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Topic » Major Depressive Disorder (Depression)

Major Depressive Disorder (Depression)

Understanding-Depression

Major depressive disorder (MDD) is characterized by feelings of sadness, loss of interest, and worthlessness. It can significantly affect our health and our lives if left untreated. Let’s take a look at what MDD is and how you can deal with it.

What Is Major Depressive Disorder?

What Is Major Depressive Disorder, types, causes and symptoms
Major Depressive Disorder (Depression)

Major depressive disorder (MDD) is a mood disorder resulting in chronic sadness, a sense of despair, low mood, irritability, insomnia, lethargy, and even suicidal thoughts. Depression is different from general feelings of sadness, as episodes can last for two weeks.

Unlike mood fluctuations, depression can require weeks, months, or even years of treatment. According to a 2022 study 1, “Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.”

MDD is also known as clinical depression, unipolar depression, and major depression. It greatly affects how an individual thinks, feels, behaves, and acts—leading to different emotional and physical issues. A person with depression may feel hopeless and think that life is not worth living. This can affect their daily life and lead to suicidal tendencies.

Understanding Major Depressive Disorder

Certain devastating life events like losing a loved one, serious illness, a divorce, experiencing a breakup, unemployment, or life challenges can often make us feel sad temporarily. However, when such feelings of sadness persist for an extended period of time (for instance, for more than 2 months), then it may be considered as depression by mental health professionals.

Major depressive disorder is a psychiatric disorder 2 that not only affects our thinking, mood, and behavior, but also our physical wellbeing. Those affected may experience low energy, low self-esteem, aches, and pains without any probable reason and lose interest in activities they used to enjoy earlier.

It can also affect their ability to study, work, eat, sleep, and socialize. Certain individuals experience MDD once in a lifetime, whereas others may experience various episodes throughout their life. According to the WHO, depression is also the primary reason for disability across the globe.

Thankfully, major depressive disorder has been thoroughly studied and understood by mental health professionals and it is considered a treatable condition. People with severe major depressive disorder can recover fully with the help of therapy and medication. Unfortunately, due to stigma, most people suffering from clinical depression do not seek treatment to cope with their symptoms.

Prevalence Of Major Depressive Disorder

According to the WHO, over 264 million individuals of all ages suffer from depression across the world, with more women affected than men. Moreover, MDD happens to have an average lifetime prevalence 3 of about 12%. Research 4 also shows that lifetime rates in developed nations are around 15%, which is relatively higher than that of developing countries at 11%.

However, the short-term prevalence of major depressive disorder symptoms is around 7% with significant differences across age groups. The researchers also found that major depressive disorder is “more common in people without close interpersonal relationships, and who are divorced or separated, or widowed.”

However, differences were not observed across different socioeconomic statuses or racial or ethnic groups. The research also reveals that MDD is ranked as the third most debilitating disease worldwide by the World Health Organization (WHO) in 2008.

People suffering from this disorder are prone to developing certain comorbid disorders, that can further increase the likelihood of suicidal thoughts and behavior in sufferers. Such disorders include:

  • Obsessive-compulsive disorder
  • Social anxiety disorder
  • Panic disorders
  • Substance use disorders, etc.

What Are The Symptoms Of Major Depressive Disorder?

Symptoms Of Major Depressive Disorder
Symptoms Of Major Depressive Disorder


A person suffering from major depression will experience the following signs and symptoms for at least two weeks, almost every day, as specified by the DSM-5 and International Classification of Diseases (ICD-10):

A. Psychological symptoms:

  1. Persistent sadness
  2. Low mood
  3. Excessive overthinking
  4. Stress, anxiety, and frustration
  5. Feelings of hopelessness and worthlessness
  6. Irritability and agitation
  7. Feelings of guilt
  8. Pessimism and helplessness
  9. Loss of interest in pleasurable activities
  10. Difficulty in concentrating and making decisions
  11. Memory problems or difficulty in remembering details
  12. Angry outbursts over small issues
  13. Poor performance at work or school
  14. Drug and alcohol abuse
  15. Suicidal thoughts and tendencies

B. Physical symptoms:

  1. Reduced energy, constant exhaustion, and fatigue
  2. Lethargy
  3. Feelings of restlessness
  4. Slowed thinking, talking, or body movements
  5. Difficulty in sleeping
  6. Acute or chronic insomnia
  7. Changes in appetite
  8. Weight loss or gain
  9. Digestive problems
  10. Headache disorders
  11. Body aches or pains due to unknown reasons

Some individuals may also experience fluctuations in motor abilities, have psychotic episodes, and show signs of mania. However, not every person suffering from major depressive disorder will experience all of its symptoms.

Types Of Major Depressive Disorders

Types-Of-Depression
Major Depressive Disorder (Depression)

There are various types of major depressive disorders, each of which is subtly different and may develop under different circumstances. However, all types of depression involve the same feelings of unhappiness, hopelessness, and disinterest.

Some of the most common types of depression are:

1. Persistent depressive disorder (Dysthymia)

It refers to a type of depression that lasts at least two years. This clinical disorder causes a depressed mood and may result in episodes of both major and mild depression.

2. Postpartum depression

Most women experience this type of depression after giving birth. It is a lot more severe than after-pregnancy “baby blues”. After giving birth, this type of serious depression causes severe feelings of despair and anxiety. It frequently makes caring for a newborn on a daily basis very difficult for new mothers.

3. Psychotic depression

It is a form of major depression with psychosis-like symptoms like hallucinations or delusions. The symptoms of this condition generally have psychotic and depressive themes.

4. Seasonal affective disorder (SAD)

SAD 5 usually refers to the onset of a depressive state during the winter months. As there is less sunlight, many people become severely depressed till the arrival of spring or summer. It is often followed by social isolation and withdrawal, weight gain, and increased sleepiness.

5. Bipolar disorder

Bipolar disorder is separate from depression, as stated in the Diagnostic and Statistical Manual of Mental Health Disorder (DSM-5). However, studies 6 have found that signs and symptoms of major depressive disorder and bipolar disorder are similar, particularly the episodes of intensely low moods and high energy. As a result, it is often difficult to distinguish clinical depression from bipolar disorder.

Apart from these, the common types of depression include:

  • Catatonic depression
  • Disruptive mood dysregulation disorder
  • Depressive disorder due to other medical conditions
  • Melancholic depression
  • Premenstrual dysphoric disorder
  • Substance/medication-induced depressive disorder
  • Other specified and unspecified depressive disorder

Read More About Types Of Depression Here

How Major Depressive Disorder Affects Us

People suffering from MDD are affected in a variety of ways. Not only do they experience low moods, but also stress and anxiety. They are also prone to worrying excessively about their physical health.

A depressed individual may have difficulty functioning effectively at school or work, have frequent conflicts in interpersonal relationships, and are prone to substance abuse. Moreover, this condition may also affect their sexual drive and functioning.

Major depression is also believed to affect and alter 7 regions of the human brain which help regulate moods. In people with depression, nerve cells in specific areas of the brain function ineffectively, which affects communication between nerve circuits. This makes it difficult for an individual to control his/her mood.

Hormonal changes and major traumatic life events can also trigger biological processes that enhance risk factors for clinical depression. Our genetic structure also determines how we might be affected by this mental condition.

People with the major depressive disorder also experience hallucinations, false perceptions, delusions, and other “psychotic symptoms” during a depressive episode. However, they can also have episodes in which they feel highly irritated or even energetic. If a person suffers from depression, he/she is more likely to experience a disrupted sleeping pattern or insomnia.

A person becomes vulnerable to this mental disorder at any age. For instance, major depressive disorder in children can manifest as – lost interest in activities, sadness, and extreme introversion, and hyperactivity. Moreover, a person’s vulnerability to depression increases if he/she has a family history of depression or substance abuse.

Read More About Stress Here

What Causes Major Depressive Disorder?

Causes of Major Depressive Disorder
Causes Of Major Depressive Disorder

Medical professionals are yet to fully understand the specific causes of major depressive disorder. However, research 3 suggests that this mental condition is likely caused by a combination of factors, like:

  • Genetic factors
  • Biological factors
  • Environmental factors

1. Genetic factors

According to the American Psychiatric Association (APA), depression can be an inherited condition. If you have a family member who suffers from depression, then it is highly likely that you will develop major depression sometime in your life. Research 8 shows that a person is twice more likely to suffer from major depression if he/she has a grandparent or a parent with depression.

Studies at the APA also claim that if one identical twin suffers from clinical depression, the other has a 70% chance of having the disorder. Moreover, studies 9 on families and twins reveal that the risk of developing MDD can be explained by genetic factors 10. A 2019 study 11 identified 102 variants in the genome linked to risk for major depression.

2. Biological factors

Major depressive disorder is a serious medical illness distributed across several brain regions and circuits 12. Hence, substantial changes in the human brain may lead to depression in some people. Disruptions in brain chemistry and brain function 13 can be a notable cause of MDD.

Dysregulated neurotransmitters, like norepinephrine, dopamine, and serotonin, can influence our emotions and put our feelings of happiness and joy out of balance—thereby leading to a depressive state. But why neurotransmitters become imbalanced and how they lead to major depression is not fully understood.

Moreover, hormonal changes or varying hormone functioning may also lead to depression. Thyroid problems, childbirth, menopause, and different health disorders can result in hormonal changes, leading to depression.

3. Environmental factors

According to the APA, major depressive disorder can occur due to constant exposure to violence, abuse, trauma, neglect, or poverty. People who have experienced adverse events in life, like the loss of a loved one 14, unemployment, relationship problems, financial issues, serious illness, or childhood trauma 15 are highly vulnerable to developing depression.

Different physical illnesses—like cardiovascular diseases (CVD), Parkinson’s disease, and cancer—may also result in depression.

Apart from these, there may be various other factors that can contribute to the development of MDD in an individual. These include:

  • Lifestyle changes
  • Social isolation
  • Separation or abandonment
  • Personal conflicts in relationships
  • Changes in appetite or poor nutrition
  • Circadian rhythm disturbances
  • Alcohol or drug abuse
  • Excessive stress
  • Physical, emotional, and sexual abuse
  • Personality issues like low self-esteem and pessimism
  • Major stressful life events

Read More About Causes Of Depression Here

How Is Major Depressive Disorder Diagnosed?

The DSM-5 criteria for major depressive disorder state 16 that a person needs to exhibit at least five or more symptoms of MDD nearly every day for at least two weeks to be diagnosed as depressed. Major depressive disorder diagnosis is usually carried out by a mental health professional or a primary care physician.

After analyzing the patient’s medical history, the health professional will evaluate the symptoms by asking certain questions. Moreover, the professional may also carefully assess the patient’s personal and family psychiatric history before coming to any definitive conclusion about major depressive disorder treatments.

Currently, there is no major depressive disorder test that can help screen for the disorder. However, a primary care physician may run certain medical tests or use particular psychiatric questionnaires to determine if the patient’s symptoms are caused by other medical problems or medication.

What Is The Treatment For Major Depressive Disorder?

Many people suffering from major depression do not seek any treatment. According to a 2018 study 17, only one in five people in the richest countries seek treatment for depression, whereas only one in 27 people in the poorest countries seek help. This is perhaps due to the stigma attached to mental health and the regressive attitude of our society towards depression.

Moreover, the patient’s ability to recognize the condition and seek help may be distorted due to the limited knowledge surrounding clinical depression and the debilitating nature of the mental illness. Hence, friends and family play a crucial role when it comes to recognizing the major depressive disorder symptoms and encouraging individuals to seek treatment.

Fortunately, depression is one of the most treatable mental conditions. According to the researchers at the APA, around 80-90% of patients respond well to treatment. Moreover, almost every patient has reported that they have experienced some relief from symptoms of MDD with proper treatment—including medication and psychotherapy.

1. Medications

A mental health professional may begin treatment for clinical depression by prescribing antidepressant medications. Different types of antidepressants may be recommended by the healthcare provider depending on the individual and the severity of his/her symptoms. These include:

  • Atypical antidepressants 18
  • Monoamine oxidase inhibitors (MAOIs 19)
  • Selective serotonin reuptake inhibitors (SSRIs 20)
  • Selective serotonin and norepinephrine reuptake inhibitors (SNRIs 21)
  • Tricyclic antidepressants 22

Antidepressants can substantially help in treating moderate to severe major depressive disorder. Each type of medicine focuses on a specific neurotransmitter, influencing how our brain processes specific chemicals which regulate stress and mood. However, SSRIs and SNRIs can have certain side effects like diarrhea, constipation, nausea, weight loss, low blood sugar, and sexual dysfunction.

The depressed patient may start experiencing the benefits after the first 2-4 weeks; but for the antidepressants to be fully effective, the medicine needs to be taken for at least 2-3 months. It is crucial that the patients must speak with their doctor if they do not experience any improvement or experience any side effects from the medicinal drugs.

However, antidepressants should be taken by patients only when they are prescribed by their doctors. If someone stops taking the medication once the symptoms start to improve, then it can result in a relapse. It should be noted that medications used in treatment for major depressive disorder are not safe for pregnant women or mothers who are breastfeeding.

Moreover, children, adolescents, and young adults may experience serious suicidal tendencies in the initial weeks of taking antidepressants. Hence, the patients should be observed closely and cared for at all times.

2. Psychotherapy

Psychological therapy or talk therapy can be a helpful treatment option for major depressive disorder. It includes therapy techniques like cognitive-behavioral therapy (CBT), interpersonal psychotherapy, problem-solving therapy, and others. Therapy requires that the patient interacts with the therapist regularly and talks about his/her condition, feelings, and related problems.

A person suffering from major depression can fully recover with a combination of psychotherapy and medications. In fact, CBT has proven to be highly effective in treating depression 23. However, the duration of major depressive disorder treatment depends on the severity of the condition, lasting from a few weeks to a few months.

Psychotherapy can help an individual to:

  • Cope with emotional problems
  • Accept and adjust to stress or a mental crisis
  • Remove negative thoughts and behaviors
  • Reinforce positive thoughts and behaviors
  • Understand how depression affects their mood
  • Improve communication and relationships
  • Devise effective self-help strategies
  • Cope better with problems and challenges
  • Boost self-esteem
  • Regain control in their life

Read More About Psychotherapy Here

3. Electroconvulsive therapy (ECT)

When medications and psychotherapy prove ineffective, a mental health professional may recommend electroconvulsive therapy (ECT 24) to relieve the symptoms of major depressive disorder. ECT is commonly used for people with severe major depression or bipolar disorders, especially those who do not respond well to other types of treatment. It requires the doctor to put the patient under anesthesia and apply brief electrical stimulation to the brain.

This type of major depressive disorder treatment involves several sessions over a stipulated period of time, usually two to four weeks. Although it may cause some short-term side effects, ECT is not painful. It is an effective and safe treatment option for a majority of patients with major depression.

Read More About Treatment Of Depression Here

Self-help And Coping Strategies

Self-Help-Tools-To-Cope-With-Depression
Major Depressive Disorder (Depression)

People who suffer from major depressive disorder can benefit a lot by educating themselves about the disorder. Psychoeducation will not only enable them to understand their condition and how it affects them, but it will also help them to formulate several self-help strategies to relieve the symptoms.

Several coping strategies can help people with MDD reduce the symptoms. However, self-help techniques for coping with depression have proven to be most effective when used along with medication and therapy under the guidance of mental health professional.

Here are some self-help tools that can help someone with major depression cope with the illness:

1. Lifestyle changes

Changing daily habits can help to improve symptoms of major depressive disorder. By replacing bad habits with healthier ones, an individual can develop a positive mindset and improve his/her mood over time. By setting realistic goals and continually educating themselves about depression, a person can improve his/her mood gradually.

Moreover, getting quality sleep and avoiding smoking 25 and alcohol use can also help in reducing the symptoms of major depressive disorder.

2. Exercise

Physical exercise has proven to be highly effective in treating MDD. Research shows that it has improved treatment outcomes 26 for depressed patients when teamed with cognitive-behavioral therapies.

Exercising regularly greatly helps with managing the symptoms of clinical depression—so much so that it is considered an effective alternative to medication and therapy. Moreover, relaxed breathing exercises 27, yoga 28, meditation 29, and mindfulness 30 practices have also been proven to be helpful in alleviating the symptoms of MDD.

Read More About Cognitive Behavioral Therapy (CBT) Here

3. Diet and nutrition

Food plays a crucial role when it comes to sound mental health and depression. According to a 2019 study 31, a diet intervention can help relieve depression symptoms in young adults. The same study found that symptoms of depression can be reduced by adding the following foods into a person’s regular diet:

  • Fish
  • Fruits
  • Vegetables
  • Olive oil
  • Wholegrain cereals
  • Protein (lean meat, poultry, eggs)
  • Unsweetened dairy
  • Nuts and seeds spices (turmeric and cinnamon)

4. Support

The support of family and friends can play a big role in the patient’s recovery from major depressive disorder. Not only should the patient’s loved ones educate themselves about clinical depression, but also they should encourage the patients to seek and continue treatment.

Moreover, talking to a trusted family member or friend can help in lifting their moods and communicating their inner thoughts. The patient should also avoid isolating himself/herself and allow others to provide support.

Read More About Coping Strategies For Depression Here

Takeaway

Major depression is a serious mental illness that can be effectively treated with timely and prompt diagnosis and treatment. If you or someone you know is suffering from depression, then the first thing to do is visit a primary care physician or mental health professional. But it is also important to stick with the treatment program to improve the patient’s perspective in life and enable his/her full recovery to live a happier and better life.

Major Depressive Disorder At A Glance 

  1. Major depressive disorder (MDD), generally known as depression, is a mood disorder characterized by chronic sadness, despair, and even suicidal thoughts.
  2. MDD affects our thinking, mood, behavior, and physical wellbeing.
  3. It can be of various types.
  4. It alters regions of the human brain that regulate mood.
  5. It is commonly addressed with a combination of medication, psychotherapy, and social support.

Frequently Asked Questions (FAQs)

1. Is major depressive disorder a disability?

Major depressive disorder is a crippling psychiatric disorder that negatively impacts our quality of life by affecting our personal and professional lives and social relationships.

2. How to know when I should seek treatment for depression?

If your depressed mood lasts for more than two weeks or you feel its debilitating impact on your everyday functioning (like at work or with your social life) or you are contemplating suicide—it is a good idea to seek treatment for depression.

3. What goals should I set for my major depressive disorder?

Try setting short-term goals like finishing a household chore, getting out of bed, joining a gym club, meeting new people, etc. It can make you feel that you are taking control of your life and returning healthily to your normal schedule.

4. What could be some biological reasons for developing depression after traumatic events?

The biological risk factors for depression include genes, hormonal imbalances, and dysfunction of brain chemicals. So, depressive episodes trigger when a family unit has a history of depression.

5. What is the difference between major depressive disorder and persistent depressive disorder?

Major depressive disorder involves bouts of depressive episodes, separated by at least 2 months. On the other hand, the symptoms of persistent depressive disorder (PDD) last for at least 2 years in adults.

6. Can schizoaffective disorder and major depressive disorder coexist at the same time in the same person?

Most mental illnesses are ‘spectrum disorders’ that exist simultaneously with each other. So major depressive disorder can parallelly coexist with schizophrenia and bipolar disorders in the same person.

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