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Depressive Disorders

Major Depressive Disorder

ICD-10-CM: F32.9, F33.9

1. Criteria

DSM Criteria

Criterion A

  • Five or more symptoms are present during the same 2-week period and represent a change from previous functioning.
  • At least one of the symptoms is either depressed mood or markedly diminished interest or pleasure.

DSM Criteria

Criterion A symptom list

  • Depressed mood most of the day, nearly every day, as reported by the patient or observed by others.
  • Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day.
  • Significant weight loss when not dieting, significant weight gain, or a clear decrease or increase in appetite nearly every day.
  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation or psychomotor retardation nearly every day that is observable by others, not just a subjective sense of restlessness or being slowed down.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt, which may be delusional, nearly every day.
  • Diminished ability to think, concentrate, or make decisions nearly every day.
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific suicide plan.

DSM Criteria

Criterion B

  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM Criteria

Criterion C

  • The episode is not attributable to a substance or another medical condition.

DSM Criteria

Criterion D

  • The presentation is not better explained by a schizophrenia-spectrum or other psychotic disorder.

DSM Criteria

Criterion E

  • There has never been a manic or hypomanic episode unless clearly substance- or medically induced.

2. Context

  • Major depressive disorder is usually the picture people imagine when they think of a true depressive episode: a sustained drop in mood or interest, plus changes in sleep, energy, appetite, thinking, and day-to-day functioning that feel like a clear shift from the person's baseline.
  • Clinical frame: Think in episodes. The key question is whether this looks like at least 2 weeks of symptoms that clearly differ from the person's usual self.
  • Rule-outs: Before settling on MDD, slow down and check for bipolarity, substance effects, psychosis, grief context, and medical contributors.
  • Specifier thinking: Once the episode is established, the next useful step is asking how it presents: anxious distress, melancholic features, psychosis, seasonality, catatonia, or peripartum onset can all change management.
  • Clinical focus: Fast symptom burden tracking in outpatient settings.

3. Validated scales

PHQ-9

Fast symptom burden tracking in outpatient settings.

HAM-D

Clinician-rated depression severity, often used in specialty care and research.

QIDS-SR16

Useful when you want a brief depressive symptom measure with repeated follow-up.

MADRS

Sensitive to change during treatment response assessment.

4. FDA approved treatments

Acute treatment of major depressive disorder

Common FDA-indicated antidepressants for MDD; agent choice still depends on age, comorbidity, and adverse-effect profile.

Common treatment side effects

Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.

Interventional psychiatry modalities

  • ECT is established for severe or psychotic depression and is often considered when rapid response is needed.
  • Repetitive TMS is used in treatment-resistant depression.
  • Ketamine or esketamine-based strategies are used in treatment-resistant depression settings.

Related Guides

5. Top management articles

  1. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder The Lancet, 2018
  2. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report American Journal of Psychiatry, 2006
  3. Practice guideline for the treatment of patients with major depressive disorder American Psychiatric Association guideline

When to seek professional help

  • Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
  • Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
  • Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
  • Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3
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References