What Is Major Depressive Disorder (MDD)?

By: Sarah Fader

Updated February 11, 2021

Medically Reviewed By: Deborah Horton

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Major Depressive Disorder also goes by the name Unipolar Depression or Major Depression. The condition is defined as experiencing continuous feelings of sadness and a lack of interest in daily activities.

It is different from bipolar depression in that instead of shifting between highs and lows, major depression leaves the individual always feeling low. Major depression often goes hand in hand with anxiety. The good news is it's an illness that can be and often is treated easily by combining a regime of psychotherapy and medication

According to the World Health Organization (WHO) approximately 350 million people around the world experience depression and it is one of the leading causes of disability. The rate of depression in women is 50% higher than men regardless of their socio-economic class. Levels of mortality and morbidity are much higher in people who experience Major Depression and it is fast becoming a growing concern globally. WHO is urging countries and states to take action, raise awareness and provide support.


Depression is not a lifelong condition and while in most cases it first surfaces in the teens or 20s or 30s, it can happen earlier (in childhood) or later. In some cases it can occur only once, but typically when someone has gone through an episode of depression, they are likely to push through others. The symptoms don't come and go sporadically rather they are experienced throughout the day, everyday for an extended period of time.

When someone is experiencing a major depressive episode, it means they are experiencing symptoms such as fatigue, social isolation, feeling worthless and a general sense of depression. Some of the other symptoms commonly experienced in people with MDD are:

  • Intellectual impairment;
  • Physical impairment;
  • Poor sleep patterns (either sleeping too much or experiencing insomnia);
  • Feelings of anxiety and restlessness;
  • Slow movements and reflexes while speaking, moving or thinking;
  • Difficulty remembering things;
  • Difficulty with focusing, concentrating or making decisions;
  • Emotional instability, feeling sad, tearful, guilt or worthless;
  • Loss of control over emotions i.e. getting angry, agitated or irritated over things that wouldn't normally be upsetting;
  • Lack of interest in daily activities which were previously enjoyable i.e. sex, reading, playing sports, shopping etc.
  • Lack of appetite which can often lead to a dramatic weight loss;

The symptoms experienced during a depressive episode range from mild to severe. When the symptoms are mild, the individual is capable of going on with their everyday tasks, however they may not be functioning to their full capacity and they may simply be feeling unhappy or miserable without being able to explain why.

When experiencing severe symptoms the chances are high the individual will be unable to complete or continue their usual activities such as work, household chores, social responsibilities etc.

Children who are depressed often experience similar symptoms, in addition they may also have difficulty at school, become overly clingy and sad, be irritable and lose weight.

For teens going through puberty, dealing with depression can be particularly difficult since they are already going through a rough time emotionally. Depression can add to self-esteem issues, make them feel misunderstood and angry and often leads to abusing drugs and alcohol and becoming socially withdrawn. Because symptoms of depression can sometimes be confused with a teenager going through a moody, irritable phase, parents and loved ones should keep a close eye on sudden or continued behavioural changes and get help if needed.


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There is no exact cause for major depressive disorder, it's a complicated illness with many layers to it and like many other mental disorders, the condition is caused by one or a combination of the following factors:

  1. Brain Chemistry: Research has shown a chemical imbalance in the brain is a contributing factor to depression.
  2. Genetics: Although genetics is not the only cause, it is a major contributor to having depression. Individuals with depression, bipolar disorder, or other mental disorders in their family history are more likely to become afflicted and diagnosed with the condition.
  3. Biology: Physical changes in the brain are noticeable for people who experience depression. As of yet there is no why or how, simply that these changes exist.
  4. Hormones: Changes in our hormones can cause depression. For instance during pregnancy or post-partum, women are more likely to experience episodes of depression. Hormone changes during puberty and menopause can also trigger depression.

Some external factors (non-biological), which can trigger or increase the chances of MDD are:

  • Substance abuse (alcohol or drugs);
  • Having low self-esteem;
  • Victims of trauma or domestic/sexual abuse;
  • Some kinds of medication i.e. sleeping pills or blood pressure medicine;
  • Being gay or transgender or a lesbian;
  • Particular medical conditions;
  • Going through a difficult period in life;
  • Grief due to a death or loss of some kind.


The first step to getting a proper diagnosis of MDD is to speak to your family doctor or a health care professional. The doctor will first conduct a physical exam (including some blood work) to ensure there is nothing else going on with you physically. Once physical problems have been ruled out, the doctor may refer you to a mental health professional who will do a psychological evaluation. This evaluation will involve discussing your symptoms and behaviours and may include completing a questionnaire. When there is a family history of mental disorders, the doctor will also screen for manic and hypomanic episodes.

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Once all the information is on hand, the mental health care professional will make a diagnosis based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)published by the American Psychiatric Association. Usually five or more symptoms of a depressive episode have to last for at least two weeks or more to get a proper diagnosis of MDD.

Depending on the circumstances and the symptoms exhibited you might be diagnosed with a specific type of depression for example MDD with Psychotic Features, also known as Psychotic Depression.

Psychotic Depression is a subtype of MDD and is a very serious condition. Medical attention should be sought immediately when psychosis is present because it's an illness that needs to be monitored by mental health professionals. Approximately 20% of people with MDD have psychosis symptoms i.e. psychotic depression. When someone is diagnosed with psychotic depression it essentially means they have lost touch with reality. They have hallucinations, hear voices and see things that are not there. Some of the symptoms to watch out for are:

  • Hypochondria;
  • Insomnia;
  • Physical immobility;
  • Anxious or agitated behaviour;

MDD with Psychotic Features is divided into two types:

5. MDD with Mood-Congruent Psychotic Features: the hallucinations or visions experienced by the patient revolve around depressing themes, for example the hallucinations might include feeling guilty and worthless, a preoccupation with death. The voices they hear may say things like, "You deserve to die because you're not good enough to live."

6. MDD with Mood-Incongruent Psychotic Features: the hallucinations have nothing to do with depression and are often contradictory to feelings of depression, for example, having visions of being chosen by God for a special mission. The symptoms for this type of MDD overlap with Schizophrenia and are much harder to recover from.

In their deluded state, the patient is likely to believe the things they see or hear and may attempt to harm themselves or do something impossible (like jump of a building because they believe they can fly). Which is why it's so important to get help immediately and follow a treatment plan. The risk of suicide is higher in people experiencing Psychotic features.

If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255, and is available 24/7.


There is no exact scientific or medical reason why some people develop psychosis but studies have shown that genetics and a family history of mental disorders are linked to someone developing a psychotic depression. Stress can also affect and lead to a chemical imbalance in the brain.

There are various types of major depressive disorder tests and quizzesavailable online to do a self-test for you or a loved one. The test results should not be taken as a formal diagnosis, only a medical professional can do that. But these tests are often a good start to getting help.


Major Depression is easy to diagnose and treatment options are reliable and successful. The World Health Organization has published an Intervention Guide for mental, neurological and substance abuse disorders outlining treatment options. The document is readily available online in multiple languages.

The best and most successful way of treating Major Depression is by using a combination of:

7. Psychotherapy (cognitive behaviour therapy, interpersonal psychotherapy, problem-solving treatment);

8. Psychological support: regular sessions with a psychologist to talk through feelings, emotions and progress;

9.Antidepressant medication: Generally medication is prescribed to individuals whose depression symptoms are moderate to severe. For milder forms of depression medication is saved as a last resort. Greater emphasis is placed on psychotherapy.

10. Self-Help Approach: Recent studies have shown that Self-Help is an important part of treating depression in individuals and according to research the symptoms of depression are easier to treat / reduce when the patient is involved and willing to use self-help books, activities and internet based programs.

It is a proven fact that treatments for depression are highly effective and benefit patients enormously. Studies have shown patients start seeing and experiencing the benefits of treatment within four to six weeks. Despite this, a big majority of the population experiencing depression get no help. Either out of a personal choice because of the stigma attached to the idea of experiencing a mental condition or simply due to a lack of resources, trained providers and care in their country.

When left untreated, depression can lead to other serious complications such as:

  • Physical problems, related to the individual's health such as heart disease or obesity;
  • Difficulty in maintaining relationships with family members, friends leading to isolation socially;


Depression is something we rarely think about until it hits us close to home. We often forget it's an illness, which affects us all in one way or another. It hampers individuals from living fully and contributing to our society in a positive manner to the best of their abilities. In the end it's society that loses.

What's important to remember is that being diagnosed with major depression is not the end of the world and should not stigmatized. Depression can affect anyone at anytime and if/when it does people should be encouraged to get help. It is one of the easier mental illnesses to treat and with the right combination of medication and psychotherapy it is possible to get your life back.

The sooner you get treatment; the sooner life goes back to normal.

Even MDD with psychotic features is treated when help is sought early and quickly. Medications will need to be taken for a longer period of time to ensure the symptoms don't come back and you'll have to work closely with your doctor but you can get your life back!


If you or someone you know is experiencing any of the symptoms described in this article, you are strongly urged to speak to your family doctor or a mental health professional. Occasionally feeling sad and out of sorts is a normal part of our every day life, but if you're plagued by troubling feelings and emotions on a continuous basis, or being plagued by dark thoughts it's time to see a doctor. Getting treatment for depression has never been easier and is as simple as having an open conversation with someone.

If you are going through a major depressive episode right now and thinking of hurting yourself or having suicidal thoughts contact a crisis hotline or hospital right away, reach out to a loved friend or loved one or dial 911.

Remember you are not alone, and you have the ability to make things better with the right treatment. Support is available everywhere, all you have to do is ask for it.

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