Major Depressive Disorder: Types, Symptoms, & Treatments

What Is Clinical Depression?

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.

Depression Vs. Sadness

At times, people may mistake moments of sadness for depression. 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. 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.

How Common Is MDD?

Approximately 280 million people worldwide have depression. That breaks down to about 3.8% of the population, or about 5% of all adults. Women are twice as likely to have depression than men. Approximately 10% of pregnant women and postpartum women have depression. Subsequently, suicide, which often coincides with depression, is associated with more than 700,000 deaths each year.³

Major Depressive Disorder Symptoms

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.

MDD Symptoms in Children & Teens

The symptoms of clinical depression in children and teens include:

• Feelings of sadness, hopelessness, emptiness, or a high level of irritability
• Social withdrawal or difficulty with relationships
• Increased sensitivity to failure or rejection
• Indecisiveness
• Physical complaints of stomach issues, headaches, or fatigue
• Sudden decline in academic performance
• Increased or decreased need for sleep
• Increased or decreased appetite with or without weight changes
• Decreased energy
• Nightmares and night terrors
• Regressive behavior in young children (i.e. bedwetting, clinginess to caregivers)
• Less interest in activities they used to enjoy
• Feeling worthless and guilty with low self-esteem
• Thinking about death, dying, and suicide

MDD Symptoms in Older Adults

The symptoms of clinical depression in older adults include:

• Feelings of sadness, hopelessness, emptiness, or a high level of irritability
• Social withdrawal or difficulty with relationships
• Increased or decreased need for sleep
• Increased or decreased appetite with or without weight changes
• Decreased energy
• Cognitive or memory issues
• Increased sense of chronic pain
• Less interest in activities
• Feeling worthless and guilty with low self-esteem
• Thinking about death, dying, and suicide

Major Depression Can Be Mild, Moderate, & Severe

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 depending on more specific situations, like being postpartum or having a seasonal pattern.

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.

What Causes Major Depressive Disorder?

There is no known single cause of major depressive disorder. Instead, research points to a variety of factors that may increase one’s susceptibility to developing depression. While depression can emerge at any time, the average age of symptom onset is adolescence to young adulthood. However, symptoms in young children, in particular, may be overlooked.

Potential causes of depression can include:

• Brain chemistry: Differences in serotonin and dopamine neurons may be associated with depression.
• Hormones: Hormonal imbalances can coincide with depression symptoms, which may account for why symptoms may peak during hormonal changes associated with puberty, pregnancy, and menopause.
• Inherited traits: Depression often runs in families, and a combination of both genetic and environmental factors may speak to this phenomenon.

Risk Factors for Clinical Depression

Clinical depression affects all people without regard to their age, gender, cultural background, or religion. 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 include:⁴

• Individual differences in brain structure and functioning
• Having other family members with 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

Complications of Living With Major Depression

Living with major depression can undoubtedly be difficult. Without proper treatment or support, it can contribute to immense emotional distress and interference with one’s daily life. Depression can impact both physical and mental health, and untreated symptoms can worsen over the lifespan. Even if someone functions well, they still may struggle privately.

Long-term effects of depression include:

• Low self-esteem and low self-worth
• Relationship problems
• Financial issues
• Health problems
• Substance abuse
• Pronounced loneliness
• Job or academic problems
• Exacerbated mental health symptoms associated with other conditions
• Heightened risk of suicide

How Is Major Depressive Disorder Diagnosed?

Major depressive disorder is generally diagnosed via a psychiatric evaluation. These evaluations assess your mental health history, current symptoms, medical history, and current lifestyle habits. Qualified healthcare providers, such as primary care physicians, therapists, and psychiatrists, can diagnose depression. They will compare your current symptoms to the criteria listed in the DSM-5. They may also use the Beck Depression Inventory (BDI) as an assessment tool.

Major Depression Disorder Criteria

The DSM-5 is the standard classification of all mental disorders. It is published by the American Psychiatric Association (APA) and used by mental health professionals throughout the United States. The DSM-5 acts as a reference for diagnosing depression, and it provides guidance on using such diagnoses to establish treatment goals. In 2022, the APA published the revised copy of the DSM-5, the DSM-5-TR.

Five or more of the following criteria must be met for a diagnosis of clinical depression:

• Depressed mood
• Loss of interest or pleasure in almost all activities
• Significant (more than 5%) unintentional weight loss/gain or decrease/increase in appetite
• Sleep disturbance (insomnia or hypersomnia)
• Psychomotor changes
• Tiredness, fatigue, or low energy
• A sense of worthlessness or delusional guilt
• Impaired ability to think, concentrate, or make decisions
• Recurrent thoughts of death, suicidal ideation, or suicide attempts

The symptoms are not due to the direct physiological effects of a substance or medical condition, and they cause clinically significant distress or impairment in functioning. There has never been a manic episode or hypomanic episode, and the episode is not better explained by schizophrenia, other psychotic disorders, or bereavement. The symptoms persist most days or every day for at least two weeks in a row.

Major Depressive Disorder Treatment

With a professional treatment plan for depression, usually consisting of therapy, medication management, and lifestyle changes, 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

Therapy for depression typically involves a person meeting one-on-one 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 CBT for depression, 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

Antidepressant Medication

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, 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.

Other Treatment Options

Today, there are numerous cutting-edge treatments available for treating depression. The following methods may be used as standalone treatment. However, they may also be integrated with other forms of depression treatment. In many cases, they are recommended when there is little or no symptom improvement after trying other treatment options for depression.

Other treatment options for major depression include:

• ECT: ECT involves briefly stimulating the brain under anesthesia to cause seizures. This method may rapidly improve depressive symptoms.
• TMS: TMS uses magnetic fields to stimulate particular nerve cells. This approach can increase neuroplasticity, which can impact mental health problems, such as depression.
• VNS: VNS entails installing a pacemaker-like device within the body that sends electric impulses to the vagus nerve. This process can relieve depression symptoms.
• Ketamine and esketamine: Ketamine and esketamine are both used in depression treatment. They act as rapid antidepressants that can reduce depressive symptoms within hours.

Hospital & Residential Treatment Options

Someone may be hospitalized for depression if they are at grave danger of harming themselves or others. Residential treatment may be recommended for serious forms of depression, particularly if there is comorbid substance misuse, eating disorders, personality disorders, or other psychiatric concerns. Residential treatment offers 24/7 monitoring and stabilizing, which can help people in acute states of distress.

How to Get Out of a Depressive Episode

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:⁶

• Spending more time with loved ones
• Sharing thoughts and feelings with trusted supports
• Increasing physical activity; even 10 minutes of walking per day can help 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 Long Will Treatment Take Before I Feel Better?

Depression treatment varies, but someone should expect to feel better within a few weeks or months of consistent therapy. Antidepressants, which are commonly prescribed to treat depression, take between 4-8 weeks for the full effect to emerge. That said, treatment outcomes are unique, and if something isn’t working, it’s important to address your concerns.

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
• Looking into the best online therapy options available to you

If you’re ready to begin online therapy, Talkspace is an excellent choice for those with insurance. If you do not have insurance, there are several online depression therapy options to choose from, with one of the most accessible options being BetterHelp.

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:⁴

• 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.

Can Clinical Depression Be Prevented?

Clinical depression can’t be prevented. Depression isn’t your fault, and you aren’t choosing to experience such distress at this time. While this may at times feel frustrating, it can be empowering to recognize that you can make proactive steps to help yourself feel better. Many people live fulfilling lives despite their depression.

• Try to mitigate stress when possible: Stress can exacerbate depression, and depression can make things feel more stressful. Mindfulness, self-care, gratitude, and creative expression can all help reduce the impact of stress.
• Stay connected to loved ones: Isolating may be a tempting choice when you feel depressed, but it only tends to exacerbate depressive symptoms. Staying connected to positive support can help you feel better about yourself.
• Get treatment as soon as you sense a problem: Depression can worsen progressively over time. While there’s never a “wrong” time to seek support, getting help early can be beneficial for learning how to identify and manage your triggers. 
• Consider lifelong maintenance to prevent relapsing symptoms: Depression is considered a chronic disease. Many people benefit from having an ongoing plan to take care of themselves, particularly in times of stress or hardship.

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

What’s the Outlook for People With Clinical Depression?

The outlook for people with clinical depression varies based on several factors, including the current treatment, severity, and the presence of other medical or mental health conditions. Having a strong support system and staying actively engaged in treatment generally yields a better prognosis. Research shows that 40-60% of people taking antidepressants notice depression improvements within 6-8 weeks.⁷

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.