Major Depressive Disorder Symptoms, Causes & Treatment Options

Depression is a common and serious but treatable mood disorder characterized by persistent feelings of sadness and loss of enjoyment of activities that one previously enjoyed for a period of more than two weeks.

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Major Depressive Disorder?


Depression affects 7% of adults in a given year [1] and can occur at any age, but most commonly begins in one’s teens or 20’s. Depression changes how you experience the world and is associated with a variety of physical symptoms. Although the exact cause of depression is not well understood, it seems to arise due to a complex mix of biological, psychological, and environmental factors. Fortunately, depression is one of the most treatable mental illnesses, with over 80% of people eventually experiencing symptom improvement with treatment. Treatment may include medications, talk therapy, neuromodulation procedures, and lifestyle changes.

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Major Depressive Disorder Symptoms

Main symptoms

During a depressive episode, symptoms occur most days for more than two weeks and typically include low mood or loss of pleasure in most activities.

  • Depressed mood: feeling sad, empty, hopeless, discouraged, or “down in the dumps”
  • Decreased interest or pleasure in most or all activities
  • Unintentional weight loss
  • Increase or decrease in appetite: may have to force self to eat or may crave foods rich in carbohydrates
  • Changes in sleep patterns: including difficulty falling or staying asleep or sleeping more than usual
  • Observable restlessness: inability to sit still, pacing, pulling at skin or hair
  • Slowing of movement and speech
  • Feeling low energy nearly every day
  • Decreased ability to concentrate
  • Feelings of worthlessness or excessively placing blame on oneself
  • Thoughts that life is no longer worth living [2]

Other symptoms

  • Increased irritability: becoming frustrated over minor matters
  • Anger
  • Bodily aches and pains: including headache, joint pains, stomachache
  • Excessive worry about physical health
  • Withdrawing from social activities
  • Decreased sexual desire
  • Difficulty making decisions
  • Tearfulness
  • Ruminative thinking [2]

Symptoms of depression in children and adolescents

Children and adolescents may experience depression differently than adults, although most symptoms are the same. Features of depression that may be more apparent in young people include:

  • Irritable mood may be more predominant than sad mood
  • Failure to make expected weight gains
  • Feelings of boredom
  • Separation anxiety
  • Physical complaints, such as headache or stomach aches
  • Phobias [3]

Major Depressive Disorder Causes

Like most mental health conditions, depression is thought to result from a complex interplay of biological, psychological, and environmental factors. Some major factors thought to be involved in depression include:

  • Genetics: Depression tends to run in families. Personality traits such as pessimism and being easily overwhelmed increase the risk of depression
  • Brain chemistry: Some theories of depression focus on abnormal levels of brain chemicals, such as serotonin, glutamate, norepinephrine, and dopamine as the cause of mood disturbance. Other theories suggest that dysregulation of stress hormones, thyroid hormones, and growth hormones may contribute to depression.
  • Gender: Depression is more common in women, although the exact reason why is unclear.
  • Psychosocial stressors: Severe life stressors, such as separations and losses or chronic exposure to violence, neglect, abuse, or poverty, can contribute to depression.
  • Depression often occurs in the context of substance use, anxiety, or personality disorders as well as chronic medical conditions (e.g., diabetes, morbid obesity, cardiovascular disease). [1,2,4]

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Treatment Options, Relief, and Prevention for Major Depressive Disorder

The course of major depression varies from person to person, with 80 to 90% of people with depression eventually responding well to treatment [1]. Treatment may include a combination of medications, psychotherapy, and lifestyle modifications.


“Talk therapy” alone may be a sufficient treatment for depression or may be recommended in combination with medications, depending on the severity of depressive symptoms. There are many different methods of therapy. Cognitive behavioral therapy (CBT) is a common and effective method that brings attention to distorted patterns of thought that occur in depression and facilitates positive changes in thoughts and behaviors. Often, significant improvement can be made following a few months of weekly sessions [1].


A variety of medications can be used to treat depression. Your physician will recommend the best medication for you based on your symptoms, other medical conditions, and concerns about side effects, which vary across medications.
The full benefits of antidepressants may not be experienced for two to three weeks, although some people notice some improvement in symptoms in the first two weeks after starting an antidepressant. Doctors typically recommend continuing antidepressants for at least 6 months after a depressive episode has resolved to reduce the risk of re-experiencing depression [1]. Medications typically used to treat depression include the following:

  • Selective serotonin or norepinephrine reuptake inhibitors (SSRIs and SNRIs): SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), or escitalopram (Lexapro) are the most common first-line treatment for depression. They are typically well-tolerated, but may be associated with nausea, diarrhea, and insomnia upon initiation and may reduce sexual desire and function in both men and women. SNRIs, including duloxetine (Cymbalta) and venlafaxine (Effexor), are also effective for depression by a slightly different mechanism of action.
  • SSRI discontinuation: When SSRIs and SNRIs are abruptly discontinued, some people experience anxiety, irritability, nausea, vomiting, diarrhea, headaches, sensations to “electric shocks” or “brain zaps,” difficulty sleeping, or visual disturbances. These symptoms get better with time but can be mitigated by a slow and careful taper with guidance from your doctor [5].

  • Atypical antidepressants: Medications such as bupropion (Wellbutrin) and mirtazapine (Remeron) are commonly prescribed for depression and may be particularly helpful for certain symptoms (e.g., bupropion when low energy and poor concentration are predominant or mirtazapine when appetite is severely impaired).

  • Older antidepressants: Tricyclic antidepressants (TCAs) are an older class of medications, including nortriptyline and amitriptyline. Although they are effective for depressive symptoms, they have more side effects than SSRIs and SNRIs, including weight gain, sedation, dry mouth, low blood pressure, and increased risk of heart problems. Monoamine oxidase inhibitors (MAOIs) such as phenelzine are potent antidepressants, but can be difficult to take due to strict dietary restrictions and interactions with numerous other medications. Although less commonly used today, these medications remain viable treatment options when other medications have not been effective [5].

  • Augmentation: When depressive symptoms do not fully resolve with an antidepressant alone, a second medication may be recommended. Depending on your history, a physician may recommend supplementing treatment with an antipsychotic medication, lithium, thyroid hormone, or other agents.

Other treatment options

In addition to therapy and medications, neuromodulation techniques are effective methods of treating depression.

  • Electroconvulsive therapy (ECT) is a medical procedure that is often effective for individuals who have not responded to medications and therapy. ECT is typically delivered in a hospital by a team including a psychiatrist, an anesthesiologist, and nurses. During ECT, the brain is briefly electrically stimulated to induce a short and controlled seizure, while under anesthesia. The procedure is typically painless but can be associated with short term memory problems, so driving is discouraged while receiving ECT. When used to treat depression, initial treatment typically involves 6 to 12 treatments, 2 or 3 times weekly. After symptoms improve, treatments may subsequently be spaced out to weekly or monthly to help maintain remission of depressive symptoms.
  • Transcranial magnetic stimulation (TMS) is a newer neuromodulation technique that uses magnetic fields to stimulate brain cells. Treatments occur in a physician’s office, typically for 30-60 minutes, 5 times per week, for 4 to 6 weeks. The procedure is typically well-tolerated, sometimes involving mild headache or scalp discomfort.


The risk of developing or exacerbating depression may be reduced by the following strategies to promote mental wellbeing.

  • Avoid alcohol and other drugs: Alcohol, tobacco, and other drugs, despite sometimes seeming to relieve negative feelings in the short-term, can worsen symptoms overall. Quitting is often difficult, but your physician can offer you resources to help.
  • Practice good sleep hygiene: Poor quality sleep can negatively affect mood. Do your best to get seven to eight hours of quality sleep every night. Quality sleep is best ensured by going to sleep at the same time each day, avoiding caffeine, nicotine, alcohol, and large meals before bed, avoiding bright screens for an hour before bed and maintaining a quiet and comfortable bedroom.
  • Stay physically active: Many people find that regular exercise (ideally 5 days per week) can improve mood. The type of exercise, be it team sports, running, hiking, or swimming, does not matter, as long you can do it regularly. Relaxing exercises, like yoga, can also be helpful.

When to Seek Further Consultation for Major Depressive Disorder

If your mood is difficult to control and interferes with your daily life

A mild amount of distress is normal and can be healthy in some circumstances. However, if you feel like your mood is out of control and gets in the way of work, family, school, and other responsibilities, report these concerns to your physician.

If you are having thoughts of ending your life

If for any reason you are feeling that life is no longer worth living, report these thoughts to your physician, call 911 or the National Suicide Prevention Lifeline (1-800-273-TALK), or seek help at the nearest emergency room.