Major Depressive Disorder (MDD) is a common but serious mental illness that causes symptoms affecting emotions, thoughts, and daily activities, such as sleeping, eating, or working. To be diagnosed with MDD, the symptoms must be present for most of the day, almost every day, for at least two weeks. Though there are many characteristics that are similar between patients with depression, no two people diagnosed with the disorder will have symptom profiles that are exactly alike.
I am an Expert by Experience, a Patient Advocate and a Mental Health Professional.
I have personal experience with depression. I was first diagnosed in 2010 at just 21 years old, though looking back I believe it had begun a few years earlier already. Recovery was difficult and the illness stuck with me for almost a decade, in lighter and darker shades.
Today I feel good, but acknowledge that in daily life I need to be mindful of my thoughts and actions perhaps a bit more than the average joe. The tendencies for depression cannot be shaken away easily; it walks by my side.
In my work as a patient advocate, I’ve met hundreds of individuals who have had the same illness, some for a shorter and others for longer periods of time. I’ve lived and witnessed the struggle to find help and suitable treatment. I’ve seen some people struggle with issues that I found easy and personally tripped up again and again on obstacles easy for someone else.
What then makes MDD so hard to treat? It is exactly that.
Successful treatment is usually defined by the absence of symptoms. However, depression's difficulty lies with its influence on the way an individual thinks. Lowered self-esteem, self-blame, the inability to enjoy the moment and fear for relapse are some issues that often hunt the patient even after a clinical remission of the illness, preventing a full recovery.
Often even when a clinical remission has been achieved, a patient with a long history with the illness does not feel this way. This is why measuring outcomes of treatment should always emphasize the patient perspective and medical treatment of depressive symptoms accompanied by psychotherapy, psychoeducation or other psychosocial support.
Patient perspective today is measured mostly by interviews and assessments made at an appointment with a professional. More than in the current treatment, professionals should show interest in what depression means to the patient as an individual.
There are various symptoms listed in the diagnosis for MDD but not all single symptoms, let alone combinations, present in the same way for different individuals. Some very typical symptoms are indeed almost opposites to one another, such as fatigue, exhaustion and difficulty to self-initiate action, compared with the inability to concentrate or difficulty to rest and relax.
For a professional to personalize and recommend a treatment suitable for the patient’s needs, it’s crucial to discuss and measure how the different symptoms present in this individual and which ones the patient feels are the most distressing and obstructive to their recovery. For example insomnia, as a part of depression, can be damaging if not dealt with right. If the sleeplessness continues for a long period of time, it may even develop an impulse to the individual to get stressed by the very thought of going to sleep. However, with an understanding of their issue of sleeplessness the patient and the professional can prepare a coping strategy — for example, organising daily activities to begin later in the morning, which enables them to learn to not get agitated by staying up, which may even make falling asleep easier and less anxious.
Another point in the assessment of symptoms of depression that needs to be considered is the patients’ view on meeting a professional. An appointment can be a stressful situation which may alter the results gained by standard testing.
Depression is a holistic experience: it is not just a mindset of the blues, but rather the sensation of tiresomeness and anxiety can be very physical. When a patient gets an appointment they already know that the appointments are short and scarce, and that it is their only opportunity to convince the professional of their ill-feeling.
Adding pressure to the situation, this causes stress levels to rise which affect the physical body (e.g., causing change in heart rate, glucose levels and alter in hormonal function), which again has a negative effect on the mental health status as well as social competence at that moment. Even though many questionnaires used to determine the severity of depression ask for the patient to answer in regards to the last two weeks, it can be difficult for the patient to exclude themselves from the situation of stress they’re in, and think in a more common approach.
A more suitable assessment might be found by asking a patient to fill out the measure, or perhaps several copies, in the previous weeks in situations they feel A) more and B) less depressed, or to keep a journal of ratings for different emotions (“11:30 a.m.: feeling 6/10, not too bad, but don’t have the energy to go out” etc.) for example.
This would bring more work to the professional and the patient, but it would also bring very valuable information now lost in translation by focusing on a medium, on how the feelings of depression change in the course of the week or a day, and potentially highlight any correlations between moods, for example, in regards to time, daily activities, eating, sleeping, social interactions or others.
It would also propose a great opportunity for a more conversational approach in the realisation that, indeed, even with a severe case of depression, the feeling is not always as depressed as it is when it’s at its worst, which can present an opportunity to discuss thinking how to make the most of even the slightest positive change.
Unfortunately, recovery from a severe or long case of MDD seldom means a life without any depressive symptoms — the brain has learned to think in a specific way. For an individual who has suffered from depression, even after recovery, the “negative” feelings may persist — but what’s worse is they may bring a reminiscing of the past and trigger a reaction towards depression and depressive thinking once again.
However, when treatment of depression includes psychotherapy, psychoeducation or other psychosocial help with the possible medication, individuals dealing with depressive tendencies can learn to trust their wellbeing even with all the ups and downs, seek help before a relapse and all in all live a perfectly sound life, such as any other.
I should know what I’m talking about; with 10 years of living with the diagnosis, I’m a living example. Recovery from depression is not necessarily an absence of all symptoms, but a way to live regardless of them.
NOTE FROM THE EDITORS: Thank you, Fanni-Laura, for sharing this lovely piece on your personal experience with depression and for highlighting the importance of the patient perspective — and for your pictures and photos! Fanni-Laura Mäntylä is a Mental Health Activist, a Patient Advocate and a Mental Health and Substance Abuse Work Professional. She was also the Chair of the 5th Edition of European Health Parliament: Committee on Mental Health and Healthy Workforce (2019–2020). Thanks again, Fanni-Laura — look forward to reading your next piece!