In today’s fast-paced digital age, accessing information has never been easier—but navigating accurate intel has become increasingly challenging. Conflicting opinions, sensationalized content, and a flood of unchecked data that seem to inundate our news feeds and influence social media trends can make it easy to misinterpret health symptoms—both mental and physical—or fall prey to misinformation. This confusion is particularly concerning when it comes to conditions like depression, where clarity and proper understanding are critical for seeking effective treatment.
According to the World Health Organization (WHO), about 280 million people experience depression. And with the myriad of unique and specific diagnoses, such as psychotic depression versus atypical depression, for example, it makes distinguishing between the different types incredibly taxing—and receiving effective treatment options even more so. That’s why it’s vital to see a trusted and experienced provider in order to get accurately and properly diagnosed.
As discussed recently, this time of year can often result in seasonal affective disorder (SAD) in individuals, where their feelings of sadness can become very overwhelming and deleteriously impactful, affecting sleep, appetite, motivation, energy levels, and even causing problems at work, home, or school. But how does this differ from major depressive disorder (MDD), another common and serious mental disorder that negatively affects how people feel, think, act, and perceive the world?
Major depressive disorder and seasonal affective disorder share several symptoms, including low mood, fatigue, and a diminished interest in activities, making them easy to confuse. However, their underlying causes and treatment approaches distinguish them.
Diagnoses And Distinctions
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), major depressive disorder is a mood disorder characterized by the following:
- Mood: Experiencing a sad or depressed mood.
- Loss of interest: A noticeably diminished interest or pleasure in most or all activities (anhedonia).
It’s important to note here that those two symptoms—having a depressed mood or lack of interest in activities—must be present in order to meet the other diagnostic criteria for depression. That means for those individuals who may encounter a bad day on occasion, but still enjoy partaking in hobbies, they do not have a diagnosis of major depression. A depressed mood is potentially a symptom of something else, but in and of itself, it isn’t a clinical diagnosis.
This is an incredibly important distinction because the additional symptoms of depression, outlined below, could potentially be related to some other medical problem, like hypothyroidism, the beginning of an autoimmune disease, or even the start, unfortunately, of certain types of cancers. This is why receiving an accurate and proper diagnosis is essential, so that other potential illnesses that can mimic major depressive disorder aren’t missed.
Additional symptoms are as follows:
- Sense of guilt or feeling worthless: Feeling like expected role requirements, at home, in school, at your job, etc., aren’t being met.
- Poor energy: Not having the strength or will to get out of bed or even move.
- Problems concentrating: Difficulty focusing attention for a sustained period of time.
- Appetite changes: A noticeable increase (hyperphasia) or decrease (anorexia) in appetite.
- Psychomotor changes: An inability to sit still (agitation) or feeling lethargic and not wanting to move (retardation).
- Sleep disturbance: Unable to sleep (insomnia) or sleeping all the time (hypersomnia).
However, it’s not enough to experience these symptoms from time to time, or even frequently, but not steadily. In order to be diagnosed with MDD, individuals have to embody a majority of the symptoms outlined previously, most of the day, every day, for two weeks in a row. Additionally, impairment by those symptoms, such as missing an important obligation, has to be present.
As mentioned previously, many of these symptoms are present in several mental health conditions, adding more layered complexity and making it even harder to assess, diagnose, and treat. So how does one tell the difference?
The short answer: It’s incredibly tricky to make the clarification. That’s because depression can emerge any time, including during the holiday season, when there may be daunting familial expectations, for example, or large changes in lifestyle behaviors (like eating and drinking more than usual).
While there is a plethora of overlap in the symptoms of MDD and SAD, the main distinction is really related to the temporal pattern of when people develop their symptoms. Generally, MDD is a pervasive and persistent condition, often arising from a combination of genetic, biological, and environmental factors, affecting individuals year-round. In contrast, SAD is a type of depression linked to seasonal changes, typically surfacing during the darker months of fall and winter and subsiding in spring or summer, though not always. While definitely more common in those months where there’s less sunlight exposure, SAD can be present in other, sunnier seasons. What’s important is that regardless of what time of year they occur, symptoms typically improve as the season changes. Whereas with major depressive disorder, those same symptoms can occur any time, in any of the seasons — and with no temporal link to how much sunlight is present.
The Tailored Trio Of Treatments
While seasonal affective disorder may respond well to light therapy and other interventions tailored to its cyclical nature, major depressive disorder requires a more comprehensive and sustained treatment strategy to address its nuanced intricacies. By recognizing these distinctions, individuals can seek tailored care that addresses the nuances of their condition and leads to better outcomes.
The most effective, evidence-based treatment for MDD is a combined approach, which includes taking the appropriate medication at the correct dosage, partaking in productive psychotherapy practices, and making behavioral changes from a lifestyle perspective. Those three avenues, when performed in conjunction, have the best chances of improving and ultimately reaching remission from major depressive disorder.
Psychiatric Medication Management
It’s important to ensure the safest and most effective use of medications to match each individual’s changing needs throughout their mental health journey. The most common class of medications that people are prescribed to help treat MDD are called selective serotonin reuptake inhibitors, or SSRIs. Studies show that these antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), or citalopram (Celexa), when dosed appropriately, are a great first step in treating major depressive disorder. Similarly, there are atypical antidepressant medications as well, for those people who may eat and sleep more when they are depressed (versus eating and sleeping less). These medications, such as venlafaxine (Effexor), duloxetine (Cymbalta), and bupropion (Wellbutrin), affect the neurotransmitter system serotonin, while also impacting activity within another neurotransmitter system, such as the dopamine system, or the norepinephrine system. Either class can be effective, it’s just dependent upon someone’s specific symptoms and which choice works the best with an individual’s unique metabolism and neurotransmitters.
It’s important to leverage the appropriate therapeutic technique to ensure effective, lasting results. The kind of psychotherapy that’s been studied for major depressive disorder specifically, with or without anxiety symptoms, is called cognitive behavioral therapy, or CBT. Developed by Aaron Beck, a researcher and clinician from the University of Pennsylvania, CBT is the philosophy that purports how individuals think, feel, and behave are inextricably linked. And in order to change either one of those points on that sort of “triangle” of interactions, the other two components can be altered.
For example, if someone is feeling depressed and incapable of being able to do anything, they can change that emotion just by thinking and behaving differently. In terms of the thinking component, people can control their thought processes by making an agreement with themselves not to focus on all the negative thoughts that go along with being depressed. And for the behavioral aspect, if individuals stick to a routine, start exercising regularly, and begin eating healthily, they can ultimately improve how they’re feeling—just by thinking and behaving differently! Essentially, CBT teaches people how to intervene on how they think, feel, and behave, especially if those thoughts, feelings, and actions are unhelpful or unhealthy.
In fact, clinical research shows that the combination of psychopharmacology and psychotherapy produces better outcomes than either alone. Ideally, through improvements with medication and therapy, individuals dealing with major depressive disorder will have enough motivation and energy to make the lifestyle changes that are long-lasting and will help prevent future episodes of depression.
Taking a whole-body approach to treating mental health conditions is crucial. Changing lifestyle habits, such as increasing exercise, implementing a nutritious diet, and spending more time with loved ones are vital to combatting MDD.
Exercising (strength training and high intensity interval training (HIIT), if medically cleared) just 30 minutes a day, four times a week is a known physiological mechanism for treating depression and anxiety. And incorporating anti-inflammatory foods, as seen in the Mediterranean diet, is another impactful tool to reduce the high inflammation that is often found in both the brains and bodies of people experiencing depression. Social interconnectedness is equally as important, and could possibly be the most crucial variable that can help prevent other episodes of depression.
The Importance Of An Integrative Approach
It cannot be stressed enough how crucial it is to take a comprehensive, combined approach when treating MDD. It may be difficult to understand the importance behind some of these tactics, especially when it seems impossible to prioritize exercise and eating right when it’s daunting to just get out of bed. But by really appreciating the pathophysiology and the corresponding physiologic changes that go along with depression, it’s easy to recognize that those components are just as important in some ways as picking the right antidepressant. Treatment options really can’t leave any of these avenues out of the equation.
And it’s this exact integrative medicine approach that Hightop Health, the premier outpatient mental health group, focuses on—and champions consistently.
At Hightop Health, we are at the forefront of integrative mental health care, specializing in understanding the interconnections between mental and physical health that significantly enhance overall well-being. We believe it’s crucial to study both psychological and biological factors because many chronic mental health conditions are often influenced by or enhanced by lifestyle choices, just as one’s ability to prioritize exercise, nutrition, and restorative sleep is impacted by their thoughts and feelings.
That’s why we’ve developed a revolutionary approach to integrative medicine to help patients better understand the simple lifestyle changes they can make to optimize their well-being. Our Integrative Medicine Center of Excellence embodies a cutting-edge approach to mental health care by focusing on the intricate link between brain health, lifestyle, and mental and physical health.
Our clinics, which are independently owned and operated physician practices, focus on optimizing our patients’ overall health and well-being, with support from a compassionate team of clinicians and support staff. We employ a holistic approach to mental health care that treats the whole person, integrating mental, physical, and emotional health for comprehensive, personalized care.
No matter the best direction for you, what’s most important is that you find a mental health care provider that is reputable, knowledgeable, and experienced.
If you have any questions regarding effective MDD treatment options for you or someone you care about, please feel free to contact us today—we’re always here to help.