Major Depression

by Kathi Ifri
Disability Specialist

There are several different types of depression. One of the primary types is called Major Depressive Disorder, formally known as clinical depression. MDD is more than just feeling down or blue.

Everyone feels sad at times, but feelings of sadness or despair that become overwhelming and last for extended periods of time may be a sign of MDD. If not treated, depression can keep an individual from leading a normal, active life. Depression can interfere with the ability to work, study, eat, sleep, and enjoy life. Untreated, symptoms may worsen and last for years. Each year over 17 million American adults experience a period of major depression.

According to the National Institute of Mental Health, there are many symptoms of depression that may occur in any combination resulting in persistent sadness, anxiety, or “empty” feelings. Frequently found symptoms include difficulty concentrating, memory loss, difficulty in making decisions and loss of interest in activities or hobbies once pleasurable.

Additional symptoms include loss of energy, fatigue, and changes in sleep patterns and appetite. Feelings of worthlessness, hopelessness or excessive guilt, low self-esteem, irritability, and thoughts of suicide or suicide attempts are emotional manifestations of depression. There are many causes of depression. It is generally believed that depression is caused by a combination of biological, psychological, environmental, and social factors.

Stressful life experiences, loneliness, marital or relationship problems, early childhood trauma or abuse, unemployment, and family history of depression can all be risk factors for depression. Health problems and chronic pain are often causes of depression. Once identified, most people with depression can be successfully treated. Establishment of the diagnosis should include a mental status evaluation done by a qualified psychiatrist, psychologist, or other mental health professional. Treatment may include therapy and/or antidepressant medication. Therapy aids individuals in several ways. Supportive counseling helps alleviate the suffering that comes with depression. Cognitive therapy changes the negative ideas, unrealistic expectations, and overly critical self evaluations that plague many depressed individuals. Therapy helps individuals solve problems, make changes to reduce stress levels, and develop better coping and communication skills.

When suicidal ideation or attempts are present, hospitalization may be necessary for the safety and treatment of the individual. In cases of extreme depression electroconvulsive therapy (ECT) may be needed to break the cycle. Under Social Security guidelines, the diagnosis must be established by medical evidence from an acceptable medical source. Evidence includes office notes, hospital records, work evaluations, rehabilitation progress notes, and psychological testing. Once the diagnosis of depression is established, information regarding functional limitations is gathered from the treating physician and the individual. Information may also be gathered from people who know the individual, such as a spouse, family members, friends, or coworkers.

The severity of a claimant’s depression is measured according to how the claimant’s functioning is limited by the depression. Functional limitations are assessed using four domains: activities of daily living; social functioning; concentration, persistence or pace; and episodes of decompensation.
Activities of daily living include activities such as household chores, using transportation, maintaining personal finances, and caring appropriately for one’s grooming and hygiene. Social functioning refers to a person’s capacity to interact independently, appropriately, effectively, and on a sustained basis with other individuals. This includes the ability to get along with others, such as family members, friends, the general public, coworkers, and supervisors. Concentration, persistence or pace refers to the ability to sustain focused attention and concentration long enough to permit the timely and appropriate completion of tasks commonly found in work settings. Episodes of decompensation include worsening of symptoms accompanied by a loss of ability to function. Episodes of decompensation are marked by changes in medications, hospitalizations, or placement in a highly structured environment. Adjudicators must determine the extent to which a claimant is capable of participating in each of these domains without supervision or direction.

For those individuals who are diagnosed with Major Depression, Social Security evaluates disability under Listing 12.04 in the Mental Disorders category. Additional mental impairments will be discussed in future editions of the Vantage Point. For further information please contact Mary Garrett, Director of Operations and Support Services at (800) 899-3433, you can visit our Contact Page, or fill out our Free Evaluation and someone will be contacting you soon.