Major Depressive Disorder: Symptoms, Types, & Treatments

Written by Dr. Paul Kelly, C.Psych.              February 8, 2024

You don’t have to be afraid of depression. This article tells you what to do.

• What Is Clinical Depression?
• Depression is More Than Sadness
• Major Depressive Disorder Symptoms
• What Does Depression Feel Like?
• What Would Love Ones Notice?
• What are the Risks of Not Getting Treatment?
• Psychotherapy Treatment for Clinical Depression
• 5 Lifestyle Changes to Help Overcome Depression
• A Personal Note

What Is Clinical Depression?

Clinical depression is also known as Major Depressive Disorder (MDD). Signs and symptoms include feeling sad and hopeless, lack of enjoyment and loss of motivation. Clinical depression can develop if you are overwhelmed by relationship troubles or other life challenges. When depression sets in, it can last a long time. It can make it very difficult to carry on with life, and it feels miserable.

Depression is More Than Sadness

Sadness is a normal human emotion. All of us experience it at times. Sadness can develop after we have been upset, hurt, or disappointed. Sadness is temporary. Usually, you can figure out what caused it.

Depression differs from sadness in several ways. It is more intense. It lasts longer and it has a greater impact on your ability to carry on with your life and responsibilities.

Depression often starts with sadness. When people are sad, they pull back to think things over and recharge their batteries. Sometimes they get stuck in depression. The symptoms of depression make it hard for them to start living again. They feel too sad, too unmotivated, and too hopeless.

Major Depressive Disorder Symptoms

The DSM 5 is a psychiatric diagnosis manual. Here is a summary of the diagnostic criteria for MDD from the manual. These are the main symptoms of clinical depression.

1. Depressed Mood: Most of the day, nearly every day, a person feels sad, empty, or hopeless. They feel like crying. They might also feel agitation and anxiety.
2. Diminished Interest or Pleasure: A noticeable loss of interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Weight Loss or Gain: A weight change unrelated to dieting. Increase or decrease in appetite. Significant weight loss or gain.
4. Insomnia or Hypersomnia: Trouble sleeping or sleeping too much nearly every day.
5. Psychomotor Agitation or Retardation: Observable restlessness or physically slowed down nearly every day.
6. Fatigue or Loss of Energy: Feeling unusually tired or losing energy nearly every day.
7. Feelings of Worthless or Excessive Guilt: Frequent feelings of worthlessness or undue guilt.
8. Diminished Ability to Think or Concentrate: Indecisiveness or a reduced ability to think or concentrate, nearly every day.
9. Thoughts of Death or Suicide: Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide.

What Does Depression Feel Like?

When someone is depressed, they might feel a heavy blanket of sadness. Or they seem to be looking at the world through dark glasses. They can’t shake off feelings of gloom and sadness. All their thoughts are negative. They don’t want to get out of bed. Hanging out with friends feels draining. Nothing feels pleasant or good. Everything seems hopeless and not fun.

What Would Love Ones Notice?

When someone is depressed, their friends and family might notice these changes:

• Don’t laugh or smile as much as they used to.
• Don’t want to join in on activities or hang out.
• Seem really tired all the time.  Might complain about not sleeping well.
• Don’t talk as much. It seems like they’re always thinking about something sad.
• Gets upset or angry more easily than before.

What are the Risks of Not Getting Treatment?

Here are the risks if someone has depression and doesn’t get help:

1. Feeling Worse: The feelings of sadness, loneliness, and hopelessness can get stronger and harder to deal with.
2. Problems at School or Work: Concentrating might become tough.  Homework, tests, or work tasks could feel much harder. Grades or job performance could drop.
3. Trouble with Relationships: Depression can make it hard to connect with friends and family. You might pull away from people who care about you. Then you would feel more alone.
4. Not Taking Care of Yourself: You might not want to eat right or even take care of basic things like showering and getting out of bed. Then you will feel even worse.
5. Risky Behaviors: Sometimes, people with untreated depression try to make themselves feel better with drugs or alcohol. Or they might do dangerous things, which can lead to more problems.
6. Other Health Issues: Depression affects your immune system. So, you might get sick more often or have other health problems.
7. Thoughts of Hurting Yourself: People with severe depression sometimes think about suicide or hurting themselves. Talk to someone and get help if you feel this way.

Psychotherapy Treatment for Major Depressive Disorder

Here is the Good News: Psychotherapy is a very effective treatment for depression, even severe depression.  Have a look at the list below. Which type of therapy feels right for you? They are all safe choices. All of them can help you overcome depression.

Here is a Tip: Most therapists are eclectic. They know about several types of therapy. They blend them to make a personal treatment approach for you. You can trust this way of working. Eclectic therapy can be very effective.

Here is Another Tip: Make sure you find a therapist who feels right for you. Who your therapist is matters more than the type of therapy. If your therapist is rigid, passive, cold and distant, or disorganized, then you probably need a new therapist. Check my article about this for more advice.

1. Cognitive Behavioral Therapy (CBT): This talk therapy helps you challenge negative thoughts so you can behave differently and improve your mental wellbeing.
2. Interpersonal Therapy (IPT): IPT is helpful if you are depressed because of relationship problems. You improve your communication skills to cope with relationship issues. You reconnect with people for social support. As your relationships improve, your low mood will improve.
3. Psychodynamic Therapy: This approach focuses on early life events, unconscious emotions, and motivation. The goal is to increase self-awareness and understanding. These insights help you be more accepting of yourself, so you can break free of patterns that keep you depressed.
4. Dialectical Behavior Therapy (DBT):  DBT teaches you how to regulate emotions, improve interpersonal skills, and tolerate distress. A comprehensive DBT program is very helpful for people at risk of suicide or self-harm. It combines CBT with mindfulness practices.
5. Behavioral Activation (BA): BA helps you get moving and doing. When you complete more rewarding activities, you will feel more hopeful and your mood improves. BA is simple and powerful. All by itself, it can be an effective treatment for severe depression. Here is how to get started.
6. Mindfulness-Based Cognitive Therapy (MBCT): MBCT combines cognitive therapy with mindfulness. You learn coping skills to overcome negative thinking. MBCT training also protects people from having a second bout of depression, after the first cure.
7. Acceptance and Commitment Therapy (ACT): ACT uses acceptance and mindfulness strategies. You learn to live according to your personal values, with kindness for yourself.

5 Lifestyle Changes to Help Overcome Depression

You can help prevent or overcome depression by maintaining a healthy lifestyle. Start with some small changes and trust yourself. Here are 5 things to try.

1. Regular Exercise: Doing physical activity, such as walking, running, or yoga, can significantly boost your mood. Exercise releases endorphins.
2. Healthy Eating: Eat a balanced diet of fruits, vegetables, whole grains, and lean proteins. Omega-3 fatty acids found in fish, and folic acid found in leafy greens, are particularly helpful for depression.
3. Limit Screen Time: Too much time on your phone, or other screens, can make you feel more down. Try to set some limits for yourself. Spend more time doing things in the real world.
4. Connect with Others: Spend time with friends or family who make you feel good about yourself. Talk and share with them. Then, you will feel less alone and more understood.
5. Do Things You Enjoy: Engage in activities that you enjoy and find meaningful. This will help you feel better about yourself. It will also boost your mood. Try something active like learning to play an instrument, paint or draw, or embroidery.

Would you like more advice? Have a look at this article.

A Personal Note

I know how tough depression can be. I have faced depression in my own life. Depression can almost always be overcome. Keep trying things until you find what you need. You deserve to feel better.

Sources

It is important to me that you find practical and trustworthy information. That is why I personally selected and reviewed all the sources for this article. My advice is also based on my decades of experience, working in hospitals, treating clients, and mentoring other therapists and psychologists.

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth edition.). Arlington, VA.
• Barlow, D.H. (Editor). Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, (sixth edition). The Guilford Press, 2021.
• Dozois, D. & Dobson, K. (Editors). Treatment of Psychosocial Risk Factors in Depression. American Psychological Association. Washington DC. 2023
• National Institute of Mental Health. Depression. (2024). Retrieved from: https://www.nimh.nih.gov/health/topics/depression.
• American Psychological Association (2023, March) Overcoming Depression: How Psychologists Help with Depressive Disorders. Retrieved from: https://www.apa.org/topics/depression/overcoming.
• American Psychiatric Association (October, 2020). What Is Depression? Retrieved from: https://www.psychiatry.org/patients-families/depression/what-is-depression.