What is Major Depressive Disorder?
While sadness is a normal part of the human experience – we all feel sad some of the time as a natural result of grief, loss, isolation, loneliness, or other psychologically painful life events. Sadness is natural. However, when sadness becomes more than feeling blue for a lot longer, it can become Major Depressive Disorder (MDD). Major Depressive Disorder (also known as recurrent depressive disorder, clinical depression, or unipolar depression) is a form of depression that is characterized by an all-encompassing depressed mood and/or decreased interest in pleasurable activities nearly every day for at least two weeks. To be classified as a major depressive disorder, there must not be a history of manic, mixed, or hypomanic episodes. Major Depressive Disorder can either be a single episode or recurrent and is just as much an illness as diabetes. In fact, major depressive disorder is one of the most common forms of mental illness in the United States, in 2015, nearly 7 percent of Americans over age 18 had an episode of MDD.
Depression is more than just a feeling of having the blues or feeling miserable. It isn’t a weakness; nor is it something a person can simply snap out of.
Some people never do seek treatment for major depressive disorder. Those who do learn that depression is a chronic illness that typically requires long-term treatment possibly including medication, therapy, and/or psychological counseling.
When to Get Emergency Help:
If you think you may hurt yourself, someone else, or attempt suicide, call 911 or your local emergency number immediately.
Also, consider these options if you’re having suicidal thoughts:
- Call your doctor or mental health professional.
- Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
- Reach out to a close friend or loved one.
- Contact a minister, spiritual leader or someone else in your faith community.
If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
What Causes Major Depressive Disorder?
It’s uncertain to scientists what precisely causes major depressive disorder to evolve in certain people and not others. However, there are several factors that can increase the risk of developing the condition. A combination of genes and stress can affect brain chemistry and reduce the ability to maintain mood stability. Insufficient production of neurotransmitters such as serotonin, norepinephrine, and dopamine can cause major depressive disorder. In neurology, differences in brain structures between people that are and are not depressed have also been noted. Changes in the balance of hormones might also contribute to the development of major depressive disorder.
Depression may also be triggered by:
- alcohol or drug abuse
- certain medical conditions, such as cancer, pain, and/or hypothyroidism,
- particular types of medications, including steroids
- changes in sleeping patterns may also contribute to depression
Who Is At Risk For Major Depressive Disorder?
Anyone can get Major Depressive Disorder, but there is a high hereditary link, either due to genetics, or learned behaviors. While children and adolescents can and do get Major Depressive Disorder, symptoms often begin in the late twenties. People who have a history of traumatic experiences, have had family members that have attempted or completed suicide, or have few personal relationships are also at risk for developing Major Depressive Disorder. Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.
This list is by no means all-inclusive or meant to diagnose Major Depressive Disorder. Most people who have MDD experience symptoms strongly enough that they begin to affect daily life – be it school, work, home life, relationships with others.
If you suspect you may have depression, please call your doctor or a mental health practitioner.
Factors that may increase the risk of developing or triggering depression include:
- Certain personality traits, such as low self-esteem, and being too dependent, self-critical, or pessimistic
- Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
- Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
- Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren’t clearly male or female (intersex) in an unsupportive situation
- History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
- Abuse of alcohol or recreational drugs
- Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
- Certain medications, such as some high blood pressure medication
What Are The Symptoms of Major Depressive Disorder?
The main symptom of Major Depressive Disorder is a pervasive feeling of sadness, loss, anger, or frustration that interferes with daily life for more than two weeks, however, there are often additional symptoms a person experiences.
Other symptoms of MDD may include:
- Agitation, restlessness, and irritability
- Change in appetite and weight
- Difficulty concentrating
- Feelings of hopelessness, worthlessness, self-hate, and guilt
- Loss of interest in activities that were once enjoyable
- Thoughts of death or suicide
- Social isolation – ignoring social requests, preferring to stay in alone
- Changes in sleeping patterns
Symptoms in Older Adults
In older adults, MDD may look a bit differently than it does to those younger which unfortunately means that older adults may be under-diagnosed with MDD. Here are some specific symptoms of major depressive disorder in the elderly:
- Memory difficulties or personality changes
- Physical aches or pain
- Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
- Often wanting to stay at home, rather than going out to socialize or doing new things
- Suicidal thinking or feelings, especially in older men
Symptoms in Children and Teens:
Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.
- In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
- In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.
Diagnosis of Major Depressive Disorder:
Physicians or mental health practitioners will take a mental health history and discuss your mood as well as other symptoms with you. Health care providers may request blood or urine tests to rule out any physical/medical causes of depression. If this your symptoms come and go, it may be diagnosed instead as Major Depressive Disorder, Recurrent.
What Are The Complications of Major Depressive Disorder?
Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn’t treated, resulting in emotional, behavioral, and even physical health problems that affect every area of your life.
Examples of complications associated with depression include (but are NOT limited to):
- Excess weight or obesity, which can lead to heart disease and diabetes
- Pain or physical illness
- Alcohol or drug misuse
- Anxiety, panic disorder or social phobia
- Family conflicts, relationship difficulties, and work or school problems
- Social isolation
- Suicidal feelings, suicide attempts or suicide
- Self-mutilation, such as cutting
- Premature death from medical conditions
How Is Major Depressive Disorder Diagnosed?
it’s important to call your doctor, and ALWAYS remember that you know yourself better than any physician. You may have to be your own advocate for treatment and care of major depressive disorder. It is VITAL to be honest with your therapist, doctor, or other members of your care team. You may not find the right doctor or therapist the first time you visit one. Do not hesitate to say “this relationship isn’t working for me,” and obtain a referral for another therapist/doctor/care team. They work for you, not the other way around.
Your doctor may determine a diagnosis of depression based on:
- Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
- Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it’s functioning properly.
- Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
- DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
How Is Major Depressive Disorder Treated?
Treatment for Major Depressive Disorder often includes antidepressants and therapy. While both are singularly effective, the combination of the two is often the best course of treatment, especially for severe depression. If depression is so severe that someone is feeling suicidal or cannot function in daily life, they may need treatment at a psychiatric facility to assist them in maintaining their own safety.
Primary care providers often start treatment for MDD by prescribing antidepressant medications, but treatment may evolve to include specialists in mental health care.
Selective serotonin reuptake inhibitors (SSRIs). These antidepressants are frequently prescribed. SSRIs work by helping inhibit the breakdown of serotonin in the brain, resulting in higher amounts of this neurotransmitter. Serotonin is a brain chemical that’s believed to be responsible for mood. It may help improve mood and produce healthy sleeping patterns. People with MDD often have low levels of serotonin and may relieve symptoms of MDD by increasing the amount of available serotonin in the brain. These include Prozac and Celexa.
Other medications. Tricyclic antidepressants and medications known as atypical antidepressants may be used when other drugs haven’t helped.
Psychotherapy, also known as psychological therapy or talk therapy, can be an effective treatment for people with MDD. It involves meeting with a therapist on a regular basis to talk about your condition and related issues. Psychotherapy can help:
- adjust to a crisis or other stressful event
- replace negative beliefs and behaviors with positive, healthy ones
- improve your communication skills
- find better ways to cope with challenges and solve problems
- increase your self-esteem
- regain a sense of satisfaction and control in your life
Your healthcare provider may also recommend other types of therapy, such as cognitive behavioral therapy or interpersonal therapy. Another possible treatment is group therapy, which allows you to share your feelings with people who can relate to what you’re going through.
In addition to taking medications and participating in therapy, you can help improve MDD symptoms by making some changes to your daily habits.
Eating right: Consider eating foods that contain omega-3 fatty acids, such as salmon. Foods that are rich in B vitamins, such as beans and whole grains, have also been shown to help some people with MDD. Magnesium has also been linked to fighting MDD symptoms. It’s found in nuts, seeds, and yogurt.
Avoiding alcohol and certain processed foods: It’s beneficial to avoid alcohol, as it’s a nervous system depressant that can make your symptoms worse. Also, certain refined, processed, and deep-fried foods contain omega-6 fatty acids, which may contribute to MDD.
Getting plenty of exercise: Although MDD can make you feel very tired, it’s important to be physically active. Exercising, especially outdoors and in moderate sunlight, can boost your mood and make you feel better.
Sleeping well: It’s vital to get at least 6 to 8 hours of sleep per night. Talk to your doctor if you’re having trouble sleeping.
It’s important to remember that treatment-resistant depression does occur, in which case you’ll work with a doctor to determine what other options may work for you, such as higher doses of antidepressants and a combination of medication may also be used. Please talk to your doctor about any concerns you may have with your medication, or if you do not believe the medication prescribed is working after the initial adjustment period is over.
Additional Major Depressive Disorder Resources:
Depression And Bipolar Support Alliance – The DBSA fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date, scientifically based tools and information written in language the general public can understand.
National Institute of Mental Health – The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.
National Suicide Prevention Lifeline – is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.
Page last audited 7/2018