Major Depressive Disorder

About Major Depressive Disorder

Major depressive disorder is among the most common mental health conditions worldwide, and the World Health Organization ranks depression as a leading cause of disability. Under DSM-5, diagnosis requires at least five of nine symptoms present for at least two weeks, including depressed mood or loss of interest or pleasure, together with changes in sleep or appetite, psychomotor agitation or slowing, fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and recurrent thoughts of death or suicide. Women are diagnosed roughly twice as often as men. Causes involve an interaction of genetic vulnerability, stressful life events, physical illness and changes in brain systems that regulate mood and stress. Evidence based treatments include psychotherapies such as cognitive behavioral therapy and interpersonal therapy, and antidepressant medications such as SSRIs and SNRIs, often in combination. Response varies, and some people do not improve after several treatment attempts, a situation described as treatment resistant depression. Options for these cases include esketamine nasal spray, approved in the United States in 2019, and brain stimulation treatments such as electroconvulsive therapy and transcranial magnetic stimulation.