Major Depression (MDD) Symptoms, Causes, Treatments
Major depressive disorder (MDD) is a common, treatable mental illness. Major depression, sometimes referred to as clinical depression, is part of a category known as "mood disorders." Mood disorders also include cyclothymia, bipolar disorder and dysthymia. Major depression is characterized by long periods of a low or sad mood. Major depressive disorder consists only of low moods and does not vacillate between high and low mood states like bipolar disorder. For this reason, major depression is sometimes called unipolar depression.
Of Americans, 20% of women and 12% of men will experience major depression at some point in their lives; however, only 3.4% of people are currently experiencing major depression at any given time. Major depression can happen at any time in a person's life and is most common between 24 – 44 years of age.1 You can take our free online depression test to see if you have the symptoms of major depression.
What is Major Depression Disorder?
Major depression is defined as the presence of one or more major depressive episodes. It can be recurring, with many major depressive episodes, or in remission, where no symptoms are present. The definition of a major depressive episode is provided by the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). A major depressive episode is at least two weeks long and must significantly impair a person's day-to-day functioning. (read: DSM Criteria for Major Depressive Disorder)
It's also possible to have major depressive disorder with psychotic features. Psychotic features in major depression are typically mood-related and tend to be delusions. For example, a person may have the delusion of extreme inferiority or believe in a nonexistent physical defect.
Symptoms of Major Depressive Disorder
According to the DSM-IV-TR, the diagnostic symptoms of major depression are the following:
- Low mood (depressed)
- An inability to feel pleasure (esp. in things that used to bring pleasure)
- Gaining or losing weight; increasing or decreasing appetite
- A change in sleep patterns
- Speeding or slowing of muscle activity
- Decrease in energy; fatigue
- Feelings of low worth
- Decreased thinking, concentration and decisiveness
- Repeated thoughts of death, dying or suicide
- Pattern of self-rejection; a suicide plan or attempt
To be defined as a major depression episode, the symptoms of either low mood or lack of pleasure must be present, and the mood must not be attributable to other factors. No instances of manic or hypomanic moods can be present as that indicates bipolar disorder.
Treatment for Major Depressive Disorder
The most effective treatment for major depressive disorder is a combination of antidepressant medication, therapy and lifestyle factors. The longer and more severe a depressive episode has been, and the more depressive episodes a person has had, the harder the depression is to treat. Therefore, it's essential to get treatment for major depression disorder as soon as possible.
The right medication treatment for major depressive disorder can be difficult to find. More than 50% of people may not respond to the initial antidepressant drug. However, 70% - 80% of people can achieve a meaningful recovery from major depressive disorder.
The types of medications used to treat major depression include:2
- Antidepressants that affect serotonin –Many antidepressants target a neurotransmitter (brain chemical) called serotonin. Each antidepressant further targets additional neurotransmitters like norepinephrine to produce antidepressant effects. If one type of antidepressant doesn't work, another antidepressant targeting slightly different neurotransmitters can be tried. Examples of SSRIs (Selective Serotonin Reuptake Inhibitors) include: fluoxetine (Prozac) and duloxetine (Celexa). Examples of SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) include: desvenlafaxine (Pristiq) and duloxetine (Cymbalta).
- Antidepressants targeting other neurotransmitters – some antidepressants target neurotransmitters like dopamine. Examples: bupropion (Welbutrin) and mirtazapine (Remeron).
- Tricyclic antidepressants (TCAs) – older style antidepressants which tend to have additional side effects. These are not generally frontline treatment for major depression. Example: imipramine (Tofranil).
- Monoamine oxidase inhibitors (MAOIs) – also older antidepressants which may have additional side effects and require dietary changes. These are not frontline major depressive disorder treatments. Examples: selegiline (Emsam) and tranylcypromine (Parnate).
- Other medications – other depression medications like atypical antipsychotics may also be used depending on the individual case. Atypical antipsychotics include: quetiapine (Seroquel) and aripiprazole (Abilify).
Multiple types of psychotherapy have been shown to be beneficial in treating major depressive disorder. These therapies work on dealing with current stressors as well as providing psychological tools with which to deal with depressive symptoms and future stressors. Education about depression and underlying psychological issues are also the focus in some types of therapy. Types of psychotherapy for major depressive disorder include: interpersonal, cognitive behavioral, psychodynamic, and group or family therapy.
Lifestyle Treatments for Major Depression
While medication and therapy are key major depressive disorder treatments, lifestyle changes are important too. Everyday behaviors can increase or decrease depression symptoms, often without the patient even knowing it. Lifestyle treatments for major depressive disorder include:
- Maintaining a daily schedule
- Good sleep hygiene
- A healthy diet and exercise routine
- Avoiding all drugs and alcohol
For in-depth information on treatment of major depression, read the Gold Standard for Treating Depression.
Last Updated: 31 January 2018
Reviewed by Harry Croft, MD