Major Depressive Disorder (MDD)

Overview

Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when they’re going through a life challenge, such as a divorce or serious illness.

These feelings are normally short-lived. When someone experiences persistent and intense feelings of sadness for extended periods of time, then they may have a mood disorder such as major depressive disorder (MDD).

MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep..

Some people with MDD never seek treatment. However, most people with the disorder can learn to cope and function with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms.

Symptoms

Your doctor or a mental health professional can make a diagnosis of major depressive disorder based on your symptoms, feelings, and behaviors.

Typically, you’ll be asked certain questions or given a questionnaire so they can better determine if you have MDD or another diagnosis.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

• you must experience a change in your previous functioning
• symptoms must occur for a period of 2 or more weeks
• at least one symptom is either depressed mood or loss of interest or pleasure

You must also experience 5 or more of the following symptoms in the 2-week period:

• You feel sad or irritable most of the day, nearly every day.
• You’re less interested in most activities you once enjoyed.
• You suddenly lose or gain weight or have a change in appetite.
• You have trouble falling asleep or want to sleep more than usual.
• You experience feelings of restlessness.
• You feel unusually tired and have a lack of energy.
• You feel worthless or guilty, often about things that wouldn’t normally make you feel that way.
• You have difficulty concentrating, thinking, or making decisions.
• You think about harming yourself or suicide.

Depression 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.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• 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

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you’re reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

Causes

It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Risk factors

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.

Factors that seem to 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 medications or sleeping pills (talk to your doctor before stopping any medication)

Treatment

MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms.

People who have severe MDD or who have thoughts of harming themselves may need to stay in a hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.

Medications

Primary care providers often start treatment for MDD by prescribing antidepressant medications.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a frequently prescribed type of antidepressant. 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 are often thought to have low levels of serotonin. An SSRI can relieve symptoms of MDD by increasing the amount of available serotonin in the brain.

SSRIs include well-known drugs such as fluoxetine (Prozac) and citalopram (Celexa). They have a relatively low incidence of side effects that most people tolerate well.

Similar to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant often prescribed. These affect serotonin and norepinephrine.

Other medications

 Tricyclic antidepressants and medications known as atypical antidepressants, such as bupropion (Wellbutrin), may be used when other drugs haven’t helped.

These drugs can cause several side effects, including weight gain and sleepiness. As with any medication, benefits and side effects need to be weighed carefully with your doctor.

Some medications used to treat MDD aren’t safe while pregnant or breastfeeding. Make sure you speak to a healthcare provider if you become pregnant, you’re planning to become pregnant, or you’re breastfeeding.

Psychotherapy

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 you:

• 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.

Lifestyle changes

In addition to taking medications and participating in therapy, you can help improve MDD symptoms by making some changes to your daily habits.

Eat right

Nutritious foods benefit your mind and body, and while no foods can cure depression, certain healthy food choices can benefit your mental well-being.

Consider eating foods:

• containing omega-3 fatty acids, such as salmon
• rich in B vitamins, such as beans and whole grains
• with magnesium, which is found in nuts, seeds, and yogurt

Avoid 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.

Get 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.

Sleep well

It’s vital to get enought sleep per night, which can vary from person to person but typically ranges between 7–9 hours.

People with depression often have trouble with sleeping. Speak to a doctor if you’re having trouble sleeping or oversleeping.

Prevention

There’s no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
• Get treatment at the earliest sign of a problem to help prevent depression from worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

What is the outlook for someone with major depressive disorder?

While someone with MDD can feel hopeless at times, it’s important to remember that the disorder can be treated successfully. There is hope.

To improve your outlook, it’s critical to stick with your treatment plan. Don’t miss therapy sessions or follow-up appointments with your healthcare provider.

You should also never stop taking your medications unless you’re instructed to do so by your therapist or healthcare provider.

On days when you feel particularly depressed despite treatment, it can be helpful to call a local crisis or mental health service.

A friendly, supportive voice could be just what you need to get you through a difficult time.