Major depressive disorder (MDD) is a serious, debilitating mental illness that is often described as an invisible disability. Unlike many physical disabilities which cannot be hidden, people who suffer from MDD may not exhibit clearly identifiable symptoms of disability upon first glance. But, while the full extent of the debilitating effects remain obscured to the outside world, over time some observers may notice changes in what a person with MDD says or does.
Persistent fatigue, loss of energy, irritability, changes in weight and sleep patterns, and poor concentration may give family, friends, and co-workers a clue that something is wrong. Yet the true toll of this illness cannot be known unless a person suffering from it shares what is going through their mind. Unshakable feelings of worthlessness and guilt, thoughts of death, and even plans for suicide are just some of the invisible obstacles a person with MDD may be grappling with in their day-to-day lives.
While a variety of treatments have shown great success at easing symptoms and helping people diagnosed with major depressive disorder return to a state of good mental health, the road to recovery may take some time. When a person is suffering from MDD, they may find themselves unable to work or attend school as they normally would, and they may not be able to effectively manage responsibilities in their lives.
Fortunately, disability benefits may be available to people experiencing MDD. Unfortunately, insurers can sometimes make the application process difficult or even deny benefits to someone who is clearly in need and eligible to receive them.
Howie, Sacks & Henry LLP has assisted many people just like you or your loved one when they have encountered difficulties applying for disability benefits. Our experienced, knowledgeable, and skilled team of personal injury lawyers is ready to listen to your story, offer trusted legal advice, and help in any way we can. At a time when your disability is making it incredibly difficult for you to fight for the benefits that are rightfully yours, you may feel as though your situation is hopeless. But, at HSH LLP, Hope Starts Here.
Diagnosing Major Depressive Disorder (MDD)
Major depressive disorder is a condition that occurs when a person is experiencing a prolonged depressive state. The World Health Organization projects the disease will rank as the top cause of the burden of disease worldwide by 2030.
A mood disorder, it is diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To be classified as having MDD, a person must have a combination of at least five recognized symptoms. The constellation of symptoms must include either persistent depressive mood and/or anhedonia (inability to feel pleasure), and some of the following:
- lack of energy
- poor concentration
- sleep disturbances
- changes in appetite
- feelings of guilt or worthlessness,
- psychomotor retardation or agitation (a mental-physical connection to slowed or heightened physical activity)
- suicidal thoughts
- irritability (for children and adolescents only)
Approximately five to 10 percent of people diagnosed with MDD will eventually be diagnosed with bipolar disorder. Therefore, clinicians must rule out manic or hypomanic episodes before diagnosing MDD.
Other recognized depressive disorders in the CDM-5 are:
- persistent depressive disorder (dysthymia)
- disruptive mood dysregulation disorder
- premenstrual dysphoric disorder
- substance/medication-induced depressive disorder
- depressive disorder due to another medical condition
- unspecified depressive disorder
Since there is no objective testing that can identify depression, MDD is a clinical diagnosis which primarily draws on patient interviews, clinical history, and often collateral information from people who know the patient well. Physical/neurological examinations, including routine lab work, are conducted to rule out other conditions but not to confirm an MDD diagnosis.
Many people with MDD (almost half) will not present to primary care providers with complaints of depressive feelings. Rather, somatic complaints brought on by depression are frequently the reason for their visit. Alternatively, they may be visiting at the insistence of friends, family, or employers as a result of noticeable decreases in socialization and/or activity.
What Causes Major Depressive Disorder?
MDD is thought to manifest from a combination of biological, genetic, psychosocial, and environmental factors. Although it has previously been associated with abnormalities in neurotransmitters (particularly dopamine, serotonin, and norepinephrine), researchers now suspect these abnormalities are secondary disturbances resulting from more complex dysregulation of neuroregulatory systems and neural circuitry.
Major depressive disorder has been linked to
- lower levels of serotonin metabolites, brain GABA (an inhibitory neurotransmitter amino acid), plasma, and Cerebrospinal fluid (CSF)
- thyroid and growth hormone abnormalities
- multiple adverse early childhood stress and trauma (learned helplessness and other cognitive distortions)
Studies suggest about 12 percent of people will experience at least one episode of MDD over their lifetime. Statistics also suggest:
- women are twice as likely as men to experience MDD
- the average age of onset is about 40, but trending younger due to use of alcohol and drugs
- people who are divorced, separated, widowed, or who otherwise have few or no close interpersonal relationships are more likely to experience MDD
- MDD is frequently comorbid with order disorders, including: obsessive-compulsive disorder, social anxiety disorder, panic disorder, or substance abuse
- MDD is less common in urban areas than in rural areas
Treatments for MDD
Left untreated, MDD can last for six to 12 months or longer, and increase the risk of developing comorbidities or death by suicide. Moreover, MDD is a chronic, recurrent condition with recurrence rates of 50, 70, and 90 percent after a first, second, or third episode, respectively. Among people who do receive treatment, 80-90 percent will respond positively. Finding the most effective type of treatment or combinations of treatment can take time, however.
Initial treatments of MDD tend to include pharmaceutical medication and/or psychotherapy, with combined treatment substantially more likely to be effective. For severe cases of MDD, electroconvulsive therapy has been found to be most effective as a treatment.
Antidepressant medications are categorized by the particular chemical agent they target. Certain people with MDD will respond differently to these interventions, and in some cases multiple medications will be tried on their own or in combination before an effective treatment with manageable side effects is determined between doctor and patient.
Come types of antidepressants include:
- serotonin modulators
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- tricyclic antidepressants (TCAs)
- monoamine oxidase inhibitors (MAOIs)
- atypical antidepressants, including mood stabilizers and antipsychotics (often used to augment other antidepressants or minimize certain side-effects)
Common forms of psychotherapy used to treat MDD include cognitive-behavioral therapy (CBT), which focuses on identifying and changing unhelpful feelings, thoughts, and actions to improve a person’s mental and physical well-being, and interpersonal therapy, which focuses on identifying and improving problems in relationships.
Other potential second-line therapies include: Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and Vagus Nerve Stimulation (VNS).
Time Off Work During Treatment
A challenging condition to properly treat, and one prone to recur over time, major depressive disorder can significantly hinder a person’s ability to sustain work and maintain healthy relationships. Untreated MDD may also lead a person to engage in destructive behaviour, such as substance abuse, as a means to self-medicate and soothe their symptoms.
Fortunately, many people with private insurance plans (through an employer or self-purchased), will be able to draw on disability benefits that can greatly ease the financial costs of missing extended periods of work and/or receiving therapeutic treatments. There is also a public option: Canadian Pension Plan disability benefits may supplement these benefits or provide some funds to people who do not have a private plan.
Depending on the provisions in your insurance policy, you may be able to take up to 15 weeks to a year of short-term disability leave while receiving all or a portion of your normal earnings. If you are unable to return to work at the end of this leave, you may be eligible to apply for long-term disability benefits to extend your leave.
While short-term disability benefits ordinarily only require reports from the medical practitioner providing treatment to you, when you apply for long-term disability the insurer will likely require you to see one or more medical providers of their own choosing to evaluate you.
Denied Benefits? We Can Help
If you or a loved one is suffering from major depressive disorder and been denied disability benefits or been told you must return to work before you and your doctor believe you are ready, the team at Howie, Sacks & Henry LLP is here to help.
When you contact our experienced, knowledgeable and skilled personal injury lawyers for free initial consultation, we’ll take time to listen to your story attentively and with great empathy, outline your legal rights and options, answer any questions you may have, and provide trusted legal advice. If we believe we can successfully access the benefits you need and deserve, we will gladly offer to become your staunch advocate and legal representative.
Insurance companies know the HSH LLP name very well. We have a reputation for building strong cases designed to encourage the insurer to offer a fair settlement. And, we won’t hesitate to take the matter to trial if they are not willing to give one to you.
Renowned among our peers as one of Canada’s top ranked personal injury firms, HSH has established a track record for our tenacity in getting results for our clients. But, we’re also aware that when you are trying to manage a disabling condition such as MDD, the end result is not the only thing you care about. We know our clients want to work with professionals who treat them with the respect, concern, and compassion they need and deserve during this challenging time in their lives.
People suffering from MDD frequently feel their situation is hopeless and, even more worryingly, that they are worthless.
At HSH, we will always see your worth as a person in need, and strive to show you that there is hope by helping in any way we can. Contact us today to learn more about what we can do for you.
