Major depressive disorder
| Major depressive disorder | |
|---|---|
| Other names | Clinical depression, major depression, unipolar depression, unipolar disorder, recurrent depression |
| Sorrowing Old Man (At Eternity's Gate), an 1890 portrait by Vincent van Gogh | |
| Specialty | Psychiatry, clinical psychology |
| Symptoms | Low mood, low self-esteem, loss of interest in normally enjoyable activities, low energy, pain without a clear cause, disturbed sleep pattern (insomnia or hypersomnia) |
| Complications | Self-harm, suicide |
| Usual onset | Age 20s |
| Duration | > 2 weeks |
| Causes | Environmental (e.g. adverse life experiences), genetic predisposition, psychological factors such as stress |
| Risk factors | Family history, major life changes, living alone, certain medications, chronic health problems, substance use disorder |
| Differential diagnosis | Bipolar disorder, ADHD, sadness |
| Treatment | Psychotherapy, antidepressant medication, electroconvulsive therapy, transcranial magnetic stimulation, exercise |
| Medication | Antidepressants |
| Frequency | 163 million (2017) |
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder 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, 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.
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. There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. The most common time of onset is in a person's 20s, with females affected about three times as often as males. 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. While a mainstay of treatment, the clinical efficacy of antidepressants is controversial. 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.
Major depressive disorder is believed to be caused by a combination of genetic, environmental, and psychological factors, with about 40% of the risk being genetic. Risk factors include a family history of the condition, major life changes, childhood traumas, environmental lead exposure, certain medications, chronic health problems, and substance use disorders. 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.