maintained in order to consolidate emotional well-being and prevent a new decompensation.

Major depression, while a serious condition, can be effectively treated and managed with timely, appropriate, and ongoing intervention. Commitment to long-term treatment and professional support are key to a favorable outcome.