Let's Talk About Major Depressive Disorder
MDD is a sneaky sonofabitch. Depression likes to stealthily creep into your mind, gradually tanking your mood and harming your quality of life. Recognizing the warning signs—which can vary depending on your age—is the first step in getting the right support.
Before we get into what MDD is, let’s talk about what it isn’t. One misconception centers around the “major” in Major Depressive Disorder —just because that word is in its name doesn’t mean it’s the worst depression ever. MDD is actually just the term for clinical depression. (No one asked us, but we think it should just be called Regular Depression.) Learning to spot the red flags in yourself, a friend, or a family member can make all the difference in preventing the escalation of a depressive episode.
Our Pro Panel
We asked some of the nation’s top depression experts to bring you the most up-to-date information possible.
Charles B. Nemeroff, M.D., Ph.D.
Chief Medical Officer of the Anxiety and Depression Association of America, Professor and Chair of Psychiatry at Mulva Clinic for the Neurosciences
Dell Medical School, The University of Texas
Jennifer L. Payne, M.D.
Director of the Women's Mood Disorders Center and Associate Professor of Psychiatry
Johns Hopkins School of Medicine
Carol A. Bernstein, M.D.
Psychiatrist, Vice Chair for Faculty Development and Well-Being in the Departments of Psychiatry and Obstetrics and Gynecology
Montefiore Medical Center/Albert Einstein College of Medicine
The Bronx, NY
Nope. If you have clinical depression, that means you’ve been diagnosed with MDD by a doctor. Think of it as your depression having the blue verified checkmark on Twitter. In casual conversation, people throw around the word “depressed” when they really mean “sad” or “bummed out.” Those types of feelings will eventually pass, but time generally doesn’t make depression go away. While being sad and bummed out is a part of MDD, a clinical diagnosis requires your depression to get in the way of your life, make you ambivalent to the things you once loved, exhausted, change your appetite and sleeping patterns, and in some cases, lead to recurring thoughts of suicide.
Deciding who to tell about your disorder is a personal and sometimes difficult decision. Your friends and family love and care about you the most, so odds are good they’ll have your best interests at heart if you give them the opportunity to support you. However, you can’t expect everyone to react the way you wish they would. They may not know the right things to say or even take the news very well, so think carefully about who might be the most emotionally equipped to handle this new info. In the workplace, disclosure gets even trickier. Your place of business may not be the wokest environment, and management might still attach stigma to mental illness. Even though there are laws protecting employees from workplace discrimination (check out your rights here), consider that research shows around 25% of people who come out about their disability at work face negative consequences afterward, including lowered expectations, isolation from co-workers, and increased likelihood of termination. We’re not saying you should hide your depression from your bosses and coworkers, but be sure to weigh the pros and cons first.
A person can’t just snap out of a depressive episode. It just doesn’t work that way. However, when you feel a wave of depression coming on (usually via a tell-tale barrage of constant negativity in your brain), it’s important to challenge those thoughts. When you tell yourself, “I can’t ever do anything right,” think back to a time when you absolutely nailed it. Automatic negative thoughts are a symptom of depression and are in no way reflective of you or your value as a person. Even if you’re not feeling yourself right now, stay engaged with the world. Make plans with friends and family, even if you don’t want to. Don’t self-isolate and close yourself off. If your depression lasts for two weeks or more, or you feel overwhelmed, see a mental health professional. It’s easier to pull yourself up with a helping hand.
The median age for a person to get diagnosed with depression is 32, according to the Anxiety and Depression Association of America (ADAA). (Coincidentally, it’s also the average age of a PGA golf champion, but that’s definitely unrelated.) Now, that doesn’t necessarily mean that you’re more likely to become depressed at the age of 32. Many people with depression put off mental health treatment for years, even decades, either self-medicating or suffering in silence.
Ok, Now Let’s Chat More About Major Depressive Disorder
MDD is more than simply feeling sad, experiencing grief, or being super drained of energy. Those feelings are totally valid, but like most feelings, they’ll eventually pass. MDD is an often-debilitating mental illness that presents as a cluster of depressive symptoms. For most people, clinical depression won’t go away on its own and you can’t “just snap out of it.”
While melancholy and exhaustion are part of depression, there are other symptoms to look for, including losing interest in things you once enjoyed, trouble sleeping, sudden crying spells, withdrawing from others, hopelessness, thoughts of self-harm or suicide, and more. Depressive episodes vary in severity and duration, but they must last for two weeks or more to qualify for an MDD diagnosis.
Many people with clinical depression do their best to conceal symptoms from the people around them. They may feel vulnerable and embarrassed for showing “weakness,” or worry that their friends and colleagues might judge them or just plain ghost them. Remember: MDD is not a negative attitude, a character flaw, or a sign of weakness.
Some people with depression can’t recognize depression in themselves. They’re not necessarily imperceptive. Symptoms can pop up gradually and, before you know it, you haven’t been to work, showered, or changed out of pajamas in three days. Classic depression attributes like hopelessness and suicidal comments are easy to spot, but some signs are less obvious.
11 Warning Signs of Major Depression
Here’s what to look out for in people you love (and in yourself!).
1. Not caring about the things that used to excite you. If you haven’t bothered to tune in to The Mandalorian yet even though you were president of your local Boba Fett fan club and have watched every Star Wars movie 10 times, that’s a warning sign. Used to be an avid vegan chef and yogi but now you’re into lying on the couch eating potato chips? That’s another check mark.
2. Transforming into a Negative Nancy/ Ned/ Nat. If your first reaction to any question is to just say no—and you can think of five reasons why everything will go wrong in every situation—MDD is a possibility. Research shows that people with major depressive disorder generally have a more negative view of the future.
3. Avoiding your friends and family. Do you find yourself ducking social situations because you feel like you just can’t muster the energy to hold up your end of a conversation or even smile and pretend you’re having a good time? People with depression tend to socially isolate themselves, which studies say is twice as harmful to physical and mental health as obesity.
4. A change in your eating habits. Do you notice feeling hungrier (or less hungry) or weighing more (or less)? Some people with depression turn to food for comfort, while others lose their appetite because they feel numb or apathetic. Plus, studies have found that excess fat is linked to increased inflammation, which could play a part in causing depression in the first place.
5. Feeling exceptionally angry or irritable. We always picture people with depression as sad and morose, but there’s another side to depression—a crabby, snippy, and outright aggravated side. This kind of behavior is seen particularly often in depressed children.
6. Bitching about aches and pains. MDD might be a mental illness, but research tells us it can affect physical health, too. In one study, nearly 70% of people who met the criteria for MDD visited their docs for mystery aches and pains like joint pain, bloating, and backaches.
7. Always being so damn tired. Sleep deprivation can contribute to MDD—people with insomnia are 10 times more likely to have depression than people who can reliably catch Zs. Plus, depression can make getting a good night’s sleep seem impossible. One study says more than 90% of people with depression feel fatigued.
8. Having no sex drive to speak of. Remember we were talking about how people with depression often lose interest in stuff they used to care about? Sex is a great example of that. What was once pleasurable can become…unenticing. Makes sense, since depression can sap both energy levels and self-confidence.
9. Increased drinking or drug use. When people with depression are overwhelmed by feeling like a sad, lonely, anxious loser, it’s not uncommon for them to cope with a few too many beers, glasses of wine, whiskey shots, cannabis joints…you get the gist. According to the Anxiety and Depression Association of America (ADAA), 20% of people with anxiety or a mood disorder like depression have an alcohol or substance abuse problem.
10. Being super zoned out. Feeling distracted, not being able to focus on tasks at work or at home, and noticing you’re regularly losing your train of thought are all common symptoms of MDD. There’s data indicating that concentration and memory issues can make the social ramifications of depression worse.
11. Recurring suicidal thoughts. It doesn’t matter if you have a plan to actually do it, or if you’re just daydreaming about it. Or talking about suicide more than usual. Or even joking about it, especially if that’s not your usual sense of humor. It may or may not be a legit cry for help, but the fact that suicide keeps crossing your mind could signify trouble. Remember, if you need help—for yourself or someone else—call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
What Does MDD Look Like in Children?
As much as we hate thinking about kids experiencing MDD, the harsh truth is that around 5% of children and adolescents experience depression at any given time. The number may be much higher, since the symptoms aren’t always the ones parents expect and they may not seek help.
Along with the usual signs, a depressed kid is likely to:
Be irritable, frustrated, angry, and on edge
Have frequent crying fits and temper tantrums
Being aloof and not having any interest in interacting with peers or classmates
Become super-sensitive to scolding or criticism
Complain of recurring tummy aches or headaches
Try to get out of going to school, after-school activities, and on playdates
See a decline in school performance
Experiment with vaping, smoking, or alcohol (it seems early, we know, but according to the American Academy of Pediatrics, children start thinking positively about alcohol between 9 and 13 years of age)
What Does MDD Look Like in Teens?
Let’s get real: Teenagers act downright bananas most of the time. Even without clinical depression, they can channel the angst of a French existentialist and Evel Knievel’s self-destructive impulses in the span of an hour.
Some scientists think this is due to their stage of brain development. At this time, their anxiety and fear responses are high, and their ability to regulate emotions is low. The problem starts when they use maladaptive coping strategies (like self-blame, catastrophizing, and rumination).
These unhelpful “habits” can create or exacerbate depressive symptoms. It’s important for teens to get treatment early. Here’s a shocking stat: Suicide is the second leading cause of death for people age 15 to 24.
Along with the usual signs, a depressed teen is likely to:
Complain of headaches and stomachaches
Argue or fight with family and friends
Start skipping meals or eating everything in the house
Miss classes or after-school appointments
Self-isolate in their room
Not having any interest in social events
Extended amount of time spent on the internet and chatrooms
Let hygiene slip (skip showers, stop brushing their hair)
See their grades drop
Start vaping, smoking, drinking, or doing drugs
Act recklessly (promiscuity, speeding)
Self-harm (cutting, eating disorders)
Talk or joke about suicide, research suicide methods, seek out weapons
What Does MDD Look Like in Older Adults?
Spotting MDD in people age 65 and older isn’t as easy as it seems. Many older adults have medical conditions like heart disease, stroke, cancer, and arthritis, which are strongly linked to depressive symptoms and can lead to social isolation.
Their activity level may already be low for physical reasons. They may not be comfortable talking about mental health (if they clam up or change the subject whenever it comes up, there’s your clue). Some older adults with no prior history of depression may develop vascular depression, caused by restricted blood flow to the brain.
Along with the usual signs, a depressed older adult is likely to:
Experience confusion and memory problems (often mistaken for dementia or Alzheimer’s disease)
Avoid social activity
Move in a slowed-down manner (Sluggish)
Make persistent, vague complaints
Demand assistance or frequently seek help
Lose their appetite or lose weight
Have delusions or hallucinations
MDD is a beast of an illness. And, not surprisingly, it can be really difficult to ask for help when you are experiencing the symptoms we’ve discussed. If you or someone you know is showing signs of MDD, know that treatment (which comes in many forms) can and will help.
Being a Negative Nancy: Psychological Medicine. (2014) “Depression is related to an absence of optimistically biased belief updating about future life events.” ncbi.nlm.nih.gov/pmc/articles/PMC3880066/
Social isolation: Perspectives on Psychological Science. (2015) “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review.” journals.sagepub.com/doi/10.1177/1745691614568352
Appetite and weight change (1): Brain, Behavior, and Immunity. (2020) “Appetite change profiles in depression exhibit differential relationships between systemic inflammation and activity in reward and interoceptive neurocircuitry.” ncbi.nlm.nih.gov/pubmed/31604141
Appetite and weight change (2): Archives of Medical Science (2017) “Obesity and inflammation: the linking mechanism and the complications” ncbi.nlm.nih.gov/pmc/articles/PMC5507106/
Anger and irritability (1): Journal of Clinical Psychiatry. (1999) “Anger attacks in patients with depression.” ncbi.nlm.nih.gov/pubmed/10418810
Anger and irritability (2): Indian Journal of Psychological Medicine. (2014) “Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression.” ncbi.nlm.nih.gov/pmc/articles/PMC3959025/
Depression and pain (1): PLoS One. (2014) “The Association of Depression and Anxiety with Pain: A Study from NESDA.” ncbi.nlm.nih.gov/pmc/articles/PMC4198088/
Depression and pain (2): Dialogues in Clinical Neuroscience. (2006) “Somatic symptoms in depression.” ncbi.nlm.nih.gov/pmc/articles/PMC3181769/
Depression and fatigue (1): Sleep. (2005) “Epidemiology of insomnia, depression, and anxiety.”
Depression and fatigue (2): CNS Drugs (2018) “Fatigue in Patients with Major Depressive Disorder: Prevalence, Burden and Pharmacological Approaches to Management.” link.springer.com/article/10.1007/s40263-018-0490-z
Depression and substance abuse: Anxiety and Depression Association of America. (n.d.) “Substance Use Disorders.” adaa.org/understanding-anxiety/related-illnesses/substance-abuse
Depression and concentration: PLoS One. (2014) “The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning.” journals.plos.org/plosone/article?id=10.1371/journal.pone.0090311
Depression in children + adolescents (1): The American Academy of Adolescent Psychiatry: The Depressed Child. (2013) “Facts for Families.” aacap.org/App_Themes/AACAP/docs/facts_for_families/04_the_depressed_child.pdf
Depression in children + adolescents (2): Cleveland Clinic. (2015). “Depression in Children.” my.clevelandclinic.org/health/diseases/14938-depression-in-children
Depression in children + adolescents (3): New York Times. (2014). “Why Teenagers Act Crazy.” nytimes.com/2014/06/29/opinion/sunday/why-teenagers-act-crazy.html
Teen suicide: The National Institute of Mental Health. (2019). “Suicide.” nimh.nih.gov/health/statistics/suicide.shtml
Depression in older adults: National Heart, Lung, and Blood Institute. (2017). “Heart disease and depression: A two-way relationship.” nhlbi.nih.gov/news/2017/heart-disease-and-depression-two-way-relationship
Depression in older adults (2): National Alliance on Mental Illness (NAMI). (2009). “Depression in Older Persons Fact Sheet.” ncoa.org/resources/depression-in-older-persons-fact-sheet/