Major Depressive Disorder, Single And Recurrent Episodes

Major depressive disorder encompasses a wide range of symptoms that can vary significantly in severity. The signs and symptoms of MDD generally fall into three main categories: emotional, cognitive, and physical. 

These symptoms must last at least two weeks, represent a change from previous functioning, and cause significant distress³ or impairment in social, occupational, or other vital areas of functioning to be diagnosed as a major depressive episode.

Emotional symptoms

Emotional symptoms of major depression can include the following: 

• Persistent sadness or emptiness
• Irritability or frustration
• Loss of interest or pleasure in activities like hobbies, sports, or sex
• Feelings of guilt, fixating on past failures, or blaming oneself for what is beyond one’s control 
• Thoughts of hopelessness or worthlessness 

Cognitive symptoms

Cognitive symptoms of major depressive disorder may include the following: 

• Difficulty concentrating, making decisions, or remembering details 
• Frequent or recurrent thoughts of death or suicide or suicide attempts
• Unexplained physical symptoms, such as back pain or headaches

Physical symptoms

Below are some physical symptoms of major depressive disorder: 

• Tiredness and lack of energy so that even minor tasks take extra effort
• Insomnia or excessive sleeping
• Changes in appetite, whether increased or decreased 
• Weight fluctuations 
• Slowed movements or speech that is noticeable by others

In the case of recurrent major depressive disorder, the individual experiences these symptoms during multiple depressive episodes, separated by periods of at least two months where they are not depressed.

Major depressive disorder symptoms can appear at any age. However, they commonly first develop in the teenage years or early 20s. If left untreated, episodes may last about six months but can be shorter or significantly longer.

There has not been one specific cause of major depressive disorder. Researchers believe a combination of biological, psychological, and environmental factors are causes for depression. 

Biological factors

Potential biological factors in the development of major depressive disorder include the following: 

• Brain chemistry: Neurotransmitters are naturally occurring brain chemicals that may play a role in depression. Changes in the function and effect of these neurotransmitters and how they interact with neural circuits involved in maintaining mood stability may cause depression. 
• Genetics: MDD is more common in people whose blood relatives also have this mental illness, which suggests a genetic link. However, depression can occur in people without family histories of depression. 
• Hormones: Changes in the body's balance of hormones, such as during pregnancy, after childbirth, or during menopause, may be involved in causing MDD. 

Psychological and environmental factors

Depression may also be caused by environmental and psychological factors, such as the following: 

• Trauma: Early life trauma, such as childhood abuse, neglect, or the death of a parent, may make a person more vulnerable to developing MDD later in life.
• Life changes: Significant life changes, such as losing a job, going through a divorce, or the death of a loved one, may cause a depressive episode.
• Chronic illness: Living with a chronic illness can lead to depression, especially if the illness is causing ongoing pain or limiting a person's lifestyle.

These factors may all uniquely interact, so a combination of many factors, rather than any one factor alone, may be responsible for causing MDD. Additionally, substance use and certain medications can contribute to depression.

Treatment⁴ for major depressive disorder (MDD) often involves medication, psychotherapy, or a combination of the two, with the primary goal being alleviating symptoms, improving quality of life, and preventing future depressive episodes. In some cases, other treatment options may be utilized if standard treatments are ineffective.

Medication

Below are a few medication options that are FDA approved for major depression: 

• Antidepressants: Antidepressants are often the primary medications used to treat MDD. They include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. 
• Other Medications: Mood stabilizers, antipsychotics, and other antidepressant medications may also be used when other medications haven't worked adequately. 

It can take several weeks to experience the full effect of most of these medications.

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance.   

Other treatment options

Below are a couple of treatment options that might be used for treatment-resistant major depressive disorder: 

• Electroconvulsive therapy (ECT): The ECT procedure is done under general anesthesia. It involves small electric currents that are passed through the brain, intentionally inciting a brief seizure. ECT seems to cause changes in brain chemistry that may reverse symptoms of certain mental disorders, including MDD.
• Transcranial magnetic stimulation (TMS): TMS involves delivering a series of electromagnetic pulses to the brain, which can stimulate nerve cells in the region believed to control mood.

Self-care

Below are forms of self-care that may be effective in managing daily life with depression alongside evidence-based forms of treatment: 

• Physical activity and exercise: Regular physical activity can positively impact mood and may be incorporated into a treatment plan.
• Nutrition: Eating a balanced diet is essential for physical and mental health.
• Adequate sleep: Sleep disturbances often accompany MDD, so improving sleep hygiene may help you manage symptoms.
• Mindfulness and stress management techniques: Meditation, yoga, deep breathing, and other stress-reducing activities may help you manage symptoms of MDD.

Treatment plans for MDD can be complex and may require adjustments over time. However, with careful management, the symptoms can be significantly reduced, and individuals can lead healthy, productive lives.

Therapy can be a crucial element in treating major depressive disorder, providing a safe space to explore feelings, thoughts, and behaviors under the guidance of a trained professional. Online therapy, such as that offered by platforms like BetterHelp, can be effective and convenient. These platforms allow individuals to connect with a licensed therapist via phone, video, or text.

Other resources can also provide valuable information and support for MDD patients. The National Institute of Mental Health (NIMH) offers a wealth of information about depression, including symptoms, diagnosis, and treatment. They also have a list of resources for finding help in a crisis or locating a support group. 

The Depression and Bipolar Support Alliance (DBSA) offers in-person and online support groups for people with depression or bipolar disorder. These peer-led groups can provide encouragement, understanding, and advice.

The American Psychological Association (APA) and the American Psychiatric Association provide various resources, including tips for finding a suitable mental health professional and insights into the latest research and treatment options. Help is available, and no one has to manage MDD alone.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Please see our Get Help Now page for more immediate resources.

Recent research has further explored the prevalence and management of major depressive disorder (MDD), particularly regarding recurrent episodes. One study published in 2020 in BMC Psychiatry investigated factors associated with recurrence in patients with MDD. 

The findings indicated that many patients are at substantial risk of recurring episodes after initial remission, with identified risk factors⁵ such as residual symptoms of depression, multiple previous depressive episodes, and a family history of mood disorders. This study underscores the importance of ongoing monitoring and treatment to prevent relapse.

In another study published in Focus, researchers highlighted the potential of neuromodulation therapies, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), for treating MDD. 

The study showed that these therapies could be effective for individuals who don't respond to traditional treatment methods like psychotherapy and medication, demonstrating that MDD can often benefit from flexible, individualized treatment strategies. The authors emphasize that these modalities have improved over time and are associated with fewer side effects than in the past, making them viable options for more patients.

Women are twice as likely to have a depressive episode

The Depression and Bipolar Support Alliance (DBSA) highlights that women are nearly twice as likely as men to have had a depressive episode, with 8.7% of women versus 5.3% of men. However, this statistic may be due to a lack of reporting of symptoms from men due to mental health stigmas related to gender. ¹

¹The Depression and Bipolar Support Alliance

Below more key statistics on major depressive disorder (MDD):

• According to the National Institute of Mental Health (NIMH), an estimated 17.3 million adults in the United States had at least one major depressive episode. This number represents 7.1% of all US adults.
• MDD can often occur alongside anxiety disorders. The Anxiety and Depression Association of America (ADAA) notes that nearly 50% of those diagnosed with depression are also diagnosed with an anxiety disorder.
• NIMH reports that among adults with MDD, 65% received combined care by a health professional and medication treatment, indicating a high level of engagement with treatment options.