Clinical Depression (Major Depressive Disorder)

What is clinical depression (major depressive disorder)?

Clinical depressionalso known as major depressive disorder (MDD)is a mental health condition that causes a persistently low or depressed mood and a loss of interest in activities that once brought joy. Clinical depression can also affect how you sleepyour appetite and your ability to think clearly. These symptoms must be present for at least two weeks for a diagnosis.

Clinical depression is a chronic conditionbut it usually occurs in episodeswhich can last several weeks or months. You’ll likely have more than one episode in your lifetime. This is different from persistent depressive disorderwhich is mild or moderate depression that lasts for at least two years.

There are several subtypes of major depressive disorder. Some of the most common subtypes include:

• Seasonal affective disorder (seasonal depression).
• Prenatal depression and postpartum depression.
• Atypical depression.

People with clinical depression often have other mental health conditionssuch as:

• Substance use disorder (dual diagnosis).
• Panic disorder.
• Social anxiety disorder.
• Obsessive-compulsive disorder.

What is the difference between clinical depression and depression?

It’s normal to feel sad when you’re faced with difficult life situationssuch as losing your job or a relationship. Some people may say they feel depressed during these situations. Clinical depression (major depressive disorder) is different in that it persists practically every day for at least two weeks and involves other symptoms than just sadness alone.

It can be confusing because many people call clinical depression or major depressive disorder just “depression.” But there are several different types of depressive disorderssuch as persistent depressive disorder and premenstrual dysphoric disorder. Clinical depression is the most severe type of depression.

Who does clinical depression affect?

Clinical depression can affect anyoneincluding children and adults. Most cases tend to begin in your 20sbut it can develop at any age.

Clinical depression is more likely to affect women than men. It’s also more common in people without close interpersonal relationships and people who are divorcedseparated or widowed.

How common is clinical depression?

Clinical depression (major depressive disorder) is common. It’s one of the most common mental health conditions. It affects 5% to 17% of people at some point in their lives.

What are the symptoms of clinical depression (major depressive disorder)?

Symptoms of clinical depression can range from mild to severebut they typically last most of the daynearly every dayfor at least two weeks.

Signs and symptoms include:

• Feeling very sadempty or hopeless (low mood). Children and adolescents may be irritable rather than sad.
• Loss of interest in things and activities that used to bring joy.
• Increase or decrease in appetitewhich may result in weight gain or weight loss.
• Slowed speechdecreased movement and impaired cognitive function (psychomotor agitation).
• Trouble sleeping (insomnia) or sleeping too much (hypersomnia).
• Low energy or fatigue.
• Feeling worthless or excessively guilty.
• Decreased concentration.
• Thoughts of death or suicide.

If you or a loved one are thinking about suicidedial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.

What causes clinical depression?

Researchers don’t know the exact cause of clinical depression (major depressive disorder). They think that several factors contribute to its developmentincluding:

• Brain chemistry: An imbalance of neurotransmittersincluding serotoninnorepinephrine and dopaminecontributes to the development of depression. Researchers used to think these imbalances were a primary issue. Howeverrecent theories suggest that disturbances in more complex neural circuits cause secondary imbalances of neurotransmitters.
• Genetics: If you have a first-degree relative (biological parent or sibling) with clinical depressionyou’re about three times as likely to develop the condition as someone without a family history of the condition. Howeveryou can have clinical depression without a family history of it.
• Childhood development: Multiple adverse childhood experiences (ACEs) such as abuse and trauma are associated with the development of clinical depression later in life.
• Stressful life events: Difficult experiencessuch as the death of a loved onetraumadivorceisolation and lack of supportcan trigger clinical depression in people who are susceptible to it.

How is clinical depression (major depressive disorder) diagnosed?

Healthcare providers diagnose clinical depression (major depressive disorder) based on a thorough understanding of your symptomsmedical history and mental health history. They may diagnose you with a specific subtype of clinical depressionsuch as seasonal affective disorder (SAD) or atypical depressionbased on the context of your symptoms.

To receive a diagnosis of clinical depressionyou must have five or more of the symptoms listed in the symptoms section of this article that last every daynearly all dayfor at least two weeks. Two of the five symptoms must include low mood and loss of interest in previously enjoyed things and activities.

Your provider has to rule out other causes of your symptomssuch as medical conditions or substance use. They may order medical testssuch as blood teststo do this.

They also have to make sure you haven’t experienced an episode of hypomania or maniawhich could suggest bipolar disorder. About 5% to 10% of people with clinical depression develop bipolar disorder.

How is clinical depression treated?

Treatment of clinical depression (major depressive disorder) often involves medications and/or psychotherapy (talk therapy). Studies show that the combination of these treatments is more effective than either of them alone.

Psychotherapy involves talking with a mental health professionalsuch as a psychologist. Your therapist helps you identify and change unhealthy emotionsthoughts and behaviors. There are many types of psychotherapy — cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are the most common types for treating clinical depression. You may see your therapist once a week or once every other week.

Prescription depression medications called antidepressants can help change the brain chemistry that causes depression. There are several different types of antidepressants. It may take time and trying more than one medication to figure out the one that works best for you. Antidepressants have side effectswhich often improve with time.

For severe clinical depression that hasn’t responded to other treatmentselectroconvulsive therapy (ECT) is very effective. It involves passing a mild electric current through your braincausing a short seizure. ECT is safe. It involves general anesthesia and doesn’t hurt.

Other types of stimulation therapy for medication-resistant depression include:

• Transcranial magnetic stimulation (TMS).
• Vagus nerve stimulation (VNS).
• Ketamine and esketamine.

How long does depression treatment take to start working?

You may notice some improvements in your symptoms within the first week or two of starting antidepressants. But you may not see the full benefits until you’ve been on the medication for two to three months.

If the antidepressant isn’t working after this timetalk to your healthcare provider. They may adjust the dose or suggest a different antidepressant.

Depending on the severity of the clinical depressionpsychotherapy can take a few weeks or much longer before you start to feel better. In many cases10 to 15 sessions result in significant improvement of your symptoms.

What is the prognosis of clinical depression (major depressive disorder)?

The prognosis (outlook) for clinical depression depends on a few factorsincluding:

• Its severity.
• If it’s treated or untreated.
• If you have other mental health or medical conditions.

The prognosis is better in people who have mild episodesseek treatment and have strong support systems. The prognosis is worse in people who have other psychiatric or personality disorders and who are 60 years or older when they’re diagnosed.

Untreated episodes of clinical depression (major depressive disorder) can last six to 12 months.

About two-thirds of people with clinical depression think about suicide. About 10% to 15% of people with the condition die by suicide.

The good news is that clinical depression is one of the most treatable mental health conditions. Approximately 80% to 90% of people with the condition who seek treatment eventually respond well to treatment.

What are the possible complications of clinical depression?

Clinical depression (major depressive disorder) can greatly interfere with your daily functioning and quality of life if it’s not treated.

People with clinical depression are at a high risk of developing anxiety disorders and substance use disorderswhich further increase their risk of suicide.

Depression can make underlying medical conditions worse or more difficult to managesuch as:

• Diabetes.
• Hypertension (high blood pressure).
• Chronic obstructive pulmonary disease (COPD).
• Coronary artery disease.

People with clinical depression are also at high risk of developing self-destructive behavior as a coping mechanism for their symptoms.

Can I prevent clinical depression (major depressive disorder)?

You can’t always prevent clinical depressionbut you can help reduce your risk by:

• Getting quality sleep and having a healthy sleep routine.
• Managing stress with healthy coping mechanisms.
• Practicing regular self-care activities such as exercisemeditation and yoga.
• Managing any underlying medical or mental health conditions you have.
• Avoiding misuse of alcohol and other substances.

If you’ve had an episode of clinical depression beforeyou may be more likely to experience it again. If you have depression symptomsget help as soon as possible.

What can I do if I have clinical depression?

Aside from seeking professionalmedical help for clinical depressionthere are also things you can do at home to help improve your symptomsincluding:

• Getting regular exercise.
• Getting quality sleep (not too little or too much).
• Eating a healthy diet.
• Avoiding alcoholwhich is a depressant.
• Spending time with people you care about.

When should I see my healthcare provider about clinical depression?

If you have symptoms of clinical depressionsee a healthcare provider or mental health professional. They can give you an accurate diagnosis and suggest treatment options.

If you’ve started treatment for clinical depression and it isn’t working or you’re having unpleasant side effectstalk to your provider. They can recommend a different treatment plan.