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Major Depressive Disorder (Clinical Depression)

What is major depressive disorder?

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. However, these feelings are normally short-lived. When someone experiences persistent and intense feelings of sadness for extended periods of time, then they may have 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. People with MDD often lose interest in activities they once enjoyed and have trouble performing everyday activities. Occasionally, they may also feel as if life isn’t worth living.

MDD is one of the most common mental disorders in the United States. In 2015, nearly 7 percent of Americans over age 18 had an episode of MDD.

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

What are the symptoms of major depressive disorder?

Your doctor or a mental health professional can make a MDD diagnosis based on your symptoms, feelings, and behavior patterns. They will ask you certain questions or give you a questionnaire so they can better determine whether you have MDD.

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 have 5 or more of the following symptoms, and experience them at least once a day for a period of more than 2 weeks:

  • You feel sad or irritable most of the day, nearly every day.
  • You are 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 committing suicide.

What causes major depressive disorder?

The exact cause of MDD isn’t known. 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. Changes in the balance of hormones might also contribute to the development of MDD.

MDD may also be trigged by:

  • alcohol or drug abuse
  • certain medical conditions, such as cancer or hypothyroidism
  • particular types of medications, including steroids

How is major depressive disorder treated?

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 the hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.

Medication

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

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. 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.

Other medications. Tricyclic antidepressants and medications known as atypical antidepressants may be used when other drugs haven’t helped. They can cause several side effects, including weight gain and sleepiness.

Note: Some medications used to treat MDD aren’t safe for women who are pregnant or breastfeeding. Make sure you speak with your healthcare provider if you become pregnant, you’re planning to become pregnant, or you’re breastfeeding your child.

Suicidal thoughts warning
If you start taking antidepressants and have suicidal thoughts, call your doctor or 911 right away. Although it’s a rare occurrence, some MDD medications can cause suicidal thoughts in people who have just started treatment. Talk to your doctor about concerns you may have about taking medications that pose this risk.

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.

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.

What is the outlook for someone with major depressive disorder?

People with MDD can feel hopeless at times, but it’s important to remember that the disorder can typically be treated successfully. 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 sad despite treatment, it can be helpful to call the National Suicide Prevention Lifeline or a local crisis or mental health service. These free, 24-hour phone lines take calls from anyone feeling depressed or anxious. A friendly, supportive voice could be just what you need to get you through a difficult time.

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