Major Depressive Disorder

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Major depression is a serious psychiatric disorder that afflicts millions of people. For some individuals, it is a singular event. However, many people experience recurrent major depressive episodes during their lifetime.

There are different types of depression listed in the DSM. Major depressive disorder is generally one of the more serious kinds of depression, with symptoms ranging from mild to severe. It’s normal to experience bouts of sadness, the “blues”, or feeling down for a few days. But when those feelings persist and significantly interfere with your life, a diagnosis of major depression may be appropriate.


In order to meet the criteria for a diagnosis of major depressive disorder, you must be experiencing at least 5 of the symptoms below, almost every day, for at least 2 consecutive weeks.

One of the symptoms must be a depressed mood or a notable loss of interest or pleasure in most, if not all, of your activities. The symptoms must impair your functioning in your work, social life, and other important areas and / or create significant distress in your life.

Symptoms for diagnosis of major depressive disorder:

  • Depressed mood (which may be experienced as sadness, hopelessness, emptiness, or feeling down); with children and teens, the predominant mood may be irritable
  • Loss of interest in, or inability to gain pleasure from, activities once enjoyed (this may include a loss of libido as well)
  • Significant weight loss or gain without dieting, or a notable change in appetite
  • Significant change in sleep patterns (i.e. sleeping much less or much more than normal)
  • Restlessness, agitation, or feeling “slowed down”
  • Fatigue or loss of energy
  • Inappropriate or excessive feelings of guilt; feelings of worthlessness
  • Problems with concentration, thinking, or decision making
  • Suicidal ideation (which may or may not include a plan or actual attempt) or recurring thoughts of death

A diagnosis of major depressive disorder is not made if any of the following criteria are met:

  • The criteria are also met for a manic episode (in which case the diagnosis would be “mixed episode” rather than major depressive disorder).
  • There is a history of a manic or hypomanic episode (in which case bipolar disorder I or II would be a more appropriate diagnosis).
  • The symptoms are more likely due to bereavement (grief due to the loss of a loved one).
  • The symptoms are directly caused by a substance (e.g. a medication or street drug) or medical condition.


The exact cause of major depressive disorder is not known. However, it is most likely due to a combination of factors which may include genetic predisposition, biochemistry, environment, personality, learned responses, and life events.

Risk factors for major depressive disorder

Major depressive disorder can affect anyone. However, women are more likely than men to develop this disorder. Other risk factors include family history of depression, previous episodes of depression, a history of child abuse or trauma, and the presence of other psychiatric disorders including borderline personality disorder, schizophrenia, OCD, eating disorders, and substance abuse disorders.

Treatment for major depressive disorder

The treatment for major depressive disorder typically includes psychotherapy and / or medication. Studies have shown that cognitive behavioral therapy (CBT) is one of the most effective types of therapy for all types of depression. It focuses on the underlying negative thought patterns and irrational or limiting beliefs that are typically associated with the disorder.

Medication can help bring certain brain chemicals (e.g. serotonin) back into balance, which may reduce depressive symptoms. The most frequently prescribed medications for depression are SSRIs (selective serotonin reuptake inhibitors). Medication does not work for everyone and is generally most effective if used as an adjunct to psychotherapy. For many individuals, finding a medication that is effective and has tolerable side effects often involves trial and error. If the underlying issues are not addressed, symptoms often return once medication is discontinued.

If the depressive symptoms are severe and there is a risk of suicide, short-term hospitalization may be necessary for safety and stabilization.

There are many natural remedies and lifestyle that may help reduce depressive symptoms. These include regular aerobic exercise (e.g. running, brisk walking, swimming), meditation, yoga, and supplements (e.g. fish oil, St. John’s Wort).

If you have been experiencing symptoms of depression and / or suicidal thoughts, please contact a healthcare professional right away. In most cases, major depression is very treatable.

Related Reading

Sample list of drugs used to treat depression


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