3 Things To Understand About Major Depressive Disorder, According to a Mental Health Expert

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As the country continues to grapple with a mental health crisis, it may not be a surprise to learn that according to the National Institute of Mental Health, more than 21 million American adults have major depressive disorder, commonly referred to as clinical depression.

Major depressive disorder is one of the leading causes of disability in the US, which is why board-certified psychiatric mental health nurse practitioner (PMHNP) and graduate educator Bethanie Simmons-Becil, DNP, MSN, is so passionate about raising awareness about major depressive disorder.

Despite how common major depressive disorder is, there are still many misperceptions about depression symptoms and treatment. Here are three things Dr. Simmons-Becil, who has been in the mental health field for over 14 years, wants patients to understand.

Symptoms of depression can present in many ways

People with depression can experience symptoms in different ways. Major depressive disorder doesn't merely mean you feel sad all the time—it can also mean you can experience a lack of interest or pleasure. In addition to psychological symptoms, someone with depression can experience physical symptoms, such as decreased energy, changes in appetite and sleep.

"There’s a common misconception that major depressive disorder is just a person feeling sad or blue,” Dr. Simmons-Becil says. “But it can be so much more than that. It’s a combination of the sadness with the loss of interest in the things a person previously loved to do, along with physical elements like fatigue, changes in appetite, excessive sleeping, and more. These symptoms can take a toll on a person’s overall health, which may be debilitating.  If left untreated, depression may impact personal, work, and social life.”

Losing interest in the things a person once loved or the inability to feel pleasure is a symptom of major depressive disorder, also known as anhedonia, which may often be seen in people living with major depressive disorder. “One of my patients told me that she no longer enjoyed cooking for her family each night—something that brought her great joy for years," Dr. Simmons-Becil says. "Another patient told me he no longer enjoyed taking his dog for runs on the beach, which previously he loved to do several times a week. These are just a couple of examples of how depression symptoms can impact your life.”

The first step to managing depression is asking for help

One thing to know about major depressive disorder is that it doesn't discriminate. While certain factors, such as genetic risks or experiencing a traumatic event, can increase your risk of developing depression, anyone—no matter their age, race, or gender—can be affected by it. The first step in managing depression is having the courage to ask for help.

“I want people experiencing depressive symptoms to know that they can and should talk about it with those they love and trust,” Dr. Simmons-Becil says. “A support network of family and friends is a great place to start, and I’ve found many patients come to me after being encouraged by their loved ones. Depression is common and people need to know they are not alone. There are so many resources out there from individual therapy, peer-to-peer support groups, and professional clinical care.”

On the flip side, if you notice that one of your loved ones may be presenting with symptoms of depression, Dr. Simmons-Becil encourages you to check in on them. "The simple act of touching base with your loved one and asking them how they are could be the spark they need to open up about their struggles, and give you the space to encourage them to get help,” she says.

Finding a treatment plan that is right for you can help make a difference

Over her many years working in psychiatry and mental health, Dr. Simmons-Becil has witnessed firsthand how finding a treatment plan that is right for the patient can help make a difference. Initial treatment for adults with major depressive disorder is antidepressant therapy. However, after an appropriate dose and duration is achieved, some patients taking an antidepressant may still be struggling with depression symptoms (also known as having a partial response to their antidepressant). For example, Dr. Simmons-Becil worked with one middle-aged woman who was already on a selective serotonin reuptake inhibitor (SSRI), which is a type of medication commonly prescribed to treat major depressive disorder. The patient was taking the SSRI for a while, felt somewhat better, but still struggled with unresolved depression symptoms and was reluctant to bring it up with Dr. Simmons-Becil.

“I’ve found that some patients who are having unresolved depressive symptoms with their current antidepressant may be hesitant to speak up to their health care professional because they are feeling somewhat better than they did before,” Dr. Simmons-Becil says.

For this particular patient, her symptoms persisted and after some time, she raised her concerns to Dr. Simmons-Becil: For her, the current antidepressant was not providing enough relief. She was feeling somewhat better “but just not where [she wanted] to be,” Simmons-Becil says.

In addition to the SSRI that was already helping her patient, Dr. Simmons-Becil prescribed VRAYLAR (cariprazine), a prescription medicine used along with antidepressant medicines to treat major depressive disorder in adults.

“Adding VRAYLAR to the antidepressant helped the woman improve her overall depression symptoms,” Dr. Simmons-Becil says.

That's why Dr. Simmons-Becil believes it's important to openly discuss your symptoms with your provider so they can determine if changes to your treatment plan are needed, like her patient did, prompting Dr. Simmons-Becil to add VRAYLAR to the patient's current antidepressant. Individual results with VRAYLAR may vary.

Although the exact way VRAYLAR works is unknown, it is believed to work differently than most antidepressants. “VRAYLAR is thought to help manage chemicals in the brain, such as serotonin and dopamine, that may help control your mood,” Dr. Simmons-Becil says.

For more information about VRAYLAR visit Vraylar.com. Only your doctor can decide if VRAYLAR is right for you. Elderly dementia patients have an increased risk of death or stroke. Report unusual changes in behavior or suicidal thoughts. Antidepressants can increase these in children and young adults. Please see Important Safety Information below and the full Prescribing Information, including Boxed Warnings and Medication guide.

Healthcare providers can support patients suffering with major depressive disorder in helping them find a treatment plan that is right for them.

“We have to work together and keep having important conversations about mental health and encourage others to seek help when needed,” Dr. Simmons-Becil says. “We can’t be afraid to check in with our loved ones and make sure they are okay. Even if they’re on an antidepressant, they may still be experiencing depressive symptoms. As healthcare providers, we have many useful tools and resources that can help provide support for patients with major depressive disorder."

If you or someone you love is suicidal, please contact the National Suicide Prevention Lifeline at 1-800-273-8755 or visit suicidepreventionlifeline.org.


What is the most important information I should know about VRAYLAR?

Elderly people with dementia-related psychosis (having lost touch with reality due to confusion and memory loss) taking medicines like VRAYLAR are at an increased risk of death. VRAYLAR is not approved for treating patients with dementia-related psychosis.

VRAYLAR and antidepressants may increase suicidal thoughts or actions in some children and young adults especially within the first few months of treatment or when the dose is changed. Depression and other mental illnesses are the most important causes of suicidal thoughts and actions. Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when VRAYLAR or the antidepressant is started or when the dose is changed. Report any change in these symptoms immediately to the doctor.

VRAYLAR may cause serious side effects, including:

  • Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death
  • Neuroleptic malignant syndrome (NMS): Call your healthcare provider or go to the nearest hospital emergency room right away if you have high fever, stiff muscles, confusion, increased sweating, or changes in breathing, heart rate, and blood pressure. These can be symptoms of a rare but potentially fatal side effect called NMS. VRAYLAR should be stopped if you have NMS.
  • Uncontrolled body movements (tardive dyskinesia or TD): VRAYLAR may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking VRAYLAR. Tardive dyskinesia may also start after you stop taking VRAYLAR.
  • Late-occurring side effects: VRAYLAR stays in your body for a long time. Some side effects may not happen right away and can start a few weeks after starting VRAYLAR, or if your dose increases. Your healthcare provider should monitor you for side effects for several weeks after starting or increasing dose of VRAYLAR.
  • Problems with your metabolism, such as:
    • High blood sugar and diabetes: Increases in blood sugar can happen in some people who take VRAYLAR. Extremely high blood sugar can lead to coma or death. Your healthcare provider should check your blood sugar before or soon after starting VRAYLAR and regularly during treatment. Tell your healthcare provider if you have symptoms such as feeling very thirsty, very hungry, or sick to your stomach, urinating more than usual, feeling weak, tired, confused, or your breath smells fruity.
    • Increased fat levels (cholesterol and triglycerides) in your blood: Your healthcare provider should check fat levels in your blood before or soon after starting VRAYLAR and during treatment.
    • Weight gain: Weight gain has been reported with VRAYLAR. You and your healthcare provider should check your weight before and regularly during treatment.
  • Low white blood cell count: Low white blood cell counts have been reported with antipsychotic drugs, including VRAYLAR. This may increase your risk of infection. Very low white blood cell counts, which can be fatal, have been reported with other antipsychotics. Your healthcare provider may do blood tests during the first few months of treatment with VRAYLAR.
  • Decreased blood pressure (orthostatic hypotension): You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
  • Falls: VRAYLAR may make you sleepy or dizzy, may cause a decrease in blood pressure when changing position (orthostatic hypotension), and can slow thinking and motor skills, which may lead to falls that can cause fractures or other injuries.
  • Seizures (convulsions)
  • Sleepiness, drowsiness, feeling tired, difficulty thinking and doing normal activities: Do NOT drive, operate machinery, or do other dangerous activities until you know how VRAYLAR affects you. VRAYLAR may make you drowsy.
  • Increased body temperature: Do not become too hot or dehydrated during VRAYLAR treatment. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water.
  • Difficulty swallowing that can cause food or liquid to get into your lungs

Who should not take VRAYLAR?

Do not take VRAYLAR if you are allergic to any of its ingredients. Get emergency medical help if you are having an allergic reaction (eg, rash, itching, hives, swelling of the tongue, lip, face or throat).

What should I tell my healthcare provider before taking VRAYLAR?

Tell your healthcare provider about any medical conditions and if you:

  • have or have had heart problems or a stroke
  • have or have had low or high blood pressure
  • have or have had diabetes or high blood sugar in you or your family
  • have or have had high levels of total cholesterol, LDL-cholesterol, or triglycerides; or low levels of HDL-cholesterol
  • have or have had seizures (convulsions)
  • have or have had kidney or liver problems
  • have or have had low white blood cell count
  • are pregnant or plan to become pregnant. VRAYLAR may harm your unborn baby. Taking VRAYLAR during your third trimester of pregnancy may cause your baby to have abnormal muscle movements or withdrawal symptoms after birth. Talk to your healthcare provider about the risk to your unborn baby if you take VRAYLAR during pregnancy. If you become pregnant or think you are pregnant during treatment, talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or https://www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/.
  • are breastfeeding or plan to breastfeed. It is not known if VRAYLAR passes into breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with VRAYLAR.

Tell your healthcare provider about all medicines that you take, including prescriptions, over-the-counter medicines, vitamins, and supplements. VRAYLAR may affect the way other medicines work, and other medicines may affect how VRAYLAR works. Do not start or stop any medicines while taking VRAYLAR without talking to your healthcare provider.

What are the most common side effects of VRAYLAR?

  • The most common side effects include difficulty moving or slow movements, tremors, uncontrolled body movements, restlessness and feeling like you need to move around, sleepiness, nausea, vomiting, indigestion, constipation, feeling tired, trouble sleeping, increased appetite, and dizziness.

These are not all the possible side effects of VRAYLAR.


VRAYLAR (cariprazine) is a prescription medicine used along with antidepressant medicines to treat major depressive disorder (MDD) in adults.

Please see the full Prescribing Information, including Boxed Warnings, and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

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