Major Depressive Disorder

Major depressive disorder can affect you physically, emotionally, and mentally. Common symptoms include:

• Persistent sadness, emptiness, or anxiety
• Loss of interest or pleasure in activities you once enjoyed
• Changes in appetite or weight
• Sleep disturbances, such as insomnia or oversleeping
• Slowed movements, speech, or thought processes
• Restlessness, agitation, or irritability
• Low energy or feeling “slowed down” most days
• Feelings of guilt, worthlessness, or hopelessness
• Difficulty concentrating or making decisions
• Thoughts of death, suicidal ideation, or self-harm

If you are experiencing suicidal thoughts, please seek immediate help: call 911, go to the nearest emergency room, or dial 988.

The Beck Depression Inventory (BDI) is a self-report tool used to assess depression symptoms. It includes 21 items that measure attitudes and physical symptoms of depression. Each item is rated on a scale from 0 (no symptom) to 3 (severe symptom), helping both patients and providers track severity.

A single major depressive episode can last 6–12 months if untreated. MDD is often recurrent, with the likelihood of future episodes increasing after each occurrence:

• 50% risk after one episode
• 70% after two episodes
• 90% after three episodes

Yes. Fatigue is one of the most common symptoms of MDD. Patients often report low energy, tiredness, or feeling physically slowed down, even after sleep. Residual fatigue can persist after a depressive episode has subsided.

MDD is a leading cause of disability worldwide. Untreated depression can interfere with work, relationships, and daily functioning, and can increase the risk of other conditions, including anxiety disorders, substance use, diabetes, hypertension, heart disease, and lung disease. Severe depression that affects daily functioning may qualify as a disability.

Persistent depressive disorder (formerly dysthymia) is a chronic form of depression lasting at least two years. Major depressive disorder involves more intense depressive episodes but may be shorter in duration. Symptoms that distinguish MDD from persistent depressive disorder include:

• Changes in appetite
• Insomnia or hypersomnia
• Fatigue or low energy
• Low self-esteem
• Poor concentration or decision-making
• Feelings of hopelessness

A person can meet the criteria for both conditions simultaneously.

Research shows that dopamine, norepinephrine, and serotonin play major roles in regulating mood and are closely linked to MDD.

Some individuals experience MDD with psychotic features, which include hallucinations, delusions, or both, alongside depressive symptoms. Approximately 18.5% of people with MDD may experience these psychotic features. If you are experiencing hallucinations, delusions, or suicidal thoughts, seek medical help immediately—call 911 or 988.

Medication can be an important part of treatment. Common options include:

• SSRIs: Fluoxetine (Prozac®), Paroxetine (Paxil®), Sertraline (Zoloft®), Citalopram (Celexa®), Escitalopram (Lexapro®)
• SNRIs: Duloxetine (Cymbalta®), Venlafaxine ER (Effexor XR®), Desvenlafaxine (Pristiq®), Levomilnacipran (Fetzima®)
• Atypical antidepressants: Bupropion (Wellbutrin®), Trazodone (Desyrel®), Mirtazapine (Remeron®), Vortioxetine (Trintellix®), Vilazodone (Viibryd®)
• Tricyclic antidepressants: Imipramine, Nortriptyline (Pamelor®), Amitriptyline (Elavil®), Doxepin, Desipramine (Norpramin®)

Gepirone hydrochloride extended-release (EXXUA) is a newly FDA-approved oral medication that targets MDD with fewer sexual side effects compared to traditional antidepressants. It is expected to be widely available in 2024.

• Make your home or office brighter
• Spend time outdoors, especially in the morning
• Exercise regularly
• Maintain consistent sleep schedules
• Eat balanced meals and limit alcohol
• Seek social support

No. Currently, there are no FDA-approved over-the-counter medications for major depressive disorder.

You can obtain prescriptions from a licensed medical provider, either in-person or online. Telehealth providers like Future Now Rx make it easy to get medications safely and conveniently.