Major depressive disorder (MDD), also called clinical depression, is a debilitating condition that impacts about 20 million people in the U.S. each year.1 Symptoms of MDD range from mild irritability to an extremely low mood with suicidal thoughts, and can also affect sleep and appetite. Clinical depression is treatable, and professionals may recommend therapy, medication, lifestyle changes, or a combination.
What Is Major Depressive Disorder?
Major depressive disorder is a depressive disorder affecting countless people each day. The primary markers of MDD are depressed mood and loss of interest or loss of pleasure, but a person could have MDD without either of these symptoms.2 The condition has the power to negatively affect a person’s physical, mental, and spiritual health in profound ways.
MDD vs. Sadness
At times, people may mistake moments of sadness for MDD. Many people experience intense feelings of sadness without meeting all of the criteria for a diagnosis of MDD.2 Sadness is an expected part of life and should not be considered depression. A mental health professional can help explain the differences between typical and atypical levels of sadness.
MDD vs. Other Depressive Disorders
Other types of depression like persistent depressive disorder, disruptive mood dysregulation disorder, and unspecified depressive disorder share many symptoms with MDD. The main differences will involve the frequency, duration, and intensity of symptoms.2
Differentiating between MDD and another depressive disorder or between expected levels of sadness and depression can prove difficult. Spend some time reflecting on your symptoms, situations, and stressors, and if you’re unsure about your symptoms, or they point to depression, be sure to reach out to a mental health professional.
Psychologists, psychiatrists, and therapists have the experience and education needed to note the difference between expected and unexpected feelings while devising a treatment plan aimed at relieving your symptoms.
Symptoms of Major Depressive Disorder
The symptoms of clinical depression are:2
- Feelings of sadness, hopelessness, emptiness, or a high level of irritability
- Increased or decreased need for sleep
- Increased or decreased appetite with or without weight changes
- Decreased energy
- Less interest in activities and interests
- Feeling or appearing sped up or slowed down
- Poor concentration and decision-making skills
- Feeling worthless and guilty with low self-esteem
- Thinking about death, dying, and suicide
For MDD to be diagnosed, at least five of the symptoms listed above must be present, and at least one must be having a depressed mood or loss of interest or pleasure in activities. The symptoms must present nearly every day and most of the day for two weeks to count as MDD. Also, these symptoms must negatively influence performance and ability to function at home, work, school, and in the community.2
To be considered MDD, symptoms cannot be due to the effects of a substance or a medical condition. It is important to see a physician to rule out any physical problems that may be contributing to symptoms.
What Major Depressive Disorder Looks Like
Depression signs and symptoms may present very differently from person to person. Depression may invoke the image of a person weeping in bed with the curtains drawn unable to muster the energy to engage in routine activities of daily living. This view may be true for some, but there are other presentations.
Adolescents and teens may present with more anger and irritability, while depressive symptoms in older adults may go unnoticed due to different views of aging. A man with depression could experience high levels of anger, irritability, and aggression than a woman.4 A child with depression may express more physical symptoms.
Major Depression Severity & Specifiers
Low motivation, sadness, and increased need for sleep are common in typical depression, but there are many facets of major depressive disorder. Major depressive disorder can vary by the severity of symptoms, the recurrence of symptoms, and a list of specifiers that describe the distinct properties of the individual’s condition.
Major Depression Severity
Experts distinguish major depressive disorder by three levels of severity:2
- Mild: With mild MDD, sometimes referred to as high-functioning depression, a person will have few symptoms of the condition, and the symptoms they do have are limited. The symptoms will not impair the person’s functioning, and their loved ones may not even perceive the depression.
- Moderate: Moderate MDD represents a level of depression that may create noticeable changes to the person’s presentation and performance at home, work, or school. There will be more symptoms or more intense symptoms.
- Severe: When the MDD is severe, the person will have many intense symptoms. The symptoms will cause so much distress that the person is unable to maintain employment, social relationships, and household responsibilities.
Along with the severity, experts differentiate depression by the frequency of symptoms. A person could experience a single episode of depression or recurrent episodes if symptoms alleviate and then return later.
Major Depressive Disorder Specifiers
Major depressive disorder specifiers describe additional aspects of the condition.
The most common specifiers of MDD include:2
- Psychotic features: MDD with psychotic features can produce many harmful symptoms like delusional thinking or hallucinations.
- Peripartum onset: Peripartum onset refers to depression that first emerges during pregnancy or in the weeks soon after birth.
- Seasonal pattern: Though it may be referred to as seasonal affective disorder, MDD with seasonal pattern involves symptoms worsening and improving based on the seasons.
- Anxious distress: This specifier is added to the diagnosis when a person reports anxiety symptoms only during a period of depression.
Risk Factors for Clinical Depression
Clinical depression affects all people without regard to their age, gender, cultural background, or religion. Signs and symptoms of major depressive disorder are common in the U.S. as well as around the world. Though it is impossible to predict who will have MDD, certain risk factors can increase the odds of a major depressive episode.
Some risk factors for depression are:3
- Individual differences in brain structure and functioning
- Genetics and other family members who have depression
- Personality issues like chronic low self-esteem and a pessimistic world view
- Environmental factors like trauma, abuse, neglect, poverty, and chaotic environments
Clinical Depression in Different Populations
The National Institute of Mental Health (NIMH) found trends of depressive episodes that exist in certain groups. Those with high rates of depression include adult and adolescent females, teens and young adults, Native Americans, and multiracial people. On the other end of the spectrum, groups with relatively low rates of depression include Asian American adults and African American adolescents.
Differences in rates of MDD and depressive episodes may be explained by cultural expectations, as well as the ways specific groups express and accept mood symptoms. Regardless, no group is immune from depression.1
Treatment of Clinical Depression
With a professional treatment plan, usually consisting of therapy, medication management, and lifestyle changes, depressive symptoms can improve. There is no set treatment appropriate for all people, so each person should have an approach tailored to their individual needs, abilities, and goals.
Therapy for Major Depressive Disorder
Psychotherapy, or talk therapy, typically involves a person meeting with a therapist to identify and treat symptoms linked to depression. There are many types of therapy that can be used to treat MDD, but common options include Cognitive Behavioral Therapy, Interpersonal Therapy, or Acceptance and Commitment Therapy. Online and in-person therapy options each carry specific benefits and risks, but helpful therapy can occur in-person or online.
About 40% of people with mild depression who address their symptoms quickly may see improvement in three months, while 80% will see improvement within one year. Many may never see a complete elimination of depressive symptoms with therapy, but therapy may still prove helpful as a way to prevent symptoms from escalating.2
Medication for Clinical Depression
Therapy is a useful tool, and the benefits can increase with the addition of antidepressant medications to the treatment plan. Many medications are available for the treatment of depression, including SSRIs, SNRIs, atypical antidepressants (such as Auvelity [dextromethorphan-bupropion]), or MAOIs.5 People interested in medication for depression should always communicate with their prescriber when starting a new medication to limit adverse effects and find the best treatment options.
Lifestyle Changes & Self Help for MDD
Lifestyle changes are not substitutes for professional treatment, but they may support and boost the effects of therapy and medication.
Some helpful lifestyle changes for clinical depression include:4
- Spending more time with loved ones
- Sharing thoughts and feelings with trusted supports
- Increasing physical activity; even 10 minutes of walking per day can reduce symptoms
- Spending time in nature
- Focusing on smaller tasks and doing one thing at a time
- Building a stable routine that involves eating and sleeping at the same times each day
- Avoiding alcohol and other drugs
- Avoiding making major life decisions when symptoms are high
- Finding and engaging in online or local support groups
How to Get Help for Clinical Depression
Getting help for MDD does not have to be a complicated process. Once a person has made the decision to get help, a phone call to a trusted friend or mental health professional is a great way to get started.
Some other ways to get help for MDD include:
- Sharing concerns and symptoms with the primary care physician or another doctor
- Searching an online therapist directory where you can filter for a professional who specializes in depressive disorders
- Calling a local mental health agency
- Contacting the insurance company for information on covered providers
- Phoning a mental health helpline
- If you’re not as keen on in-person options, you could peruse the current best online therapy options
How to Get Help for a Loved One
The most important thing you can do to help a loved one with MDD is to approach the situation from a position of love, compassion, and understanding to let the loved one know you care. A loved one does not need to know all the answers. They need to be willing to help.
To help a loved one who is experiencing MDD, you can:3
- Offer support and patience
- Spend time with them engaged in healthy activities
- Listen carefully to their concerns and offer realistic suggestions
- Stay optimistic and hopeful for the future
- Help them with transportation or attend appointments
Safety is a high priority when your loved one has symptoms of depression. If your loved one appears very depressed and states an interest and plan to attempt suicide, take immediate action by calling 9-1-1. Doing so can avoid a dangerous situation and get your loved one the treatment they need.
How to Get Help for a Child
To help a child who you suspect is experiencing depression, contact their pediatrician or schedule an evaluation with a treatment center. Identifying depression in children and teens can be misleading, so it is best to leave this to the professionals.
Parents can help by pointing out their concerns to the child and emphasizing the benefits of treatment. Avoid assigning guilt and blame or expressing disappointment about the situation. Instead, establish a care team to fight against depression.
Major Depressive Disorder vs. Bipolar Disorder, ADHD, & Substance Use Disorders
Accurate diagnosis is essential to adequately treat clinical depression, but several conditions are easily confused with the disorder.
Other mental health conditions that overlap with MDD are:2
MDD vs. Bipolar Disorder
MDD and bipolar disorder share the presence of major depressive episodes, but bipolar disorders require the existence of a manic or hypomanic episode for the diagnosis. Manic and hypomanic episodes commonly come with a decreased need for sleep, high energy levels, increased self-esteem, and a tendency towards risky behaviors.2 Tracking symptoms and taking note of manic episodes will help identify the actual condition.
MDD vs. ADHD
Attention-deficit/hyperactivity disorder (ADHD) and MDD both produce inattention, poor memory, and limited concentration. The main difference is that ADHD does not create the depressive symptoms like low mood, worthlessness, and low energy associated with MDD. People should consider all symptoms to determine the most likely diagnosis.2
MDD vs. Substance Use Disorders
Substance misuse, dependence, and withdrawal create a number of effects that mirror a depressive episode. Someone using drugs like sedatives and opioids or withdrawing from stimulants may display a depressed mood, low energy, low motivation, increased desire for sleep, and irritability. A person could have either MDD or a substance use disorder, but in many cases, they could have both.2 Every person should be sure to offer all information to their provider, so they can make the proper diagnosis.
MDD & Co-Occurring Disorders
When someone has major depressive disorder, there is a strong chance they will have at least one other disorder as well.
MDD frequently co-occurs with other mental health conditions, including:2
- Substance use disorders
- Anxiety disorders including panic disorder
- Obsessive-compulsive disorder
- Eating disorders including anorexia and bulimia
- Borderline personality disorder
Clinical Depression Tests & Self-Assessments
Those interested in learning more about MDD may be drawn to depression tests, quizzes, and self-assessment tools, but they should always seek professional help if they suspect any form of depression.
Mental Health Evaluation
Only a mental health professional can accurately diagnose the presence of major depressive disorder. Since there are no tests, brain scans, or blood tests to check for depression, the evaluator will ask a series of questions to understand the symptoms, their onset, intensity, and impact to determine the appropriate diagnosis.3
Medical professionals can also ensure that there is no underlying physical health disorder triggering the depressive symptoms. Simple testing and lab work can rule out the influence of a physical condition.
Self-Assessments for Clinical Depression
To assess whether your symptoms may align with depression, a self-assessment can be a helpful place to start, and may help you know whether to contact a professional for your symptoms:
Final Thoughts on MDD
Some people may feel compelled to address their major depressive disorder without professional intervention, but this path could be a mistake. Contacting a trusted support to share your situation is a safe way to start the recovery process. Seeking professional guidance with therapy and medication management can drastically reduce symptoms and boost overall well-being. With a concerted effort and persistence, symptoms of major depressive disorder can improve.
For Further Reading
Major Depressive Disorder Infographics
