Major Depressive Disorder, Adult

Major depressive disorder (MDD) is a mental health condition. It may also be called clinical depression or unipolar depression. MDD causes symptoms of sadness, hopelessness, and loss of interest in things. These symptoms last most of the day, almost every day, for 2 weeks. MDD can also cause physical symptoms. It can interfere with relationships and activities, such as work, school, and activities that are usually pleasant.

MDD may be mild, moderate, or severe. It may be single-episode MDD, which happens once, or recurrent MDD, which may occur many times.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

• A family history of depression.
• Being female.
• Long-term (chronic) stress, physical illness, other mental health disorders, or substance misuse.
• Trauma, including:
  • Family problems.
  • Violence or abuse.
  • Loss of a parent or close family member.
  • Experiencing discrimination.

What are the signs or symptoms?

• Constant depressed or irritable mood.
• A loss of interest in activities.
• Sleeping or eating too much or too little.
• Tiredness or low energy.

• Unexplained weight gain or weight loss.
• Being agitated, restless, or weak.
• Feeling hopeless, worthless, or guilty.
• Trouble thinking clearly or making decisions.
• Thoughts of suicide or harming others.
• Spending a lot of time alone.
• Not being able to complete daily tasks or work.

• Psychotic depression.This may include false beliefs or delusions. It may also include seeing, hearing, tasting, smelling, or feeling things that are not real (hallucinations).
• Chronic depression or persistent depressive disorder. This is low-level depression that lasts for at least 2 years.
• Melancholic depression, or feeling extremely sad and hopeless.
• Catatonic depression, which includes trouble speaking and trouble moving.
• Seasonal depression, which is caused by changes in the seasons.

How is this diagnosed?

• Your symptoms.
• Your medical and mental health history.
• A physical exam.
• Blood tests to rule out other conditions.

MDD is confirmed if you have either a depressed mood or loss of interest and at least four other MDD symptoms, most of the day, nearly every day, in a 2-week period.

How is this treated?

• Psychotherapy, also called talk therapy or counseling. Types of psychotherapy include:
  • Cognitive behavioral therapy (CBT). This teaches you to recognize unhealthy feelings, thoughts, and behaviors, and replace them with positive thoughts and actions.
  • Interpersonal therapy (IPT). This helps you to improve the way you communicate with others or relate to them.
  • Family therapy. This treatment includes members of your family.
• Medicines to treat anxiety and depression. These medicines help to balance the brain chemicals that affect your emotions.
• Lifestyle changes. You may be asked to:
  • Limit alcohol use and avoid drug use.
  • Get regular exercise.
  • Get plenty of sleep.
  • Make healthy eating choices.
  • Spend more time outdoors.
• Brain stimulation. This may be done if symptoms are very severe and other treatments have not worked. Examples of this treatment are electroconvulsive therapy and transcranial magnetic stimulation.

Follow these instructions at home:

Alcohol use

• Do not drink alcohol if:
  • Your health care provider tells you not to drink.
  • You are pregnant, may be pregnant, or are planning to become pregnant.
• If you drink alcohol:
  • Limit how much you have to:
    • 0–1 drink a day for women
    • 0–2 drinks a day for men.
  • Know how much alcohol is in your drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).

Activity

• Exercise regularly and spend time outdoors.
• Find activities that you enjoy and make time to do them.
• Find healthy ways to manage stress, such as:
  • Meditation or deep breathing.
  • Spending time in nature.
  • Journaling.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Discuss alcohol use with your health care provider. Alcohol can affect any antidepressant medicines you are taking.
• Discuss any drug use with your health care provider.
• Eat a healthy diet and get enough sleep.
• Consider joining a support group. Your health care provider may be able to recommend one.
• Keep all follow-up visits. It is important for your health care provider to check on your mood, behavior, and medicines. Your health care provider will make changes to your treatment as needed.

Where to find more information

• National Alliance on Mental Illness: nami.org
• National Institute of Mental Health: nimh.nih.gov
• American Psychiatric Association: psychiatry.org

Contact a health care provider if:

• Your symptoms get worse.
• You develop new symptoms.

Get help right away if:

• You hurt yourself on purpose (self-harm).
• You have thoughts about hurting yourself or others.
• You have hallucinations.

• Call 911.
• Call the National Suicide Prevention Lifeline at 1-800-273-8255 or 988. This is open 24 hours a day.
• Text the Crisis Text Line at 741741.