Major depressive disorder

01

What it is

Major depressive disorder is more than sadness. It is a sustained pattern of low or irritable mood, loss of interest or pleasure, and related cognitive and physical symptoms that cause distress or impair daily life. Episodes vary in severity, duration, recurrence, and associated anxiety or physical symptoms. Depression is treatable, and needing care is not a moral, spiritual, or motivational failure.

Sources for this section: [1] [3]

02

Symptoms and how it may present

Depression involves a persistent cluster of symptoms that impairs daily life, commonly low mood or loss of interest together with changes in sleep, appetite, energy, concentration, movement, guilt, hopelessness, or thoughts of death. It can affect anyone. Grief, trauma, bipolar disorder, substance use, medicines, thyroid disease, and other illnesses can resemble or accompany depression.

Sources for this section: [1] [3]

03

Causes and risk factors

Depression can arise from interacting genetic vulnerability, brain and body processes, trauma, loss, isolation, discrimination, chronic stress, illness, pain, medicines, hormonal transitions, sleep disruption, and substance use. No single test identifies one cause. A history of mania or hypomania matters because bipolar depression requires a different treatment approach. Pregnancy and the postpartum period, adolescence, older age, disability, and serious medical illness can change presentation and risk.

Sources for this section: [1] [2]

04

Assessment for major depression

Tests should answer a clinical question and be interpreted together with symptoms, examination, and history.

Assessment is a clinical conversation, sometimes supported by a questionnaire, that considers symptom duration, function, past episodes, mania or hypomania, anxiety, substances, physical health, medicines, social conditions, and suicide risk. There is no single blood test for depression, but testing may help identify contributing illness. Privacy, culture, language, and the person’s own goals matter.

Major depression, also called major depressive disorder, is assessed through symptoms, duration and their effect on daily life—not a questionnaire score alone. Bring a brief timeline of mood, interest, sleep and functioning. Mention medicines and past periods of unusually elevated mood or energy; clinicians consider bipolar disorder and other possible explanations, including thyroid problems.

Keep a useful symptom record before your visit

Sources for this section: [1] [2] [3]

05

Treatment options

The best option depends on severity, other conditions, likely benefit and harm, access, and personal priorities.

Evidence-based psychotherapies and antidepressant medicines are core treatments; either or both may be appropriate depending on severity and preference. More severe, psychotic, bipolar, or treatment-resistant presentations need specialist planning and may involve other medicines or brain-stimulation treatments. Antidepressants take time, may cause adverse effects, and should not be stopped abruptly without a plan.

Sources for this section: [2] [4]

06

Daily life and supportive care

Regular contact, sleep routines, achievable activity, social connection, practical help, reduced alcohol or drug use, and treatment of pain or other illness can support recovery. Exercise helps some people and can complement treatment, but depression can make action unusually difficult; small supported steps are more realistic than blame. Supplements such as St John’s wort can cause major drug interactions and are not risk-free.

Read the evidence and limits of exercise for depressive symptoms

Sources for this section: [1] [2] [4]

07

Monitoring and follow-up

Follow trends that can change a decision rather than collecting measurements without a purpose.

Follow mood, interest, sleep, energy, concentration, appetite, functioning, adverse effects, adherence, substance use, and thoughts of death or self-harm. A questionnaire can organize symptoms but does not replace conversation and clinical judgment. Early follow-up is especially important after starting or changing treatment, after a crisis, and when agitation, insomnia, impulsivity, or possible manic symptoms appear. Improvement may be uneven; function and quality of life matter alongside a score.

Sources for this section: [2] [3] [4]

08

Complications and long-term outlook

Many people recover from an episode, but recurrence can occur. Continuing treatment for an appropriate period, identifying early warning signs, reducing barriers, and having a relapse plan can help. Untreated or severe depression can impair nutrition, self-care, relationships, work, and management of other illnesses and can increase suicide risk. Persistent symptoms deserve reassessment of diagnosis, treatment delivery, co-occurring conditions, adherence, trauma, sleep, substance use, and social stressors—not an assumption that the person has failed.

Sources for this section: [1] [2] [4]

09

When to seek urgent help

Thoughts of suicide, an inability to stay safe, psychosis, severe self-neglect, catatonia, or rapidly escalating agitation need urgent assessment. Ask directly about safety and do not leave someone alone when immediate danger is present; contact local emergency or crisis services. Recovery is often uneven. A relapse plan can record early warning signs, helpful actions, contacts, and how treatment will be reviewed.

Sources for this section: [1] [2] [3]

10

Questions to discuss with a care team

A guideline describes what tends to help groups of people, but it cannot decide what matters most in one person’s life. Revisit the plan when symptoms, function, other illnesses, pregnancy plans, medicine access, side effects, or personal priorities change. Ask for plain-language reasoning and say directly when cost, time, transport, caregiving, or treatment complexity makes a recommendation unrealistic.

• What evidence supports this diagnosis, and is there another condition we still need to rule out?
• What is the treatment goal, and how do the main options differ in benefit, harm, burden, and cost?
• What should be monitored, how often, and what result would change the plan?
• Which symptoms require a routine appointment, urgent assessment, or emergency care?

Sources for this section: [2] [4]