Major depressive disorder

Major depressive disorder is the most familiar form of depression. It's defined by depressive episodes: stretches of at least 2 weeks when a low mood or loss of interest is there most of the day, nearly every day, along with other changes that get in the way of work, relationships and daily life. Tasks that used to be routine can start to take far more effort.

Some people have a single episode. For many, episodes come back over the years, and people who have had depression are more likely to have it again. Without treatment, an episode typically lasts about 6 months, and sometimes 2 years or more. Treatment can shorten that and lower the chance of another one.

For the bigger picture, including the other types of depression and how they differ, see our complete guide to depression.

It doesn't always look like sadness. Some people feel irritable, flat or detached instead. Others notice it first in the body, as aches, headaches or stomach problems without a clear physical cause.

• A sad, anxious or "empty" mood that doesn't lift
• Losing interest or pleasure in things you used to enjoy
• Low energy, or feeling slowed down
• Trouble concentrating, remembering or making decisions
• Sleeping too much, too little, or waking too early
• Changes in appetite or weight you didn't plan
• Feeling hopeless, guilty or worthless
• Thoughts of death or suicide

These signs are a general guide, not a checklist for diagnosis. Not everyone has all of them.

If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

Major depression can follow a pattern, and naming it helps guide treatment:

• Seasonal pattern: episodes that come back in the fall or winter and ease in spring. See our seasonal affective disorder page.
• During pregnancy or after birth: see our women's mental health page.
• Atypical features: your mood can still lift when something good happens, plus at least two of these: eating more or gaining weight, sleeping much more than usual, a heavy, weighed-down feeling in the arms or legs, and a long-standing sensitivity to rejection or criticism that causes problems at work or in relationships. Read what makes atypical depression different.

There's no blood test for major depression. A careful evaluation checks that it's really major depression, and not something that needs a different approach:

• How long this episode has lasted, and whether you've had episodes before
• Whether symptoms have been there, more mildly, for 2 years or more, which can point to persistent depressive disorder
• Any history of unusually high or energetic periods, because antidepressant labels ask providers to check for bipolar disorder before starting one. Read bipolar vs. unipolar depression.
• Your physical health and medications, since some medical conditions, such as thyroid problems, and some medications can cause similar symptoms
• Past treatment: which medications you've tried, at what dose, for how long, and what did or didn't help

This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

Treatment usually involves medication, therapy, or both, based on your needs, your preferences and your health. For milder depression, therapy is often tried first. For moderate or severe depression, medication is usually part of the plan from the start.

Getting better

When medication fits, we explain why we're suggesting a particular one, what side effects to expect and how we'll know it's working. Antidepressants usually take 4 to 8 weeks to work, and problems with sleep, appetite and concentration often improve before mood lifts. We make changes carefully, one at a time.

Staying well

Feeling better isn't the finish line. Once you feel better, antidepressants are usually continued for at least 6 months, because stopping too soon raises the chance of the depression coming back. If you've had several episodes, your provider may talk with you about staying on treatment longer. Please don't stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly. Read why you can feel worse before you feel better on antidepressants.

Therapeutic work in visits

Visits are real conversations, not quick medication checks. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills, such as rebuilding routines or planning small activities when everything feels like effort. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them. Regular follow-ups are how we keep your plan on track and adjust it as you improve.

That's common, and it doesn't mean nothing will work. Your provider may adjust the dose, switch to a different medication, or add a second one, such as an FDA-approved add-on, a second antidepressant or an off-label add-on; some of these are listed below. Treatments such as brain stimulation therapies are generally considered only after depression hasn't improved with two or more antidepressants. Whether a referral makes sense depends on your situation, and your provider will talk with you about all your options. Read treatment-resistant depression.