Major depressive disorder (MDD) is a serious medical illness that affects 15 million American adults. MDD is not related to normal emotional experiences of sadness or loss. MDD is persistent and interferes with a person’s thoughts, behavior, mood, activity, and physical health. Unknown to many, major depression is the leading cause of disability in the US. Major depression is just one of many types of depressive disorders.

The diagnosis of MDD involves the presence of at least one of the following abnormal moods that have significantly interfered with a person’s life: abnormal depressed mood, abnormal loss of all interest or pleasure, or if 18 years old or younger, irritable mood, most of the day, every day, for at least two weeks and at least five of the following symptoms during the same two-week period: abnormal depressed mood (or irritable mood if 18 years old or younger), abnormal loss of all interest and pleasure, abnormal weight loss or decreased appetite (when not dieting) or abnormal weight gain or increased appetite, sleep disturbance (abnormal insomnia or excessive sleeping), activity disturbance (abnormal agitation or abnormal slowing observable by others), abnormal fatigue or loss of energy, abnormal guilt or self-reproach, abnormal indecisiveness or poor concentration, and abnormal morbid thoughts of death or suicide. These symptoms must not be related to psychosis, physical illness, alcohol, medication, or street drugs, or are not due to normal bereavement to be diagnostic of depression. There must also never have been a manic episode to be diagnosed as depression. Diagnosis is made from the above symptoms because there are no lab tests to diagnose MDD.

About 80 to 90% of MDD patients also have symptoms of anxiety and about one-third have full-blown anxiety disorder such as panic disorder, obsessive-compulsive disorder, or social phobia. Anxiety is an important comorbid condition because it leads to a poorer response to treatment for depression, poorer social and work function, greater risk of chronic condition, and greater risk of suicide.

About 25% of people with chronic medical conditions such as diabetes, heart attack, cancer, or stroke become depressed. Hypothyroidism, Parkinson’s disease, migraine, epilepsy, and multiple sclerosis among other chronic diseases can also cause depression. Up to 15% of MDD patients will die by suicide.

The highest rates of MDD in are in women 25 to 44 years old. Between 10 to 25% of women in this age group will suffer lifetime MDD. The rate for lifetime MDD for men in this same age group is 5 to 12%. Boys and girls are affected equally before puberty. One of the fastest-growing groups of patients diagnosed with MDD is teenagers. Prevalence is not affected by ethnicity, education, income or marital status.

The course of the disease varies. Some have isolated episodes separated by years, others have clusters of episodes, and others have increasingly frequent episodes as they get older.

There are three established treatments for depression: medication, psychotherapy, and electroconvulsive therapy (ECT). Hospitalization may be required for patients at risk for suicide. Although MDD can be a devastating disease, about 80% of patients can be successfully treated and return to their normal lives and activities.

References: http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7725, http://www.mentalhealth.com/dis/p20-md01.html.

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