Depression is a formal mental health condition, not a personal choice. It can’t be reversed by just “thinking positive,” and it doesn’t need to be permanent.

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In fact, there are different types of depression. Each of them has specific symptoms and might have different options for treatment.

When you think about depression, symptoms of major depressive disorder (MDD) might be the first to come to mind.

Lingering sadness, despair, lack of energy, and emotional numbness are all symptoms you might face if you live with MDD. A few mental and physical side effects of depression can also be experienced.

You might also experience depression as a thick fog that leaves you feeling empty, exhausted, and entirely unlike yourself.

Though they can become overwhelming, depression symptoms are manageable and treatable. Learning more about major depressive disorder can help you shine a light through the fog.

Major depressive disorder is also called major depression. Other terms for it include:

  • clinical depression
  • classic depression
  • unipolar depression

This mental health condition may involve symptoms such as:

  • low mood
  • feelings of deep sadness or despair
  • loss of interest in your everyday life

When you live with MDD, these symptoms will be present throughout the day, nearly every day, for at least 2 weeks.

You’re not alone

  • Estimates suggest just over 17 million adults living in the United States (7.1%) experienced one or more major depressive episodes in 2017.
  • Research shows 1 in 6 adults will experience MDD at some point in life.
  • MDD occurs more frequently in women.
  • In 2017, 64% of people living with MDD had symptoms that severely impaired day-to-day function.
  • MDD is common all over the world. In fact, the World Health Organization (WHO) describes it as a primary global cause of disability.
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A few types of depression exist.

The symptoms of each condition are fairly similar, but they tend to show up in different patterns.

The main types of depression include:

Persistent depressive disorder

This condition typically involves milder symptoms that linger for 2 years or longer.

MDD with seasonal patterns

Seasonal depression involves depressive episodes during specific times of the year, usually the colder, darker winter months but not exclusively.

MDD with peripartum onset

Peripartum depression develops during or after pregnancy.

Premenstrual dysphoric disorder (PMDD)

PMDD involves extreme feelings of sadness and depression, along with other physical and mental health symptoms, that show up during most menstrual cycles.

Situational depression

With situational depression, symptoms emerge after experiencing a distressing or challenging life event, such as illness, divorce, or loss.

MDD with psychotic features

With this type, you might experience symptoms of psychosis, such as hallucinations or delusions.

When you have symptoms of major depression, a qualified mental health professional or doctor can offer more insight into what might be going on.

They’ll probably want to talk with you about your concerns, difficulties, and symptoms you’ve noticed. Then, they’ll compare this information to the criteria established by diagnostic manuals.

MDD in the DSM-5

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the following criteria for a diagnosis of MDD:

  • persistent feelings of sadness, emptiness, or hopelessness
  • decreased pleasure and interest in most of your regular activities
  • changes in appetite and weight
  • sleeping much more or much less than usual
  • noticeable physical restlessness or slowed movements
  • energy loss and fatigue
  • a sense of worthlessness or personal guilt
  • difficulty concentrating or making decisions
  • regular thoughts of death or suicide, with or without a plan for suicide

A diagnosis of major depression requires either the first or the second criterion is present for at least 2 weeks. At least four more symptoms in the list must be present too.

The symptoms also need to be persistent and experienced across different situations.

MDD in the ICD

The 10th revision of the International Classification of Diseases (ICD-10) sets out slightly different diagnostic criteria for major depression.

The ICD-10 establishes general symptoms of depressive episodes. Then it categorizes these episodes as mild, moderate, or severe based on the number of symptoms present and how persistent they are.

The general criteria include:

  • a low mood
  • decreased energy and activity
  • decreased enjoyment and interest in life
  • difficulty concentrating
  • frequent tiredness
  • disrupted sleep
  • appetite loss
  • decreased self-esteem and self-confidence
  • feelings of worthlessness and guilt

The ICD-10 also notes the possibility of additional somatic symptoms, including:

  • unplanned weight loss
  • insomnia
  • restlessness or slowed movements

Unlike the DSM-5, the ICD-10 doesn’t specify the length of time you need to have these symptoms. Instead, it simply states that to be considered major depression, your low mood is a persistent symptom.

The ICD-10 describes major depression as a severe episode of depression. That means you’ll have several symptoms that cause significant distress, and you might also think about harming yourself.

The DSM-5 puts a little more emphasis on how long you’ve had symptoms, while the ICD-10 focuses more on how they affect your life.

Since diagnostic criteria can translate to a wide range of symptoms, not everyone with MDD will have the same experience or with the same intensity.

A low mood generally involves feelings of sadness and hopelessness. You might:

  • cry often
  • have difficulty enjoying activities or situations
  • feel pessimistic or bleak about the future
  • find it tough to care about anything

Not everyone with major depression feels sad, though.

You could also feel:

Some depression symptoms might seem related to each other. For example:

  • You might assume you aren’t interested or joyful about some activities because you feel so drained.
  • Feelings of guilt might lead you to withdraw from loved ones.
  • When you don’t have much energy, even everyday decisions, like what to have for dinner, might become overwhelming.

Sleep and appetite changes can vary quite a bit, as well, when you live with clinical depression. You might:

  • spend a lot of time sleeping
  • struggle to fall asleep or stay asleep, no matter how exhausted you feel
  • lose your appetite completely, forget to eat, or lack energy to prepare meals
  • eat more than usual or crave certain comfort foods

Many people with depression also experience physical symptoms, including aches and pains or stomach distress.

A healthcare professional will likely diagnose MDD when your low mood has no clear cause and symptoms persist day in and day out, keeping you from going about life as you usually would.

Experts haven’t identified one specific root cause of depression. Existing evidence suggests a number of factors play a part in the development of symptoms.

Potential causes of major depressive disorder include:

  • Genetics. According to the DSM-5, you’re two to four times more likely to develop MDD if a first-degree relative also has the condition. Research from 2016 supports family history as a key factor in MDD.
  • Biology. Imbalances in serotonin, dopamine, and other important brain chemicals might contribute to MDD symptoms.
  • Environment. Neglect, abuse, violence, and other negative experiences in childhood can cause significant stress and contribute to MDD later in life.

Other contributing factors can increase your chances for developing MDD, especially when combined with biology, genetic, or environmental factors.

These factors might include:

  • overwhelming or stressful life changes
  • traumatic events
  • low self-esteem
  • chronic health conditions
  • substance use
  • poor sleep
  • malnutrition
  • insulin resistance

What’s the difference between MDD and bipolar disorder?

Both mental health conditions are considered mood disorders. However, there are important differences between both.

Bipolar disorder can involve alternating episodes of mania or hypomania and depression. These changes can often be extreme.

For example, after experiencing a low mood for a while, you might then notice an extremely elevated mood that involves:

  • increased self-esteem
  • restlessness and distractibility
  • increased talkativeness
  • racing thoughts
  • extreme focus on specific activities

Bipolar disorder with mixed features can involve symptoms of mania and depression at the same time.

For example, racing thoughts might center around your sense of guilt, or you might find yourself unable to stop laughing even though you feel extremely sad.

Clinical depression, on the other hand, doesn’t involve changes in mood.

Both MDD and bipolar disorder can in some instances involve psychotic symptoms such as hallucinations and delusions.

Therapy and medication are the primary treatments for major depression.

The American Psychiatric Association notes that while both therapy and antidepressants can help ease symptoms, a combined approach may have the most benefit.

Medication can improve symptoms, but a therapist can teach long-term coping skills to help navigate distress in a way that works for you.

Therapy options

Talk therapy or psychotherapy involves regular (usually weekly) sessions with a mental health professional.

Your therapist can offer guidance with:

  • reframing or replacing negative thought patterns
  • learning skills to help manage and cope with distress
  • building a support network
  • developing a self-care plan

Cognitive behavioral therapy is widely used to treat MDD, but other approaches can also offer benefits:

Medication options

A psychiatrist or doctor can prescribe antidepressants to help relieve depression symptoms. You might want to consider discussing side effects with them first.

Medications used to treat depression include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), escitalopram (Lexapro), or sertraline (Zoloft)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine (Pristiq) or duloxetine (Cymbalta)
  • Tricyclic antidepressants, such as amoxapine, doxepin, or desipramine

You can learn more about medications for depression here.

Other depression treatments to consider

Including alternative approaches in your treatment plan can also have benefit.

Consider talking to your care professional about:

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With treatment and support, you’ll usually begin to see some improvement within several weeks.

Even if you don’t feel better immediately, recovery from major depression is possible.

When depression symptoms are left untreated for a while, they might become more overwhelming.

Over time, untreated depression could have a bigger impact on your relationships, work, and quality of life.

While professional support can make the most difference in coping with your symptoms, self-care is also important.

These strategies can help you work toward wellness:

Connect with loved ones

Staying in touch with a few trusted loved ones may make it easier to get the emotional support you need.

Often, a loved one may not know how to help you. Even though it might be difficult to open up, telling them what you need might help you get the support you really need.

Stick to a regular routine

Setting specific times for the things you do every day can help you stay involved in everyday life.

  • Try following a schedule for meals, bedtime, and waking up.
  • Set aside time each day for relaxation and hobbies.
  • Check in with loved ones on a regular basis.

Try to stay active

Exercise can’t cure depression, but it can help you feel better, especially when you take it outside.

It’s natural and not uncommon to feel you’re not up for an intense workout. Low-impact exercise like walking or yoga can also help lift your mood and improve your outlook overall.

Take it slow

Consider treating yourself kindly as you work to manage your symptoms.

Remember, MDD is a health condition, not a choice. You can recover, but the process may take some time.

Complete essential tasks first and remind yourself it’s OK to handle the rest another day.

Even if it may feel this way, the distress you may be experiencing right now won’t last forever. Clinical depression can be treated, and recovery is possible.

These resources can help you take the first step on the path to wellness.