What Is Major Depressive Disorder?

Major depressive disorder, also known as major depression or clinical depression, is one of the world’s most common mental health conditions. The World Health Organization estimates that around 5% of the world population, or 280 million adults, live with major depression^[1].

But what, exactly, does it mean to be depressed? What is major depressive disorder, and how does it differ from other types of depression?

If you think you or a loved one could be depressed, read this article to learn more about the symptoms and causes of major depressive disorder, as well as your treatment options.

Symptoms of major depressive disorder

Everyone feels sad sometimes, but for people with major depressive disorder, these feelings of sadness start to affect their daily functioning. Depression is much more severe and debilitating than simply a feeling of sadness.

The Diagnostic Statistical Manual (DSM-V-TR) is the guide that mental health practitioners use to make a diagnosis. According to the DSM-V-TR, a person must have the following symptoms to meet the criteria for a diagnosis of major depressive disorder^[2].

• A depressed, sad, or empty mood
• A loss of interest in all activities, even things that were previously enjoyable (like hobbies)
• Changes in appetite that lead to significant weight gain or loss
• Sleep disturbance (sleeping too much or too little)
• Changes in movement — like moving so slowly that it’s noticeable to others
• A sense of worthlessness or guilt
• Difficulty concentrating or making decisions
• Recurrent thoughts about death or suicide

To be diagnosed with major depression, you must have experienced at least 5 of the above symptoms for two weeks or more. The symptoms must also cause significant impairment in your functioning. This means that the symptoms must get in the way of your work life or relationships.

This is to help distinguish between major depressive disorder (a serious mental health condition) and normal emotional reactions to life events. For example, oversleeping a few days because you’ve been working late isn’t usually a sign of depression. But oversleeping every day for two or more weeks, paired with other symptoms on the list, could indicate depression.

People with major depressive disorder go through major depressive episodes, which is when they experience the above symptoms continuously for two weeks or more. Some people go through one major depressive episode, for example, after a significant loss in life, and never feel depressed again. Others experience symptoms of major depression most of the time for several years.

Other signs of major depressive disorder

On top of these officially recognized symptoms of major depression, some other signs that you could be depressed include:

• Withdrawing from others
• Increased drug or alcohol use
• Increased irritability or angry outbursts
• Poor self-esteem; saying negative things or having negative thoughts about yourself
• Decreased sex drive
• Unexplained aches and pains
• Feelings of hopelessness

If you’re concerned that you (or a loved one) are going through depression, we encourage you to call us at 888.771.5166. Our intake team can set up a comprehensive assessment that can provide more information about what you or a loved one is going through.

What causes major depressive disorder?

Just like most other health conditions, we aren’t able to say definitively what causes major depressive disorder. There isn’t one clearcut cause for it, but there are some factors that can increase your chance of experiencing it.

We call these risk factors, and they’re not the same thing as direct causes. For example, smoking is a risk factor for developing lung cancer. But it’s not a direct cause; if it were, then every single person who smoked would get lung cancer. And anyone who didn’t smoke would be 100% protected from lung cancer.

As we know, this isn’t the case. Not everyone who smokes gets lung cancer, and some people who get it have never smoked. But smoking does significantly raise your odds of developing lung cancer.

In the same way, major depressive disorder doesn’t have direct causes — but it does have risk factors. Researchers have narrowed down the risk factors for major depressive disorder to genetic, biological, and environmental risk factors^[3].

• Genetic: Although scientists haven’t identified a specific “depression gene,” they have determined that major depressive disorder does run in families. If you have a close relative, like a parent or a sibling, with major depressive disorder then you’re more likely to have it as well.
• Biological: Research has found that some people with major depressive disorder have biological differences in their brains. For example, they could have lower levels of certain brain chemicals like serotonin. Hormones can also play a role.
• Environmental: Lastly, there are many environmental factors and life events that can raise your risk of getting major depressive disorder. For example, people who’ve recently been through a significant loss are at high risk. Other environmental risk factors include being a victim of abuse, going through a big life change, or having interpersonal difficulties.

On top of these factors, there are also other health conditions that frequently appear together with depression. Sometimes, depression comes first, while for other people, the other condition leads to depression. Some health conditions that are often comorbid with major depressive disorder include^[4]

• Anxiety disorders
• Attention deficit hyperactivity disorder (ADHD)
• Obsessive compulsive disorder (OCD)
• Substance use disorder (SUD)
• Chronic pain disorders
• Cancer
• Insomnia
• Migraine

Certain medications can also lead someone to have symptoms of depression. Some examples are certain blood pressure medications and birth control pills. You should always tell your doctor about any history of depression so they can consider this when prescribing you with new medications.

Who is at risk for major depressive disorder?

On top of the above factors, there are also certain groups of people who are at higher risk for developing major depressive disorder.

One major group of people who are at high risk of major depression is women. Reports show that women are around twice as likely^[5] than men to develop major depressive disorder. This could be attributed to several different factors, like hormonal differences, higher stress and responsibilities, and unequal opportunities in the workplace. However, men have a higher incidence of dying by suicide (although women are more likely to attempt suicide).

People in certain age groups are also more likely to have major depression. Studies show that around 21% of people between the ages of 19 and 26 had symptoms of depression, compared with around 17% of adults aged 30 to 45^[6].

Black and Latino Americans are more likely to meet the criteria for major depressive disorder than White Americans.^[7] Asian Americans are the least likely to report being depressed in the United States.

People with lower socioeconomic status are also more likely to have major depression. This is usually explained by the fact that economic stress is an important environmental risk factor for developing major depression. People at lower economic income levels may be under more stress.

This doesn’t mean that people who don’t belong in these groups, like men, don’t get depressed. Anyone can get major depressive disorder at any age. These reports could also be skewed — for example, men could be less likely to report feeling depressed than women. Depression doesn’t discriminate based on demographic factors.

Other types of depression

Major depressive disorder is just one type of depression. Other types of depression share similar symptoms, but are different in important ways. Other mood disorders could also cause someone to go through major depressive episodes (even if they don’t have major depressive disorder).

Some other types of depression include:

• Persistent depressive disorder is a type of depression that causes people to have symptoms for a longer period of time (2 years or more). The symptoms of persistent depressive disorder are similar to those of major depressive disorder, but are often less acute. This means that people with persistent depressive disorder may be more able to function in everyday life (like at work or in relationships) than people with major depression.
• Seasonal affective disorder is diagnosed as a major depressive episode with seasonal pattern. This type of depression causes people to go through major depressive episodes but only during certain seasons. Most people who have this get depressed in the dark winter months.
• Postpartum depression, or major depressive episode with peripartum onset, happens when someone gets symptoms of major depression during pregnancy or shortly after giving birth. It affects around 1 in 8 mothers.
• Bipolar disorder is a mood disorder that causes people to swing between two extreme moods: depression and mania. A manic episode has symptoms like elatedness, a decreased need for sleep, and impulsive behavior. The person then could enter into a depressive episode, which looks like major depression. Some people with bipolar disorder spend more time depressed than manic.

During your diagnostic assessment, your provider will ask you thorough questions to determine whether you have major depressive disorder or another condition. They may also ask you to fill out diagnostic screening questionnaires.

Treatment for major depressive disorder

Major depressive disorder is a chronic condition. This means that we don’t yet have a cure for it that will make symptoms go away forever. However, there are effective treatment options. And many people with major depressive disorder are in remission, which means they haven’t had symptoms in many years.

If you live with major depressive disorder, there is hope. You can live a successful, fulfilling, and happy life whether or not you have depression. But without treatment, major depressive disorder is only likely to get worse. If you’ve received this diagnosis, it’s important to get connected to some type of treatment, no matter what option you choose.

Treatment for depression ranges from antidepressant medication to more holistic choices like increasing exercise and a healthy diet. Some people choose to receive treatment in inpatient settings, like a psychiatric hospital or a residential treatment center. Others choose to continue their daily lives and receive treatment on an outpatient basis.

Here are the most common types of depression treatment. Keep in mind that the option you choose should be unique to you and your situation. What works best for someone else may not be the right treatment choice for you.

Residential treatment for depression

Residential, or inpatient, treatment means that you receive depression treatment while residing at the facility. Some inpatient treatment centers are hospitals, while others are meant to feel like home. These can be either “residential” or “partial hospitalization (PHP).”

If you live with severe depression and feel like you could hurt yourself (or others), then you may need to be hospitalized temporarily until you are stabilized. This isn’t typically a long-term treatment option for depression, but could help keep you safe if you’re in a crisis.

You can also choose to enter into a residential treatment program for depression, whether or not you are hospitalized first.

Residential treatment centers have clinical staff that provide treatment and make sure residents are safe. Treatment options could include individual therapy, group therapy, and holistic therapies or equine therapy. Residential treatment can also help make sure you’re making healthy life choices, like staying away from drugs and alcohol, and eating a healthy diet.

Residential treatment is a great option for people who feel they could benefit from more extensive supervision and round-the-clock support. Sometimes, getting out of your usual routine and away from situations that cause “triggers” is necessary to finally recover from major depressive disorder.

The residential treatment program at The Center • A Place of HOPE is recognized as a leading program in the country. It has been voted a Top 10 depression treatment center in the United States. The Center is located 20 minutes north of Seattle with a beautiful view of the Puget Sound. Every resident lives in modern condominium-style apartments.

Intensive outpatient program

An intensive outpatient program, or IOP, can also be a great treatment option. IOPs are one step down from residential treatment in terms of intensity. Clients in IOPs receive treatment for several hours a day, but reside at home instead of at the treatment facility. IOPs can range from just a few hours of treatment every day to full 8-hour a day programs.

Outpatient counseling

Many people with major depressive disorder choose to receive treatment on an outpatient basis. This is perfectly acceptable and effective, especially if your symptoms aren’t severe.

You can receive individual, group, or family therapy from an outpatient therapist. Typically, people who choose this option attend sessions at an office or mental health clinic one or two times a week. Telehealth, or virtual psychotherapy sessions, are also becoming more common.

Different therapists use different counseling methods. Some of the most common types of psychotherapy for major depressive disorder include^[8]:

• Cognitive-Behavioral Therapy (CBT): Helps people examine and change irrational thinking patterns that cause them to feel depressed
• Dialectical Behavior Therapy (DBT): Teaches people skills to withstand painful emotions and improve their interpersonal relationships
• Interpersonal Therapy (IPT): Focuses on helping people improve their relationships
• Psychodynamic Therapy: Also known as psychoanalysis; helps people to explore and resolve the roots of emotional suffering

These are only some examples of therapy methods that have been found to help people with major depressive disorder. There are countless options for therapy, and you should have a conversation with your therapist about what method might be most helpful for you.

Brain stimulation therapies

Brain stimulation therapies help people with depression by using technology to stimulate certain areas of the brain. The main types of brain stimulation therapies that are used for depression are:

• Electroconvulsive therapy (ECT)
• Transcranial magnetic stimulation (TMS)

Both of these have been found to be safe and effective for people with major depressive disorder. However, they aren’t usually used as a first-line treatment.^[9]

Psychiatric medication

Some people choose to take psychiatric medications for major depressive disorder. Antidepressant medications can change brain chemistry to help decrease symptoms of depression.

Selective serotonin reuptake inhibitors (SSRIs) are one of the most popular categories of antidepressant medications. SSRIs work by increasing the amount of serotonin (an important brain chemical) available in the brain. This helps people feel less depressed.

Other types of medications used for major depressive disorder include^[10]:

• Serotonin norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)

Some of these antidepressant types come with significant side effects, which should be considered when deciding on the best treatment choice for you.

Lifestyle changes

Although therapy and medication are helpful (and often necessary), people usually find that recovering from major depressive disorder requires broader lifestyle changes. Even if you go to therapy, you may continue to feel depressed unless you make changes in the way you live your day-to-day life.

Physical exercise is one of the best things you can do if you have major depressive disorder. Some studies have even found that the benefits of physical activity are on-par with antidepressant medication for people with depression^[11].

Some other lifestyle habits that could help manage major depressive disorder include^[12]:

• Eating a healthy diet
• Practicing mindfulness
• Connecting with friends and family
• Getting enough sleep
• Reducing drug and alcohol use

Depression Treatment at The Center • A Place of HOPE

At The Center • A Place of HOPE, we use a unique Whole Person Care approach when working with people with major depressive disorder. We have a deep understanding that no two people with major depression are alike, and the treatment option that works for other people might not be the best choice for you.

Your treatment journey with us starts with an initial Comprehensive Personal Assessment. This helps us understand the factors in your life that have contributed to your depression. This way, we’re able to create an individualized treatment plan that directly addresses you and your needs.

We have over 35 years of experience helping people with major depressive disorder with proven results. We were voted a Top 10 depression treatment center in the United States because of our commitment to, and success with, helping people recover from this painful disorder.

Major depressive disorder can be debilitating, but it doesn’t need to run your life forever. Contact us today to start your journey of recovery.

[1] https://www.who.int/news-room/fact-sheets/detail/depression
[2] https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/
[3] https://medlineplus.gov/ency/article/000945.htm
[4] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02546-8
[5] https://www.nimh.nih.gov/health/statistics/major-depression
[6] https://www.cdc.gov/nchs/products/databriefs/db379.htm
[7] https://www.nih.gov/news-events/news-releases/african-americans-latinos-are-more-likely-be-risk-depression-whites
[8] https://www.medicalnewstoday.com/articles/types-of-therapy
[9] https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies
[10] https://www.fda.gov/consumers/free-publications-women/depression-medicines
[11] https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998225/