Major Depression

Major depression - aka major depressive disorder, unipolar disorder, and clinical depression - is a mood disorder. This article gives an overview of major depression; including diagnosis, screening tools, types of major depression, causes and treatment options.

Different from sadness and withdrawal that is a normal reaction to the painful and adverse events of life and normally resolve without medical intervention (non-pathological depression), major depression is not normal.

What Is Major Depression and How Is it Diagnosed?

Major depression is a disorder, not a disease. That means that - as understood at present - it has symptoms of disrupted functionality, rather than physical signs, like a rash or a bruise. Major depression is diagnosed when someone has at least five symptoms of depression lasting at least two weeks. Symptoms include:

  • Changes to one’s emotions, including pervasive sadness and generally depressed mood
  • Changes to one’s view of the future, including pessimism and hopelessness
  • Changes to one’s normal habits, including loss of appetite and insomnia, as well as withdrawal from normal activities and/or a loss of pleasure in them
  • Changes to one’s self-image, including feelings of helplessness, guilt, worthlessness, and/or self-hatred
  • Feeling fatigued or like one has no energy
  • Possible increases in sensitivity including agitation, irritability, and restlessness
  • Changes to one’s mental state, including mental confusion, sluggishness, and difficulty making decisions
  • Thoughts of suicide and/or suicide attempts

Postpartum depression is a particular type of major depression experienced by some new mothers.

The diagnosis of major depression is often made through the use of both a screening tool and a conversation. Commonly used screening tools - which the patient may use to self-assess or which may be administered by a healthcare professional - include:

  • Beck Depression Inventory (BDI-II)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Geriatric Depression Rating Scale
  • Goldberg Depression Questionnaire
  • Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR)
  • Wakefield Self-Report Questionnaire

Types of Major Depression

Major depressive disorder in the United States is often categorized using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) from the American Psychiatric Association (APA). In this categorization, major depressive disorder has several subcategories.

First, occurrences that are singular, involving only a singular episode, are distinguished from recurring episodes. Second, the current state is noted as being in full or partial remission (otherwise it is assumed to be active at the current time). It is then distinguished as being mild, moderate, or severe. And severe manifestations of depression are categorized by whether or not they include psychotic features, meaning hallucinations or delusions.

Causes and Risk Factors

Causes of major depression are not known with certainty and may be different for different people and even different for the same person at different times. It is thought that major depression can grow out of normal responses like non-pathological depression, the so-called “baby blues,” or other situations in which a stressful event (whether positive or negative) is causal.

Familial patterns have been seen in some cases, with APA reporting that those who have a first-degree relative who has had major depression having one and a half to three times more chance of having major depression themselves as those in the general population. and biological causes involving the brain’s handling of neurotransmitters have also been implicated. Women are more likely to become depressed than men: it is not known why. APA reports that some studies report a lifetime prevalence of depression at 26 percent in women and 12 percent in men.


Treatment of major depression is usually undertaken with antidepressant medications and psychotherapy combined, though either may be used alone. The antidepressants used fall into four groups:

  • tricyclic antidepressant medications
  • Selective serotonin reuptake inhibitors (SSRIs)
  • other antidepressant medications
  • monoamine oxidase inhibitors (MAOIs)

Antidepressants do not, and perhaps should not be expected to, work for everyone. An analysis released early in January 2010 by The Journal of the American Medical Association (JAMA) found that antidepressants work well only in the most severe cases, but for patients with less severe depression are of no more value than placebos. Other treatment options include electroconvulsive therapy (ECT); psychotherapy of a variety of kinds (interpersonal therapy, cognitive behavioral therapy, psychodynamic therapy, family therapy); support groups; and exercise programs. For more information about treatment, see the article “Treating Depression.”


Related Article: Postpartum Depression >>