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 with everyday 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 multiple times.

What are the causes?

• Your personality traits.
• Learned or conditioned behaviors or thoughts or feelings that reinforce negativity.
• Any alcohol or substance misuse.
• Long-term (chronic) physical or mental health illness.
• Going through a traumatic experience or major life changes.

What increases the risk?

• A family history of depression.
• Being a woman.
• Troubled family relationships.
• Abnormally low levels of certain brain chemicals.
• Traumatic or painful events in childhood, especially abuse or loss of a parent.
• A lot of stress from life experiences, such as poor living conditions or discrimination.
• Chronic physical illness or other mental health disorders.

What are the signs or symptoms?

• Constant depressed or irritable mood.
• A loss of interest in things and activities.

• Sleeping or eating too much or too little.
• Unexplained weight gain or weight loss.
• Tiredness or low energy.
• Being agitated, restless, or weak.
• Feeling hopeless, worthless, or guilty.
• Trouble thinking clearly or making decisions.
• Thoughts of suicide or thoughts of harming others.
• Isolating oneself or avoiding other people or activities.
• Trouble completing tasks, work, or any normal obligations.

• 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.

How is this diagnosed?

• Your symptoms.
• Your medical and mental health history. You may be asked questions about your lifestyle, including any drug and alcohol use.
• A physical exam.
• Blood tests to rule out other conditions.

• Either a depressed mood or loss of interest.
• At least four other MDD symptoms.

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:

Activity

• Exercise regularly and spend time outdoors.
• Find activities that you enjoy doing, 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.

Alcohol and drug use

• If you drink alcohol:
  • Limit how much you use to:
    • 0–1 drink a day for women who are not pregnant.
    • 0–2 drinks a day for men.
  • Be aware of 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).
  • Discuss your 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.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Eat a healthy diet and get plenty of sleep.
• Consider joining a support group. Your health care provider may be able to recommend one.
• Keep all follow-up visits as told by your health care provider. This is important.

Where to find more information

• National Alliance on Mental Illness: www.nami.org
• U.S. National Institute of Mental Health: www.nimh.nih.gov

Contact a health care provider if:

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

Get help right away if:

• You self-harm.
• You have serious thoughts about hurting yourself or others.
• You hallucinate.

• Call your local emergency services (911 in the U.S.).
• Call a suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255 or 988 in the U.S. This is open 24 hours a day in the U.S.
• Text the Crisis Text Line at 741741 (in the U.S.).

Summary

• Major depressive disorder (MDD) is a mental health condition. 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.
• The symptoms of MDD can interfere with relationships and with everyday activities.
• Treatments and support are available for people who develop MDD. You may need more than one type of treatment.
• Get help right away if you have serious thoughts about hurting yourself or others.