What is major depressive disorder with associated features?

Major depressive disorder (MDD), or clinical depression, is a common mood disorder that can affect anyone. Its most prevalent symptom includes persistent sadness or irritability.

Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when they’re going through a life challenge, such as a divorce or serious illness.

These feelings are usually short-lived. When someone experiences persistent and intense feelings of sadness for extended periods, then they may have a mood disorder such as major depressive disorder (MDD).

A doctor or a mental health professional can diagnose MDD based on your symptoms, feelings, and behaviors.

Typically, you’ll be asked specific questions or given a questionnaire so health professionals can better determine whether you have MDD or another condition.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).” This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

• You must experience a change in your previous functioning.
• Symptoms must occur for a period of 2 or more weeks.
• At least one symptom is either depressed mood or loss of interest or pleasure.

You must also experience five or more of the following symptoms in the 2-week period:

• You feel sad or irritable most of the day, nearly every day.
• You’re less interested in most activities you once enjoyed.
• You suddenly lose or gain weight or have a change in appetite.
• You have trouble falling asleep or want to sleep more than usual.
• You experience feelings of restlessness.
• You feel unusually tired and have a lack of energy.
• You feel worthless or guilty, often about things that wouldn’t usually make you feel that way.
• You have difficulty concentrating, thinking, or making decisions.
• You think about harming yourself or suicide.

Symptoms in different age groups

Symptoms in teens

Symptoms parents should be aware of in their teens include the following:

• onset or increased use of substances (i.e., alcohol, smoking)
• poorer academic performance
• problems with peers
• increased social withdrawal/isolation

Symptoms in older adults

Depression symptoms in older adults are similar to other age groups. It’s often the cause of physical pain in older adults that’s not explained by other medical conditions.

Depression is common in people with Alzheimer’s and related dementias. It’s sometimes called geriatric depression.

Older adults with one chronic health condition are 80% more at risk of developing depression than the average person, especially if their function becomes limited.

MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms.

People who have severe MDD or have thoughts of harming themselves may need to stay in a hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve.

Medications

Primary care professionals often start treatment for MDD by prescribing antidepressant medications.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a frequently prescribed type of antidepressant. SSRIs work by helping inhibit the breakdown of serotonin in your brain, resulting in higher amounts of this neurotransmitter.

Serotonin is a brain chemical that’s believed to be responsible for mood. It may help improve mood and produce healthy sleeping patterns.

People with MDD are often thought to have low levels of serotonin. An SSRI may relieve symptoms of MDD by increasing the amount of serotonin available in your brain.

SSRIs include well-known drugs such as fluoxetine (Prozac) and citalopram (Celexa). They have a relatively low incidence of side effects that most people tolerate well.

Similar to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that are often prescribed. These affect serotonin and norepinephrine, which helps manage your fight-or-flight response.

Other medications

Tricyclic antidepressants and medications known as atypical antidepressants, such as bupropion (Wellbutrin), may be used when other drugs haven’t helped.

These drugs can cause several side effects, including weight gain and sleepiness. As with any medication, benefits and side effects need to be weighed carefully with a healthcare professional.

Stopping medications immediately can cause withdrawal symptoms. It’s important not to stop taking your medications unless a mental health or healthcare professional advises you to.

Some medications used to treat MDD aren’t safe while you’re pregnant or nursing. Make sure you speak with a healthcare professional if you become pregnant, you’re planning to become pregnant, or you’re nursing.

Psychotherapy

Psychotherapy, also known as psychological therapy or talk therapy, can effectively treat people with MDD. It involves meeting with a mental health professional regularly to talk about your condition and related issues.

Psychotherapy can help you:

• adjust to a crisis or other stressful event
• working toward achieving a balanced perspective of a given situation and acting in accordance with values instead of based on mood
• improve your communication skills
• find better ways to cope with challenges and solve problems
• increase your self-esteem
• regain a sense of satisfaction and control in your life

A mental health professional may also recommend other types of therapy, such as cognitive behavioral therapy or interpersonal therapy. If you don’t already have a mental health professional, the Healthline FindCare tool can help you find a professional in your area.

Another possible treatment is group therapy, which allows you to share your feelings with people who can relate to what you’re going through.

Lifestyle changes

In addition to taking medications and participating in therapy, you can help improve MDD symptoms by making some changes to your daily habits.

Dietary changes

Nutritious foods benefit your mind and body. While no foods can cure depression, certain healthful food choices can benefit your mental well-being.

Consider eating foods:

• containing omega-3 fatty acids, such as salmon
• rich in B vitamins, such as beans and whole grains
• with magnesium, which is found in nuts, seeds, and yogurt

These can also be found in supplement form, but the Food and Drug Administration (FDA) hasn’t approved any natural products for depression. Speak with a healthcare professional before starting new supplements, especially if you take other medications.

Avoid alcohol and certain processed foods

It’s beneficial to avoid alcohol because it’s a nervous system depressant that worsens your symptoms. It has also been identified as a potential risk factor for depression.

Ultra-processed foods have also been associated with depressive symptoms.

Get plenty of exercise

Although MDD can make you feel very tired, it’s essential to be physically active. Exercising, especially outdoors and in moderate sunlight, can boost your mood and make you feel better.

Sleep well

It’s vital to get enough sleep each night. This can vary from person to person but typically ranges between 7 to 9 hours.

People with depression often have trouble sleeping. Speak with a doctor if you’re having trouble sleeping or oversleeping.

While someone with MDD can feel hopeless at times, it’s important to remember that the disorder can be treated successfully. There is hope.

Sticking with a treatment plan is a critical part of improving your outlook. Try not to miss therapy sessions or follow-up appointments with your mental health professional.

Similarly, it’s important not to stop taking your medications unless a mental health or healthcare professional advises you to.

On days when you feel particularly depressed despite treatment, it can be helpful to call a local crisis or mental health service. Resources are available.

A friendly, supportive voice could be just what you need to get you through a difficult time.

Read this article in Spanish.