{"id":6181,"date":"2021-12-17T10:38:45","date_gmt":"2021-12-17T02:38:45","guid":{"rendered":"https:\/\/scc.sg\/e\/?page_id=6181"},"modified":"2022-01-12T16:23:43","modified_gmt":"2022-01-12T08:23:43","slug":"major-depressive-disorder","status":"publish","type":"page","link":"https:\/\/scc.sg\/e\/major-depressive-disorder\/","title":{"rendered":"Major Depressive Disorder"},"content":{"rendered":"<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: center;\"><a href=\"#mdd1\"><strong>What is Major Depressive Disorder?<\/strong><\/a> | <a href=\"#mdd2\"><strong>Symptoms <\/strong><\/a>| <a href=\"#mdd3\"><strong>Risk Factors<\/strong><\/a>\u00a0|\u00a0<a href=\"#mdd4\"><b>Diagnostic Criteria<\/b><\/a>\u00a0| <strong><a href=\"#mdd5\">Course of Treatment<\/a> | <\/strong><a href=\"#mdd6\"><strong>FAQ<\/strong><\/a><\/p>\n<\/div><\/section>\n<div   class='hr hr-short hr-center   avia-builder-el-1  el_after_av_textblock  el_before_av_image '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div>\n<div  class='avia-image-container  av-styling-    avia-builder-el-2  el_after_av_hr  el_before_av_heading  avia-align-center '  itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\"  ><div class='avia-image-container-inner'><div class='avia-image-overlay-wrap'><img class='avia_image' src='https:\/\/scc.sg\/e\/wp-content\/uploads\/2021\/12\/Major-Depressive-Disorder-1080x430.jpeg' alt='' title='Major Depressive Disorder (MDD)' height=\"430\" width=\"1080\"  itemprop=\"thumbnailUrl\"  \/><\/div><\/div><\/div>\n<div  id=\"mdd1\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-3  el_after_av_image  el_before_av_textblock  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >What is Major Depressive Disorder<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">Major Depressive Disorder (MDD)<\/span><span style=\"font-weight: 400;\">, also referred to as Clinical Depression, is one of the most common forms of depression. It is characterised by long periods (at least 2 weeks) of extremely low moods and affects different aspects of life including sleep, appetite and behaviour. It should be noted that MDD is not the only form of depression;\u00a0 there are different degrees to which people experience depression and different types of depression \u2014 do refer to the <\/span><a href=\"#mdd6\"><i>FAQ<\/i><\/a> or <i>Persistent Depressive Disorder (PDD) <\/i>and <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\"><i>Depression<\/i><\/a> <span style=\"font-weight: 400;\">for more information.<\/span><\/p>\n<\/div><\/section>\n<div  id=\"mdd2\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-5  el_after_av_textblock  el_before_av_textblock  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >Symptoms of MDD<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">Symptoms of MDD are similar to that of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a> symptoms but are often at higher levels of severity and can include [<a href=\"https:\/\/www.psychiatry.org\/patients-families\/depression\/what-is-depression\">1<\/a>]:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Feeling sad or having a depressed mood<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Loss of interest or pleasure in activities once enjoyed<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Changes in appetite \u2014 weight loss or gain unrelated to dieting<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Trouble sleeping or sleeping too much<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Loss of energy or increased fatigue<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Psychomotor agitation (which often manifests itself in observably restless behaviours like inability to sit still, pacing, handwringing) or Psychomotor retardation (ie. observably Psychomotor retardation (ie. observably slowed movements or speech).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Feeling worthless, guilty, or helpless<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Difficulty thinking, concentrating or making decisions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Thoughts of death or suicide<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a>.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is also important to note that other medical conditions (e.g., thyroid problems, a brain tumour or vitamin deficiency) can mimic symptoms of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a> so it is important to rule out general medical causes.<\/span><\/p>\n<\/div><\/section>\n<div  id=\"mdd3\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-7  el_after_av_textblock  el_before_av_textblock  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >Risk Factors of MDD<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">While there is no one cause for <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a>, research has shown that a variety of genetic, biological, environmental and psychological features contribute to an increased risk of MDD [<a href=\"https:\/\/www.nimh.nih.gov\/health\/topics\/depression\">2<\/a>]:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family History of MDD<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stressful situations or major life changes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Past episodes of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a><\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Co-occurring medical conditions e.g. cancer, diabetes, heart disease<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Note: medication for these conditions may cause side effects that increase risk of MDD<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lack of a support system<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">History of physical or sexual abuse<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Childhood trauma<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Substance abuse (e.g., alcohol, drugs)<\/span><\/li>\n<\/ul>\n<\/div><\/section>\n<div  id=\"mdd4\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-9  el_after_av_textblock  el_before_av_textblock  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >Diagnostic Criteria of MDD<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">Major depressive disorder is characterised by distinct episodes lasting at least 2 weeks (although most episodes last considerably longer). Each episode is generally marked by stark changes in emotionality, cognitions, neurological capacity, and behaviour patterns. Diagnosing an individual based on a single episode is possible, but most cases are generally characterised by recurrent episodes [<a href=\"https:\/\/doi.org\/10.1176\/appi.books.9780890425596\">3<\/a>].<\/span><\/p>\n<\/div><\/section>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">These are the guidelines according to the DSM-5\u00a0 to be clinically diagnosed with MDD [<a href=\"https:\/\/doi.org\/10.1176\/appi.books.9780890425596\">3<\/a>]:<\/span><\/p>\n<p>A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.<\/p>\n<p><span style=\"font-weight: 400;\">Note: Do not include symptoms that are clearly attributable to another medical condition.<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Depressed, low mood most of the day, nearly every day as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, it can be an irritable mood.)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Markedly diminished interest or pleasure in all, or almost all activities, most of the day, nearly every day (as indicated by either subjective account or observation).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month) or increase or decrease in appetite nearly every day (Note: In children consider failure to make expected weight gains)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Insomnia or hypersomnia nearly every day<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Psychomotor agitation or retardation (e.g. slowing down of thought and a reduction of physical movement) nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fatigue or loss of energy nearly every day<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Feelings of worthlessness or excessive or inappropriate guilt (which may not be accurate) nearly every day (not merely self-reproach or guilt about being sick)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">C. The episode is not attributable to the physiological effects of a substance or to another medical condition.<\/span><\/p>\n<p>D. The occurrence of the major depressive episode is not better explained by other psychotic disorders.<\/p>\n<p><span style=\"font-weight: 400;\">E. There has never been a manic episode or a hypomanic episode (see bipolar disorder).<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.<\/span><\/p>\n<\/div><\/section>\n<div  id=\"mdd5\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-12  el_after_av_textblock  el_before_av_textblock  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >Course of Treatment for MDD<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p><span style=\"font-weight: 400;\">MDD can be treated by both <a href=\"https:\/\/scc.sg\/e\/?page_id=6098\">psychotherapy<\/a> (or counselling) and medication. Research has shown that a combination of <a href=\"https:\/\/scc.sg\/e\/?page_id=6098\">psychotherapy<\/a> and <a href=\"https:\/\/scc.sg\/e\/?page_id=5660\">antidepressants<\/a> are effective in treatment for people with chronic or severe MDD [<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1093\/clipsy.bph052\">4<\/a>].<\/span><\/p>\n<\/div><\/section>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h4><b>Medication<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">Some commonly used <a href=\"https:\/\/scc.sg\/e\/?page_id=5660\">antidepressants<\/a> include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Selective serotonin reuptake inhibitors (SSRI)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Selective serotonin noradrenaline reuptake inhibitors (SSNRI)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tricyclic Antidepressants (TCA)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Monoamine Oxidase Inhibitors (MAOIs)<\/span><\/li>\n<\/ul>\n<\/div><\/section>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><h4><b><a href=\"https:\/\/scc.sg\/e\/?page_id=6098\">Psychotherapy<\/a> and Counselling<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">Since depressive disorders affect aspects of emotional functioning, therapies which address these issues are especially helpful. The following are some examples of the therapies and how it helps people with depression.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h5><a href=\"https:\/\/scc.sg\/e\/?page_id=6168\"><b>Cognitive Behavioural Therapy <\/b><\/a><\/h5>\n<p><span style=\"font-weight: 400;\">Focuses on how the interaction between our thoughts, behaviour and feelings contribute to symptoms of MDD. Through <a href=\"https:\/\/scc.sg\/e\/?page_id=6168\">CBT<\/a>, clients learn to identify negative thought patterns and behaviours and replace them with something more helpful [<a href=\"https:\/\/books.google.com.sg\/books?hl=en&#038;lr=&#038;id=L09cRS0xWj0C&#038;oi=fnd&#038;pg=PP15&#038;ots=FYNjaL7rel&#038;sig=TxgFF-ebYG7h_PIpbpiT_b_DAmM&#038;redir_esc=y#v=onepage&#038;q&#038;f=false\">5<\/a>].<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h5><b>Psychodynamic Therapy<\/b><\/h5>\n<p><span style=\"font-weight: 400;\">Examines emotional conflicts in relation to childhood experiences and seeks to improve insight through self-reflection and self-examination.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h5><b>Mindfulness-based Cognitive Behavioural Therapy<\/b><\/h5>\n<p><span style=\"font-weight: 400;\">Encourages self-monitoring and coping with daily negative emotions, to maintain an overall state of wellness [<a href=\"https:\/\/www.nice.org.uk\/guidance\/cg90\/chapter\/Key-priorities-for-implementation\">6<\/a>].\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h5><b>Interpersonal Psychotherapy <\/b><\/h5>\n<p><span style=\"font-weight: 400;\">Focuses on how difficulties with interpersonal relations contribute to the symptoms of MDD. It involves identifying difficulties in personal relationships and targeting them to improve social relationships, which is a strong protective factor against the onset and worsening of mental health disorders [<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1414693\/\">7<\/a>]. <\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h5><b>Activity Scheduling<\/b><\/h5>\n<p><span style=\"font-weight: 400;\">A behavioural treatment for depression where clients identify and engage in activities they enjoy and monitor their mood while doing these activities. As clients may withdraw from activities they used to enjoy due to their depressed mood, activity scheduling aims to re-engage clients and improve their moods through the process [<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S027273580600136X\">8<\/a>].<\/span><\/li>\n<\/ul>\n<\/div><\/section>\n<div  id=\"mdd6\"  style='padding-bottom:10px; ' class='av-special-heading av-special-heading-h2    avia-builder-el-16  el_after_av_textblock  el_before_av_toggle_container  '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >FAQ<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div>\n<div  class=\"togglecontainer   toggle_close_all  avia-builder-el-17  el_after_av_heading  el_before_av_hr \" >\n<section class=\"av_toggle_section\"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\"  >    <div role=\"tablist\" class=\"single_toggle\" data-tags=\"{All} \"  >        <p data-fake-id=\"#toggle-id-1\" class=\"toggler \"  itemprop=\"headline\"    role=\"tab\" tabindex=\"0\" aria-controls=\"toggle-id-1-container\">1. How is Major Depressive Disorder different from Persistent Depressive Disorder and Bipolar Disorder?<span class=\"toggle_icon\" >        <span class=\"vert_icon\"><\/span><span class=\"hor_icon\"><\/span><\/span><\/p>        <div id=\"toggle-id-1-container\" class=\"toggle_wrap \"  >            <div class=\"toggle_content invers-color \"  itemprop=\"text\"   ><table>\n<tbody>\n<tr>\n<td><b>Form of Depression<\/b><\/td>\n<td><b>Adjustment Disorder with Depressed Mood<\/b><\/td>\n<td><b>Persistent Depressive Disorder (PDD)<\/b><\/td>\n<td><b>Bipolar Disorder<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>Description<\/b><\/td>\n<td><span style=\"font-weight: 400;\">Adjustment disorder with depressed mood (aka situational depression) is a short-term <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a> that results from a traumatic or dramatic event or change in an individual\u2019s life that they struggle to come to terms with. Adjustment disorder with depressed mood differs from MDD in that it does not meet the full diagnostic criteria of MDD. It is considered to be less severe than MDD as it often subsides once the individual is able to accept the changes in their life.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">PDD is a form of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a> where symptoms are less severe, but more prolonged compared to MDD. Individuals must have been experiencing symptoms for at least 2 years to be diagnosed with PDD.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">While individuals with MDD experience consistent low mood and feelings of hopelessness, individuals with bipolar disorder experience extreme mood swings, between periods of <a href=\"https:\/\/scc.sg\/e\/?page_id=5732\">depression<\/a> and mania.\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n            <\/div>        <\/div>    <\/div><\/section>\n<\/div>\n<div   class='hr hr-default   avia-builder-el-18  el_after_av_toggle_container  avia-builder-el-last '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","footnotes":""},"class_list":["post-6181","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Major Depressive Disorder (MDD) - Singapore Counselling Centre<\/title>\n<meta name=\"description\" content=\"Major Depressive Disorder is a type of mood disorder, also called Clinical Depression. 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