Major Depressive Disorder (MDD): Signs, Symptoms, and DSM-5 Criteria

Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

What is Major Depressive Disorder (MDD)?

MDD is a mental health condition characterized by feeling down, drained, and not enjoying life. MDD, by definition, significantly affects an individual’s mood to the point of hindering daily functioning. In this blog post, we aim to dissect the signs, symptoms, and diagnostic criteria of MDD, as well as discuss its prevalence and potential treatment options.

What are Some Signs of Major Depressive Disorder?

Persistent Sadness or Emptiness: Individuals with MDD often describe a pervasive feeling of sadness, emptiness, or tearfulness that doesn’t go away and affects their daily lives.
Loss of Interest or Pleasure: Called anhedonia by mental health professionals, a hallmark of MDD is the diminished interest or pleasure in activities, that the person once enjoyed, including hobbies, social activities, or sex.
Weight Changes and Sleep Disturbances: Significant weight loss or gain when not dieting, or changes in sleeping patterns, whether insomnia or excessive sleeping, are common symptoms.
Fatigue or Loss of Energy: People with MDD frequently experience a profound fatigue or a decrease in energy levels, making even small tasks seem exhausting.
Feelings of Worthlessness or Excessive Guilt: Individuals may exhibit overly critical self-evaluation or excessive guilt over past actions or circumstances beyond their control.
Difficulty Thinking or Concentrating: MDD can impair one’s ability to think, concentrate, or make decisions, affecting academic or professional performance.
Thoughts of Death or Suicide: Recurrent thoughts of death, suicidal ideation, or suicide attempts are serious symptoms that necessitate immediate intervention.

DSM-5 Criteria for diagnosing MDD:

A. To diagnose MDD, at least five of the below symptoms must be present during the same two-week period and represent a change from previous functioning. Additionally, one of the symptoms must be either a depressed mood or loss of interest or pleasure.

Depressed mood most of the day, nearly every day.
Diminished interest or pleasure in almost all activities.
Significant weight loss or gain, or changes in appetite.
Insomnia or hypersomnia.
Psychomotor agitation or retardation.
Fatigue or loss of energy.
Feelings of worthlessness or excessive guilt.
Diminished ability to think, concentrate, or make decisions.
Recurrent thoughts of death or suicidal ideation.

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

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode. (i.e. – a bipolar diagnosis trumps a major depressive disorder diagnosis)

Who is Predisposed to MDD?

According to research, approximately 10% of people experience depression within a 12-month period, while about 21% will experience depression at some point in their lifetime. Interestingly, depression appears to be more common in females, with the condition being twice as prevalent among women compared to men.

Furthermore, age plays a role in the prevalence of depression. Young adults between the ages of 18 to 29 have a particularly high prevalence, with rates three times higher than individuals aged 60 and older. This suggests that younger adults may face unique stressors and challenges that contribute to their increased vulnerability to depression.

How is MDD Treated?

Treatment for Major Depressive Disorder typically involves a combination of medication and psychotherapy, with evidence suggesting that this integrated approach yields higher remission rates compared to employing either medications or therapy in isolation. Antidepressants play a crucial role in mood regulation, while Cognitive Behavioral Therapy (CBT), psychodynamic therapy, and additional psychotherapeutic methods focus on altering negative thought patterns, enhancing coping mechanisms, and fostering deeper self-awareness. For instances resistant to several rounds of medication or therapy, or in cases necessitating urgent care, alternative treatments like Electroconvulsive Therapy (ECT) or Transcranial Magnetic Stimulation (TMS) may be explored. Tailoring a comprehensive treatment strategy to meet the unique needs of the individual can markedly elevate the chances of a successful outcome.