Understanding what Recurrent Episodes in Major Depressive Disorder (MDD) Looks Like - From a Client's Perspective.
“It all started when I was 26. That’s when I realized that I had been here before. I remembered feeling bouts of anger, frustration with multiple things going on in my life, and remembering how often they would occur. It was very consistent to the ”wave” that I noticed with my dad and older brother. They dealt with this too. I wasn’t sure if it was due to my “cycle” or not, but then again my periods weren’t always consistent anyway, but it just seemed that we would spin “out of control every 2-3 months. All of us; and some days would feel like sheer evil, confusion”....
This was my first session with Anna*. For purposes of protecting PHI (protected health information), this client‘s name & certain information is altered to protect her identity. However Anna chose to share a brief snippet of her life with recurrent Major Depressive Disorder.
Major Depressive Disorder (MDD), is a depressive disorder that is classified as a single or recurrent episode. It can also be classified with or without psychotic features depending on the severity of the episode. Depression, in general, is a mood disorder that causes persistent feelings of sadness and loss of interest in typical, enjoyable activities. Also called clinical depression, it can affect how a person thinks, feels, behaves and often leads to a variety of emotional and physical problems, including suicidality. In a lifetime, a person can have a single episode or a series of episodes that occur regularly, often interrupting daily functioning, sometimes for a specific reason (trauma such as abuse or adverse childhood experiences) and sometimes without a rhyme or reason.
Symptoms and Moods
“… it just seemed that we would spin out of control every 2-3 months. All of us; and some days would feel like sheer evil, confusion.”
Anna would complain quite regularly about her moods and often ”didn’t care“ about her exaggerated lifestyle in response to these episodes. There were days that Anna had a down mood on most days, sometimes weeks at a time and then there were days that Anna expressed excitement, sometimes over-excitement about her day, citing that she would spend hours cleaning her house, doing her makeup, going on extravagant excursions with people who weren’t always a part of her circle, and draining her bank account only to shift back into depression without a clue why she did all of these things. The way Anna explained it, she was “seeking happiness”. Anna presented many of the classic symptoms of MDD listed below.
Symptoms for MDD occur most of the day, nearly every day for more than a month and may include:
Feelings of sadness, tearfulness, emptiness or hopelessness
Angry Outbursts, irritability, frustration even over small matters
Loss of interest or pleasure in things one used to enjoy such as sex, hobbies, sports, spending time with family
Sleep disturbances, including insomnia or sleeping too much
Tiredness and lack of energy
Reduced appetite and weight loss or increased cravings for food & weight gain
Anxiety, agitation or restlessness
Slowed thinking or mind-blanking
Feelings of worthlessness or guilt, fixating in past failures or self-blame
Troubled thinking, concentrating and inability to make important decisions
Frequent or recurrent thoughts of death, dying, suicidal thoughts or completed suicide
Suicide Attempts
In her second session, Anna recounts when suicidality became a problem:
Anna: I thought about suicide nearly every day because nothing I ever did seemed right to my family, friends, professors, my bosses. More and more I began to loathe myself because I must have done something to cause people to be frustrated with me; I must be this highly toxic person that brings everyone down and I hated how that felt. Last year, I attempted suicide by taking a whole bottle of ibuprophen and the rest of my Zoloft with a cup of liquor. I did not care what happpened after that.
Me: Do you remember the thoughts that triggered you and led to your taking the pills with alcohol?
Anna: No, not really. All that I knew was that I wanted [it] to stop.
Me: It? What is the “It” you want to stop?
Anna: My thoughts!! The voice inside my head telling me that it’s time to be done with the shit I’m dealing with. My dad, my brother, the people at work, random people who I think have a problem with me, my dead mother and what she did to me, the world is NUTS!! It’s been YEARS of this madness!”
Me: Im sorry. It sounds like a lot to deal with and it sounds like it has bubbled over in the past few years. Would that be accurate?
Anna: That is exactly it. I’m just over feeling like I cant do anything right. I don’t get along with everyone and some days I can’t tell if I’m coming or going and most days all I do is cry. I dont think my meds are working…. then again I don’t always take them when I’m supposed to and I’m tired of always hearing, ”did you take your meds? Did you take your meds?” all the damn time from people just because I’m reacting to a shitty day.
Me: I see. I bet that’s tough. I think I can understand how you feel. Sounds like sometimes you just need a person to listen, not judge?
Anna: Right. Just once. I don’t always have these thoughts. But most days are tough, and I don’t know if that’s normal.
Me: It’s normal.
Depression is normal. Major Depressive Disorder is more common than most know, and affects more than 3 million people each year in the U.S. An estimated 21.0 million adults in the United States had at least one major depressive episode, representing 8.4% of all U.S. adults (NIMH )
When to get emergency help
An estimate of 21 million adults in the United States suffers from Major Depressive Disorder.
If you’ve been struggling with depression or thoughts of suicide, and don’t know how to start therapy, you can start your search on Psychology Today, reach out to a close friend, or talk to your doctor for a therapist in your community who specializes in depressive disorders.
If you think that you may hurt yourself or attempt suicide, or know someone who may commit suicide, call 911 or your local emergency crisis line immediately.
Get help & support for suicide
If you’re in emotional distress or suicidal crisis, find help in your area with Find a helpline.
Additional resources:
National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English, Spanish
Ohio Suicide Prevention Foundation
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