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Major depressive disorder

For other types of depression, see mood disorder. Not to be confused with depression (mood).

Major depressive disorder
Other namesClinical depression, major depression, unipolar depression, unipolar disorder, recurrent depression
Sorrowing Old Man (At Eternity's Gate), an 1890 portrait by Vincent van Gogh
SpecialtyPsychiatry, clinical psychology
SymptomsLow mood, low self-esteem, loss of interest in normally enjoyable activities, low energy, pain without a clear cause,[1] disturbed sleep pattern (insomnia or hypersomnia)
ComplicationsSelf-harm, suicide[2]
Usual onsetAge 20s[3][4]
Duration> 2 weeks[1]
CausesEnvironmental (e.g. adverse life experiences), genetic predisposition, psychological factors such as stress[5]
Risk factorsFamily history, major life changes, living alone,[6] certain medications, chronic health problems, substance use disorder[1][5]
Differential diagnosisBipolar disorder, ADHD, sadness[7]
TreatmentPsychotherapy, antidepressant medication, electroconvulsive therapy, transcranial magnetic stimulation, exercise[1][8]
MedicationAntidepressants
Frequency163 million (2017)[9]

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder[10] characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s,[11] the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.[12]

The diagnosis of major depressive disorder is based on the person's reported experiences, behavior reported by family or friends, and a mental status examination.[13] There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms.[13] The most common time of onset is in a person's 20s,[3][4] with females affected about three times as often as males.[14] The course of the disorder varies widely, from one episode lasting months to a lifelong disorder with recurrent major depressive episodes.

Those with major depressive disorder are typically treated with psychotherapy and antidepressant medication.[1] While a mainstay of treatment, the clinical efficacy of antidepressants is controversial.[15][16][17][18] Hospitalization (which may be involuntary) may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. Electroconvulsive therapy (ECT) may be considered if other measures are not effective.[1]

Major depressive disorder is believed to be caused by a combination of genetic, environmental, and psychological factors,[1] with about 40% of the risk being genetic.[5] Risk factors include a family history of the condition, major life changes, childhood traumas, environmental lead exposure,[19] certain medications, chronic health problems, and substance use disorders.[1][5] It can negatively affect a person's personal life, work life, or education, and cause issues with a person's sleeping habits, eating habits, and general health.[1][5]

  1. ^ a b c d e f g h i "Depression". U.S. National Institute of Mental Health (NIMH). May 2016. Archived from the original on 5 August 2016. Retrieved 31 July 2016.
  2. ^ Cite error: The named reference z273 was invoked but never defined (see the help page).
  3. ^ a b American Psychiatric Association 2013, p. 165.
  4. ^ a b Kessler RC, Bromet EJ (2013). "The epidemiology of depression across cultures". Annual Review of Public Health. 34: 119–38. doi:10.1146/annurev-publhealth-031912-114409. PMC 4100461. PMID 23514317.
  5. ^ a b c d e American Psychiatric Association 2013, p. 166.
  6. ^ Cite error: The named reference PMH was invoked but never defined (see the help page).
  7. ^ American Psychiatric Association 2013, pp. 167–168.
  8. ^ Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. (September 2013). Mead GE (ed.). "Exercise for depression". The Cochrane Database of Systematic Reviews. 2013 (9): CD004366. doi:10.1002/14651858.CD004366.pub6. ISSN 1464-780X. PMC 9721454. PMID 24026850.
  9. ^ Cite error: The named reference GBD 2017 prevalence was invoked but never defined (see the help page).
  10. ^ Sartorius N, Henderson AS, Strotzka H, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). World Health Organization. Archived from the original (PDF) on 5 February 2022. Retrieved 23 June 2021.
  11. ^ Spitzer RL, Endicott J, Robins E (1976). "The development of diagnostic criteria in psychiatry" (PDF). Archived (PDF) from the original on 14 December 2005. Retrieved 8 November 2008.
  12. ^ Global Burden of Disease Study 2013 Collaborators (August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/S0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
  13. ^ a b Patton LL (2015). The ADA Practical Guide to Patients with Medical Conditions (2nd ed.). John Wiley & Sons. p. 339. ISBN 978-1-118-92928-5.
  14. ^ World Health Organisation. "ICD-11 for Mortality and Morbidity Statistics". International Classification of Diseases, Eleventh Edition. Retrieved 26 November 2024.
  15. ^ Stone MB, Yaseen ZS, Miller BJ, Richardville K, Kalaria SN, Kirsch I (August 2022). "Response to acute monotherapy for major depressive disorder in randomized, placebo controlled trials submitted to the US Food and Drug Administration: individual participant data analysis". BMJ. 378: e067606. doi:10.1136/bmj-2021-067606. PMC 9344377. PMID 35918097. "Meta-analyses have shown small mean differences between drug and placebo arms, and the clinical significance of these differences continues to be debated."
  16. ^ Ormel J, Spinhoven P, de Vries YA, Cramer AO, Siegle GJ, Bockting CL, et al. (January 2020). "The antidepressant standoff: why it continues and how to resolve it". Psychological Medicine. 50 (2): 177–186. doi:10.1017/S0033291719003295. hdl:1887/3142545. PMID 31779735.
  17. ^ Taylor D, Horowitz M (May 2024). The Maudsley Deprescribing Guidelines – Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Wiley. p. 57. doi:10.1002/9781394291052. ISBN 978-1-119-82298-1. "The debate around the short‐term efficacy of antidepressants has continued..."
  18. ^ Hengartner MP, Plöderl M (April 2022). "Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression". BMJ Evidence-Based Medicine. 27 (2): 69–73. doi:10.1136/bmjebm-2020-111600. PMID 33593736. "The efficacy of antidepressants in the acute treatment of patients with moderate-to-severe depression remains a controversial issue."
  19. ^ Michael J. McFarland, Aaron Reuben, Matt Hauer. Contribution of Childhood Lead Exposure to Psychopathology in the U.S. Population over the Past 75 Years. Journal of Child Psychology and Psychiatry, 2024 DOI: 10.1111/jcpp.14072

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