Major Depressive Disorder

What is Major Depressive Disorder (MDD)?

Major Depressive Disorder (MDD) is a psychiatric diagnosis made when an individual has a persistently low or depressed mood, anhedonia (lack of interest, enjoyment or pleasure from life's experiences), feelings of guilt or worthlessness, changes in of energy, changes in concentration, appetite changes, psychomotor changes (moving faster or slower than usual), sleep disturbances, and/or suicidal thoughts for a period of at least 2 weeks.

People of all ages and all racial, ethnic and socioeconomic backgrounds experience MDD, and MDD can present with different symptoms, depending on the person.

What causes MDD?

The cause of MDD is believed to be multifactorial, including biochemical (your body and how it functions), genetic (your family medical history), environmental (the things around you both past and present), and psychosocial (your experiences and relationships) factors. In the brain, MDD is currently theorized to be due to changes in neural circuits causing differing levels of neurotransmitters, especially serotonin, norepinephrine, and dopamine.

What’s the difference between MDD and being “depressed”?

It’s normal to feel sad when you’re faced with difficult life situations. Some people may say they feel “depressed” during these situations. MDD is different in that it is a clinical diagnosis made by a healthcare provider. It can be confusing because many people may call MDD (or other types of depressive disorders such as Persistent Depressive Disorder) just “depression,” and additionally many people without a diagnosis of MDD say they are feeling “depressed.” To help avoid confusion, we recommend describing feelings with terms such as “sad” or “down,” and describing a diagnosis with clear language such as “clinical depression” or “major depressive disorder.”

are there treatments for mDD?

A number of treatments exist for MDD and other depressive disorders, such as medications (including antidepressants, mood stabilizers, and antipsychotic medications), talk therapy (including Cognitive Behavioral Therapy, interpersonal therapy, and group therapy), brain stimulation therapies (including Transcranial Magnetic Stimulation for severe depression or Electroconvulsive Therapy for depressive disorder with psychosis), and alternative therapies (including acupuncture, nutritional adjustments, and more). There are also a number of coping strategies and habits you can do to help reduce or manage symptoms of depression, such as regular exercise, sufficient quality sleep, balanced nutrition, avoiding alcohol (a depressant), ecotherapy, meditation, and more.

The take-home message here is: there are numerous treatments that exist for MDD, so help exists, and if one method doesn’t work for you there are other approaches that you can try. You should always consult with your mental health professional about your treatment plan.

Here’s what people with MDD want you to know:

“[MDD] doesn’t always come alone. Comorbidities are the worst part of it for me.”

-Trisha T. (Georgia Tech)

“Taking the medication I need for depression doesn’t make me weak, it makes me healthy.”

-Alex P. (University of Virginia)

“My anxiety and depression will not define who I am or what I can/cannot do.”

-Julia M. (Syracuse University)

“[MDD] is still something I must fight every day. That does not mean I am not healing.”

-Mary W. (Villanova University)

“It’s more than just being sad. [It can mean] having no motivation.”

-Rachel A. (Georgia Tech)

Where to go for help with mdd:

• Your primary care physician (these are typically doctors specializing in Family Medicine or Internal Medicine)

• A psychiatrist (a doctor specializing in Psychiatry)

• A psychologist (a mental health provider with a PhD os PsyD degree), therapist, or counselor (note that these providers cannot prescribe medications but can provide valuable interventions such as therapy)

WHEN Do I go The Doctor?

• If you experience one or more of the symptoms of MDD (loss of interest in activities, appetite and weight changes, changes in sleep patterns, slowing of physical activity or thinking, decreased energy, feelings of worthlessness or guilt, changes in concentration, thoughts of suicide)

• If any of your symptoms cause you distress or impair your day-to-day functioning

• Any thoughts of suicide should prompt emergency treatment. Please call/see your physician, call 988, or visit your local emergency department if you have any thoughts of suicide.

When in doubt, see a healthcare provider or mental health professional. They can give you an accurate diagnoses, suggest treatment options, and recommend a different treatment plan if one isn’t working.

HOW Do I find a provider that takes my insurance/form of payment?

• Visit your insurance provider’s website and locate the provider finder page. This should assist you in finding care in your area that accepts your insurance.

• Call your insurance provider to have them assist you in finding a provider in your area.

• Use FindTreatment.gov.

• See “Mental Health Providers: Tips on Finding One” for more tips and suggestions.

With all that being said, this is your reminder that you don’t need to be a psychiatrist or psychologist to discuss your mental health or to be an empathetic ear to a friend. All you need is an open mind.

Where Can I Learn More?

• Wondermind, Here’s What Depression Actually Is (and Isn’t)

• National Alliance on Mental Illness, About Mental Illness, Depression

• American Psychiatric Association, Patients and Families, Depression

what people with mdd or feelings of depression have to share with you:

Disclaimer: The information above is intended to provide education regarding Major Depressive Disorder. It is not medical advice and should not be used for medical diagnosis. For questions regarding diagnosis, treatment, and more regarding any mental health conditions, contact a mental health professional.

Published: December 2, 2023.

Written by Alexandra Lawlor (Medical Student), Edited by Max Smith (Medical Student).

References:

1. Bains N, Abdijadid S. Major Depressive Disorder. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: National Institute of Health, National Library of Medicine https://www-ncbi-nlm-nih-gov/books/NBK559078/

2. Alan Glenberg, MD, American Psychiatric Association. Depression. https://www.psychiatry.org/patients-families/depression. Accessed November 2023.

3. National Alliance on Mental Illness. Depression. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression. Accessed November 2023.

4. Johns Hopkins Medicine. Major Depression.

5. Cleveland Clinic. Clinical Depression (Major Depressive Disorder). https://my.clevelandclinic.org/health/diseases/24481-clinical-depression-major-depressive-disorder#symptoms-and-causes. Accessed November 2023.

6. Substance Abuse and Mental Health Services Administration. What is Depression? https://www.samhsa.gov/mental-health/depression. Published April 24, 2023. Accessed November 2023.