Symptoms of Major Depressive Disorder (MDD)

Dealing with symptoms of depression is something that basically everyone has to face at some point in their lives. Even the happiest individuals face tragedy and grief eventually, and managing those difficult emotions can lead to things like depression.

However, while small bouts of depression are normal in the face of adversity, some people have to deal with a much more long-term challenging issue, Major Depressive Disorder (MDD). This potentially chronic condition can have a huge impact on your daily quality of life, and left untreated, lead to dangerous symptoms like suicidal ideation.

But what is Major Depressive Disorder (MDD)? What are the different types of depressive disorders, and how do they vary? What are some severe Major Depressive Disorder symptoms to watch out for in your loved ones? If you’ve been asking these questions, this page can help.

If you’ve already spoken with a behavioural therapist or counselor who has recommended that you start Major Depressive Disorder (MDD) treatments, just complete a short online assessment to get started with Felix.

What is Major Depressive Disorder (MDD)?

Major Depressive Disorder (MDD) is a condition that’s diagnosed in patients that have a history of experiencing at least one major depressive episode (and its symptoms), but who have no history of mania or hypomania.

In some cases, MDD is simply referred to as ‘major depression’.

What is a ‘Major Depressive Episode’?

A major depressive episode is considered to be a period lasting at least two consecutive weeks, with a person experiencing at least five of the following symptoms, nearly every day:

• Depressed mood (feeling sad, empty, or hopeless for most of the day, every day)
• Irritability or frustrated mood (particularly in children and adolescents)
• Anhedonia (inability to experience joy or pleasure in any, or nearly all, daily activities)
• Insomnia
• Hypersomnia
• Change in appetite (loss of interest in eating, even food eaten for pleasure)
• Change in weight (weight loss while not dieting or more than a 5% gain of body mass in a month)
• Psychomotor retardation (motor/mental functions slow down)
• Psychomotor agitation (repetitive or unintentional movements brought on by anxiety or restlessness)
• Low energy or fatigue
• Poor concentration
• Thoughts of worthlessness
• Feelings of excessive or inappropriate guilt
• Recurrent thoughts about death (not just fear of dying)
• Suicidal ideation (with or without a specific plan)
• Suicidal attempts

At least one of these depressive episode symptoms needs to be depressed mood or anhedonia, in order for it to be classified as MDD. The symptoms of clinical depression must also cause the person significant distress or functional impairment; in either social, occupational, or other important areas of functioning.

SIDE NOTE: Major depressive episodes can occur in not just Major Depressive Disorder (MDD), but also in bipolar disorders, as well as some other psychiatric disorders.

Symptoms for MDD should not be those that are clearly attributable to another known medical condition, or the direct physiological effects of a substance. This is why it’s a good idea to talk to your practitioner, if you’re unsure about your exact diagnosis, or your long-term treatment plan.

Different Types of Major Depressive Disorder

To be clear, there are no distinctly different types of Major Depressive Disorder (MDD).

However, there are a number of other factors that can play into how symptoms of MDD present themselves, their severity, the combination of symptoms experienced, and when/how the depressive episode symptoms appear.

While one person may experience chronic depression symptoms, another may feel like they’ve lost their zeal for life, with symptoms focusing on things like hypersomnia, fatigue, poor concentration, and psychomotor retardation.

Here are some the different ways that MDD may appear in patients:

• During moments of anxious distress
• With mixed features
• With melancholic features
• With atypical features
• With psychotic features
• With catatonia
• During the onset of peripartum
• Alongside seasonal patterns

Distinguishing Symptoms from Normal Feelings

The easiest way to distinguish Major Depressive Disorder (MDD) symptoms from normal feelings is to start by recognizing whether these depressive episode symptoms are being caused by a significant loss (i.e., bereavement, financial ruin, losses from a natural disaster, serious illness or disability, etc.).

These types of situations are likely to cause feelings that resemble severe clinical depression symptoms, which is both understandable and appropriate. However, it’s important to ensure that there isn’t the presence of a major depressive episode, in addition to these normal feelings.

As we mentioned, this means watching for the symptoms of a major depressive disorder episode, such as: depressed mood or irritability, anhedonia, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, fatigue, poor concentration, thoughts of worthlessness or guilt, recurrent thoughts of death, or even suicidal ideation/attempts.

If you or someone you love is experiencing five or more of these symptoms of MDD, it’s time for them to talk to a practitioner about what Major Depressive Disorder treatments might be available to help.

Who is Most at Risk for MDD?

There are several different sociodemographic factors that are associated with an increased risk for someone experiencing MDD.

These include:

Age

In the US, MDD is more common in younger adults. A national survey found that during a 12-month period, unipolar major depression was greater in younger age groups than adults aged 65+ (11-13% for younger adults vs 5% for seniors). Lifetime prevalence was also greater in younger groups (20-23% vs 14%).

Another survey found that clinically significant depressive symptoms are more common among younger adults. In fact, it’s been found that the prevalence of depression in older adults declines as they age. A US community survey of adults over 55 found that in a 12-month period, major depression symptoms decreased significantly with increasing age.

SIDE NOTE: Certain groups of older adults have a higher rate of depression, compared with older adults in general. This group includes people living in older primary care, whose numbers are comparable to that of younger patients.

MDD becomes even more common in older adults that are living with a greater burden of medical illness, including people in assisted living or skilled nursing facilities, people receiving home health care, as well as those suffering from a wide range of acute or chronic medical conditions.

Income

When looking at the general population of the US, major depression is more common among those with lower personal or household incomes.

A national survey from 2013 in the US found that during a 12-month period, unipolar clinical depression symptoms were more prevalent in lower income household categories (between 10-14% vs 8%), for the highest family income category ($70,000+ USD). However, these differences are less prevalent when considering lifetime major depression (20-23% vs 20%).

Marital Status

Another national survey in the US found that unipolar major depressive episode symptoms are highest in adults that are either divorced, separated, or widowed.

With a 12-month period, here is how that survey represents different categories of people affected within those groups:

• Married or Cohabitating - 8%
• Never Married - 13%
• Divorced, Separated, or Widowed - 14%

When considering these same categories from a lifetime perspective, the numbers change slightly:

• Married or Cohabitating - 19%
• Never Married - 21%
• Divorced, Separated, or Widowed - 26%

Race/Ethnicity

Additionally, the same survey in the US found that within a 12-month period, unipolar Major Depressive Disorder (MDD) symptoms were highest amongst Native American populations, and they were lowest amongst Asians and Pacific Islanders.

Here’s how the statistics looked during the 12-month period:

• Asian/Pacific Islander - 7%
• Black - 9%
• Hispanic - 10%
• Native American - 16%
• White - 11%

These statistics change when considering lifetime prevalence:

• Asian/Pacific Islander - 12%
• Black - 15%
• Hispanic - 16%
• Native American - 28%
• White - 23%

Sex

When considering the general population of the US, as well as other countries, the prevalence of various depressive syndromes is roughly 2x greater in women than men.

A national survey done over a 12-month period found the prevalence of major depressive disorder symptoms in 13% of women, compared to 7% of men. When looking at lifetime prevalence, these numbers rise to 26% for women and 15% for men.

Surveys that take into account community-dwelling adults in 15 countries (including the US), found major depression and persistent depressive disorder (dysthymia) is 1.9x higher in women than men.

While it’s not entirely known why women experience higher prevalence of severe depressive symptoms, it's believed the prevalence could be related to the etiology of depression presenting differently for each sex.

How do MDD Symptoms Appear in Teens & Youth?

Children and adolescents that are experiencing depressive episode symptoms feel down most of the time, for at least 2 weeks. They’ll also be experiencing at least 1 of these two symptoms:

1. They no longer enjoy or care about doing the things that they used to like to do.
2. They feel sad, down, hopeless, or cranky most of the time, almost every day.

Children and teens with depression often won’t express their emotions in the way adults do. They may appear irritable, grouchy, or annoyed by almost everyone and everything. They may also begin to respond to frustration with anger or emotional outbursts.

In some cases, younger people with symptoms of MDD may have other symptoms as well, such as:

• Being negative
• Picking fights
• Arguing a lot
• Feeling like life is unfair
• Being restless or fidgeting a lot
• Moving or speaking more slowly than normal
• Sleeping too little or too much
• Eating too little or too much
• Gaining or losing weight without trying
• Not having a lot of energy
• Feeling guilty, helpless, or like they are worthless
• Performing risky, thrill-seeking behaviours (i.e., drug use, unprotected sex, etc.)
• Difficulty with concentration or memory
• Repeated thoughts of death or killing themselves

It can sometimes be difficult to tell the difference between a teen experiencing Major Depressive Disorder (MDD) symptoms, and one who’s facing the normal challenges of childhood, adolescence, and puberty.

If you think your child could be depressed, you should make an appointment for them to speak with a doctor or nurse as soon as possible.

How do MDD Symptoms Appear in Adults?

As we mentioned above, the symptoms of MDD can vary depending on the person, but some symptoms to watch for include:

• Depressed mood
• Irritability or frustrated mood
• Anhedonia  (diminished interest or pleasure in participating in hobbies or activities you usually enjoy)
• Insomnia or hypersomnia
• Change in appetite or weight
• Psychomotor retardation or agitation
• Low energy or fatigue
• Difficulty concentrating
• Thoughts of worthlessness
• Feelings of excessive or inappropriate guilt
• Recurrent thoughts about death (not just fear of dying)
• Suicidal ideation or suicidal attempts

If you’re an adult experiencing these symptoms, and you’ve already been diagnosed with MDD, Felix can help. Complete a short assessment online, and one of our practitioners will determine whether there are Major Depressive Disorder treatments that could help you manage your condition.

Living with Major Depressive Disorder

Living with Major Depressive Disorder (MDD) isn’t easy. It takes time to learn coping strategies, as well as find a treatment plan that can give you the additional support you need.

One method that’s often recommended for managing your Major Depressive Disorder symptoms is to talk to your doctor about getting a referral for psychotherapy.

Psychotherapists will be able to help you work through some of the mental health elements that could be contributing to your depressive state. They will also help you learn coping strategies that you can use to control these episodes when they occur.

Treatment Options for Major Depressive Disorder

For most people who are experiencing moderate major depressive symptoms, treatments that are usually suggested include either an antidepressant and/or in-person psychotherapy. In some cases, exercise and other supplemental interventions can also be used as part of an overall treatment plan.

When people with moderate major depression also have a prior history of MDD, longer symptom duration (6 months or more), or have/had active suicidal ideation or marked functional impairment, a combination treatment is usually suggestion.

This usually involves pharmacotherapy plus psychotherapy; although sometimes initiating two treatment modalities simultaneously may be challenging for some people and can affect adherence. These combination treatments will be discussed separately, which can help make it easier to adapt both modalities close together.

SIDE NOTE: Because in-person psychotherapy and antidepressants have similar efficacy, it’s important that the choice between them depends primarily on your preference.

Making the decision of what’s best for you could be impacted by things like access to treatment, quality of available psychotherapy, as well as ongoing costs associated. Antidepressants are generally widely available, more convenient, and less expensive than psychotherapy. Some people may simply prefer pharmacotherapy.

Conversely, some people may prefer psychotherapy, rather than taking antidepressants; partially due to avoidance of potential side effects and/or to minimize the risk of drug interactions. Psychotherapy may also be optimal for people with significant life stressors or relationship issues that are contributing to their depressive episode symptoms.

Antidepressant Medications

These types of medications are typically used for people experiencing moderate-to-severe depressive disorders, mainly because of their efficacy, availability, and acceptability in patients. Some people with mild major depression can also benefit from antidepressant treatments.

Antidepressant medications can be used either as monotherapy, combined with psychotherapy, or combined with other supplemental interventions, depending on what your healthcare practitioner believes is the best universal treatment plan for treating your symptoms.

If you’re someone with MDD, whose initial treatment plan includes antidepressants, there’s a good chance that your doctor will suggest second-generation antidepressants (SGAs). These could include selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs), depending on their efficacy and tolerability.

Specific guidance for selecting an antidepressant, dose initiation (and updates), monitoring, and subsequent management are all discussed separately, so that your practitioner can find the best possible solution for your chronic depression symptoms.

Building Resilience & Managing Depressive Episodes

As we mentioned before, one treatment method that’s recommended for managing Major Depressive Disorder symptoms is to request psychotherapy.

While this won’t provide instant relief, psychotherapy is a proven method for helping to learn coping skills and techniques that make it easier to manage depressive episode symptoms, when they occur.

Over time, this is a healthy, non-medical way to not only learn how to manage your depressive episode symptoms, but also to confront and deal with emotional issues that may be triggering the episodes. In turn, this can help reduce the frequency and severity of your depressive episodes.

When to Seek Professional Help for Major Depressive Disorder?

Don’t wait until you feel like you can’t get out of bed in the morning to seek help. If your chronic depression symptoms are beginning to impact your day-to-day living, it’s time to talk to a practitioner about what Major Depressive Disorder treatments might be available for you.

To get started with Felix, all you have to do is complete a short online assessment, at your convenience. Then a practitioner will evaluate what Major Depressive Disorder treatments may be appropriate for you, based on your health, medical history, and current symptoms.

With Felix in your corner, you can take back control of your quality of life, so that you can get back to living life on your terms - the way it should be.