Psychiatric Disorders: Major Depressive Disorder
Ashley Durkee, M.A.

In last quarter's newsletter, Amanda Surdock wrote the first in a series of articles profiling various psychiatric disorders. In her article, she discussed Bipolar Disorder, which is characterized by periods of mania and depression. Because Amanda focused mainly on the manic half of Bipolar Disorder, this quarter, I will discuss the other half of it, which is a disorder in its own right: Major Depressive Disorder.

In last quarter's newsletter, Amanda Surdock wrote the first in a series of articles profiling various psychiatric disorders. In her article, she discussed Bipolar Disorder, which is characterized by periods of mania and depression. Because Amanda focused mainly on the manic half of Bipolar Disorder, this quarter, I will discuss the other half of it, which is a disorder in its own right: Major Depressive Disorder.

A diagnosis of depression requires that the person exhibit at least four of the following symptoms over at least a two-week period: depressed or irritable mood, loss of interest in pleasurable activities, significant weight loss or gain, insomnia or hypersomnia, motor problems, loss of energy nearly every day, feelings of worthlessness or excessive guilt, and problems thinking or concentrating. Of these, the most important symptom is a depressed or irritable mood. In individuals with ID, a depressed mood typically presents as a sad facial expression, absence of emotional expression, or crying. However, in individuals with ID, it is more common to experience an irritable mood rather than a depressed mood. Irritable people with ID may appear grouchy or angry, display increasing amounts of agitated behaviors, such as yelling, swearing, self-injury, aggression, or destruction.

In addition to being depressed or irritable, a person suffering from depression may lose interest in activities that s/he usually enjoys. People with ID may refuse to participate in preferred activities, appear withdrawn or spend more time alone than usual. If they do participate in activities, they do not enjoy them. They might also become agitated or aggressive when prompted to participate in activities.

Other symptoms of depression include changes in appetite and sleep patterns. A change in appetite often results in significant weight loss or gain, which is defined as a change of 5% of body weight per month or a decrease/increase in appetite nearly every day. Individuals with ID may steal food, refuse meals, or become agitated or aggressive around meal times. Clothes may fit differently due to changes in weight. With regard to changes in sleep patterns, a person with depression may sleep much more or much less than is usual. People with ID may have difficulty falling asleep or staying asleep, sleep excessively, take frequent naps, seem tired, fall asleep during the day, or exhibit increased problem behaviors at night.

Related to disrupted sleep patterns is the symptom of fatigue. Individuals suffering from depression often report feeling exhausted or without energy nearly every day. You may notice that s/he appears tired, has dark circles under her/his eyes, refuses or becomes agitated about activities that require physical exertion, or spends excessive amounts of time lying down.

Differences in motor function may also be evident. Individuals who are depressed may experience either psychomotor agitation (increased physical activity) or psychomotor retardation (slowed or decreased physical activity). Individuals with ID who are experiencing psychomotor agitation may get up from their seat a lot, appear restless or fidgety, or pace back and forth. People with ID who are exhibiting psychomotor retardation may have slow movements, decreased speech, or be less physically active than usual.

A final symptom of depression is reduced ability to think or concentrate. In individuals with ID, this may present as decreased production at work, diminished self-care skills, being unable to complete tasks that s/he used to be able to complete, appearing distracted, or becoming agitated when asked to do an activity that requires concentration. Other ways that decreased concentration can manifest in this population include sporadic memory problems, unexplained loss of skills, and poor performance on tasks.

As with all psychiatric disorders, depression affects people differently. Sometimes, because depression is very likely to occur simultaneously with other psychiatric disorders, it can be difficult to identify. However, once identified, depression can be treated. If you begin to notice the symptoms described above in your loved one, please contact his or her case manager or Education and Research staff so that we at Baddour can get him or her the treatment s/he needs.