Major depressive disorder
ICD-10 F33
If you've been low for weeks and your PHQ-9 score came back high, here's what the standard first-line treatment looks like and how telehealth fits in.
- 0M+
- US adults with major depressive episode/year
- ~0%
- US adult lifetime prevalence
- PHQ0 ≥10
- screening threshold for likely MDD
- 0-70%
- respond to first-line SSRI/SNRI
What is major depressive disorder?
Major depressive disorder (MDD) is a chronic, recurrent mood disorder characterized by persistent low mood, loss of interest or pleasure (anhedonia), and a constellation of cognitive, sleep, appetite, and energy disturbances lasting ≥2 weeks. Lifetime prevalence ~16% in US adults; twice as common in women.
What are the symptoms of major depressive disorder?
- Depressed mood most of the day, nearly every day, for at least 2 weeks
- Loss of interest or pleasure in nearly all activities (anhedonia)
- Significant weight or appetite change
- Insomnia or hypersomnia
- Psychomotor agitation or retardation observable by others
- Fatigue or loss of energy
- Feelings of worthlessness or excessive/inappropriate guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death or suicidal ideation
Who is at risk for major depressive disorder?
- Family history of mood disorders (genetic component ~40%)
- Female sex (~2x lifetime prevalence vs men)
- Prior depressive episode (recurrence risk ~50% after one episode, ~80% after three)
- Chronic medical conditions: cardiovascular disease, diabetes, cancer, chronic pain
- Adverse childhood experiences and chronic interpersonal stress
- Substance use disorders (co-occurrence rate ~30%)
- Some medications: corticosteroids, interferon, some hormonal contraceptives
How is major depressive disorder diagnosed?
DSM-5-TR criteria: 5+ of 9 symptoms (including either depressed mood or anhedonia) for ≥2 weeks. Validated screening tools: PHQ-9 (score ≥10 suggests MDD, ≥20 indicates severe). Workup considers thyroid disease, vitamin B12 deficiency, and substance-related causes.
How is major depressive disorder treated?
First-line: SSRIs (sertraline, escitalopram) or SNRIs (venlafaxine, duloxetine) plus structured psychotherapy (CBT, IPT). 60-70% respond to first-trial medication; second-line includes augmentation (bupropion, atypical antipsychotic) or switch. Severe / treatment-resistant: ECT, esketamine (Spravato), or rTMS. Telehealth-prescribed SSRIs are increasingly common entry point.
Authority reference: www.nimh.nih.gov
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Practice Guideline for the Treatment of Patients with Major Depressive Disorder · American Psychiatric Association, 2024
- Major Depression — National Institute of Mental Health · National Institute of Mental Health, 2024
- Acute and Longer-Term Outcomes in Depressed Outpatients (STAR*D) · American Journal of Psychiatry, 2006 · PMID 17074942
People also ask
How long does it take for an antidepressant to work?
Sleep, appetite, and energy often improve within 1-2 weeks. Mood and anhedonia typically take 4-6 weeks for measurable improvement. Full response can take 8-12 weeks. Discontinuing prematurely (before 6-8 weeks at therapeutic dose) is the most common reason a 'medication didn't work' that actually wasn't given time.
Are SSRIs addictive?
No. SSRIs do not produce the dopaminergic reward circuitry activation that defines addiction. They can produce discontinuation syndrome (flu-like symptoms, dizziness, vivid dreams) if stopped abruptly — this is a physical adaptation phenomenon, not addiction. Taper over weeks rather than stopping cold.
Do I need therapy if I'm on an antidepressant?
Combined treatment (SSRI + CBT or IPT) outperforms either alone for moderate-to-severe depression in head-to-head trials and reduces relapse risk after discontinuation. For mild depression, therapy alone is often sufficient first-line.
Will I have to take antidepressants forever?
Not necessarily. After a single first episode, guidelines recommend 6-12 months of continuation treatment after symptom remission, then a slow taper with monitoring. For recurrent depression (2+ episodes), longer maintenance is recommended due to higher relapse risk.