Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome

RSD(S)-CRPS Advisory
Major Depression
Major Depression

This is the most severe category of depression. In a major depression, more of the
symptoms of depression are present, and they are usually more intense or severe. A major
depression can result from a single traumatic event in your life, or may develop slowly as
a consequence of numerous personal disappointments and life problems. Some people
appear to develop the symptoms of a major depression without any obvious life crisis
causing it. Other individuals have had less severe symptoms of depression for a long time
(such as Dysthymic disorder), and a life crisis results in increased symptom intensity.

Major depression can occur once, as a result of a significant psychological trauma,
respond to treatment, and never occur again within your lifetime. This would be a single
episode depression. Some people tend to have recurring depression, with episodes of
depression followed by periods of several years without depression, followed by another
episode, usually in response to another trauma. This would be a recurrent depression. In
general, the treatment is similar, except that treatment usually is over a longer time period
for recurrent depression.  

Professional debate continues regarding whether some people develop “endogenous
depression” without any identified psychological causes. An endogenous depression is a
biologically caused depression, due presumably to either genetic causes or a malfunction
in the brain chemistry. But, all depression involves some changes in brain chemistry, even
when the cause is clearly a psychological trauma. After psychological treatment and
recovery from depression, the brain chemistry returns to normal, even without
medication. To date, there is no hard research evidence to support the notion of
endogenous depression. Sometimes this term is used to describe people who do not
respond well to treatment, and sometimes it is a rationale to prescribe medication alone,
and not to offer any psychological treatment for the depression. In general, the majority
of people who require antidepressant medication for their depression respond to treatment
better when psychotherapy, particularly cognitive-behavioral psychotherapy, is provided
in addition to the medication.  Medication treats the symptoms of depression, and is often
a vital part of the treatment program, but it is essential to treat the psychological problems
that caused the depression.  

Research has shown that cognitive therapy is the best treatment for depression, as
compared to medication and other forms of psychotherapy. However, many people
respond better to a combination of medication and cognitive therapy. It does not make
sense to only prescribe medication, without offering psychotherapy as well, because of
the added benefits shown in research studies. There are some people who respond
positively to psychotherapy, but plateau at a mild level of depression, without complete
recovery from all of the symptoms. Often, these individuals are maintained on
antidepressant medication after they have completed psychological treatment. Remember,
only physicians are qualified to prescribe medication. Your psychologist will refer you to
your primary care physician, or to a psychiatrist, for a medication evaluation, if it appears
to be indicated.

Symptoms of Depression
A Major Depression is marked by a combination of symptoms that occur together, and
last for at least two weeks without significant improvement.  Symptoms from at least five
of the following categories must be present for a major depression, although even a few
of the symptom clusters indicators of a depression, but perhaps not a major depression.

Persistent depressed, sad, anxious, or empty mood
Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
Hopeless about the future, excessive pessimistic feelings
Loss of interest and pleasure in your usual activities
Decreased energy and chronic fatigue
Loss of memory, difficulty making decisions or concentrating
Irritability or restlessness or agitation
Sleep disturbances, either difficulty sleeping, or sleeping too much
Loss of appetite and interest in food, or overeating, with weight gain
Recurring thoughts of death, or suicidal thoughts or actions
This list is a guide to help you understand depression. It is not offered for you to diagnose
yourself. If you have some of these symptoms, don’t focus on how many symptoms you
have. Instead, talk to a psychologist about how you have been feeling, to see if he/she can

First Person Description of Major Depression
It takes the greatest effort to get out of bed in the morning.
I am tired all day, yet when night comes, sleep evades me.
I stare at the ceiling, wondering what has happened to my
life, and what will become of me. Nothing is getting done
at work. I have projects to complete, but I can’t think. I try
to focus on my work, and I get lost. I keep wondering when
the boss will discover how little I have accomplished. My wife
does not understand. She keeps telling me to “snap out of it.”
I’m irritable all the time, and yell at the kids, then I feel
terrible later. Nothing is fun any more. I can’t read, and the
music I used to enjoy so much does nothing for me. I am bored,
but I feel like doing nothing. There are times, when I’m alone,
that I think that life is hopeless and meaningless, and I can’t
go on much longer.  

Sleep problems, difficulty with concentration, chronic fatigue, irritability, feelings of
hopelessness, loss of interest in pleasurable activities - the list of symptoms does not
convey the despair of depression. When you feel lost, hopeless, and don’t know what to
do, you might be depressed. Even if you have just a few of the symptoms of depression,
talk to someone who can help, consult with a psychologist, and find out what can be
done to help you change!

Differences Between Major Depression and Other Depressions
The differences between Major Depression and other depressions, such as bipolar
depression, dysthymia, or reactive depression, are primarily intended for psychologists
planning treatment, and are of less concern to the average person. When you review the
list of symptoms for major depression, and you have four symptom clusters, instead of
five, you should not ignore it or forget about it. There is no diagnosis of Moderate
Depression, other than to call it “unspecified.” Instead, ask yourself this question: “Does
the depression interfere with my life, my relationships, my productivity or my happiness?”
If the answer is yes, then don’t wait, talk to a psychologist soon.

Reactive depression is called an Adjustment Disorder with depressed mood.  This means
that something traumatic occurred in your life, such as a relationship breakup, or loss of a
job, and you became mildly to moderately depressed as a result.  Psychological treatment
can definitely help you to feel better, and will help you get your life back on track sooner,
rather than later, but you can still manage okay. If a life crisis occurs and you develop
symptoms of a major depression, then it is a major depression, even if it is also a reactive

Dysthymic disorder is a chronic, low level depression, that continues for years.
Occasionally, individuals with dysthymia also experience a major depression, when a life
crisis occurs. If you are depressed all the time, even if only mildly depressed, you should
consult with a psychologist. You don’t have to live your life in depression. Often, a
person has been mildly depressed for years, and a crisis occurs, and he/she finally
consults a psychologist. In such a case, the treatment will probably take longer, because
of the chronic depression underneath the major depression.  

Depression, not otherwise specified, is a category used by psychologists when the
symptoms do not fit neatly into one of the other categories. For example, a person has
been mildly depressed for a long time, but not long enough to diagnose dysthymia. The
specific pattern of symptoms and duration of symptoms will determine the proper
psychological treatment.

(Ref: )
Go where there is no path and leave a trail.
- Ralph Waldo Emerson