Major depressive disorder (MDD)—also known as unipolar
depression or simply major depression—is a serious clinical mood disorder in
which feelings of sadness, frustration, loss, or anger interfere with a
person's everyday life for weeks or months at a time.
People with MDD are more likely to use alcohol or illegal
substances than others, are at increased risk for other mental and physical
health problems, and are at a much greater risk for suicide than the general
The exact cause of major depressive disorder is not known,
however many researchers believe it is linked to chemical changes in the brain,
problems with a person's genes, or a combination of both. It tends to run in
families, but can also occur in those with no family history of the disease.
Alcohol and drug abuse may play a role in MDD, as can other
medical conditions such as an under-active thyroid and certain types of cancer.
Other conditions associated with the disease include sleep problems as well as
some types of medications, including steroids.
Major depressive disorder can also be triggered by
stressful events in a person's life. These may include:
- job loss
- divorce or separation
- failing a class
- death or illness of a friend or
- physical or emotional abuse
People with major depressive disorder tend to have a
distorted view of their lives in which a negative attitude makes it difficult
for them to imagine how problems or situations may be resolved in a positive
way. Other symptoms may include:
- difficulty with concentration
- fatigue or lack of energy
- feelings of hopelessness and/or
- feelings of worthlessness,
guilt, or self-hate
- social isolation
- loss of interest in once
- sleep problems (insomnia or
- dramatic changes in appetite
along with corresponding weight loss or gain
ideation or behavior
In more severe cases of MDD, patients may experience
psychotic symptoms such as delusions or hallucinations.
Diagnosing Major Depressive Disorder
A physician or other health care provider will typically
ask a patient about his symptoms and medical history. Questionnaires are
usually used to aid a doctor with diagnosis and help determine the severity of
the depression. In addition, blood or urine tests may be administered in order
to rule out other possible medical conditions.
Treatments for Major Depressive Disorder
Treatments for major depressive disorder usually include
medications, talk therapy, or both. For most people with more serious forms of
clinical depression such as MDD, antidepressants are the first line of attack.
Common types of antidepressants include selective serotonin
reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), escitalopram (Lexapro) and sertraline
Other types of medication include older-style tricyclic
antidepressants (which may not be well-tolerated by older patients), a
serotonin norepinephrine reuptake inhibitor (SNRI) such as venlafaxine
(Effexor), or bupropion (Wellbutrin).
Talk therapies help a person develop coping skills to deal
with her depression. They include cognitive behavioral therapy, which teaches a
person how to deal with negative thoughts and develop problem-solving skills.
Psychotherapy is used to help a person understand issues behind negative
thoughts and feelings. Support groups are another way to help people deal with
their MDD. Talk therapy tends to work better in combination with other
therapies such as antidepressants.
Alternative therapies such as St. John's Wort and
acupuncture may help relieve symptoms of more mild forms of depression, but
studies reveal they may be ineffective for more serious types of depression,
including MDD. A person should consult with a physician before relying on an
alternative treatment as—especially in the case of St. John's Wort—they
may have potentially dangerous interactions with certain types of medications.
Regular exercise has been found to be effective treatment
for most types of depression and can be ?performed safely in conjunction with
other therapies. It has the added benefit of helping to improve a person's
physical as well as mental health.
Electroconvulsive therapy (ECT) has proven to be a very
effective (and safe) treatment for those with the most severe cases of MDD,
those who haven't responded well to other treatments and in those who
experience psychotic symptoms.
Prognosis for Those with MDD
Typically it takes people several weeks to feel better
after beginning a regimen of antidepressants. The average length of time for an
episode of MDD is usually nine months, however many people will require ongoing
treatment depending on the severity of their illness and 80 to 90 percent of
patients will remit within two years.
A person experiencing thoughts of suicide or of harming
others should immediately contact an emergency number such as 911, call the
suicide hotline at 1-800-SUICIDE (1-800-784-2433, 24 hours a day, 7 days a
week), or get to a hospital emergency room.