Major Depressive Disorders

7.1 Depressive Disorders

  • A depressive disorder is characterized by periods in which an individual experiences an unusually intense sad mood, referred to as dysphoria.

Major Depressive Disorder

  • Major depressive disorder consists of acute but time-limited periods of depressive symptoms, known as major depressive episodes.
  • The diagnostic criteria are outlined in the DSM-5-TR, detailed in Table 1.
Table 1: Criteria for a Major Depressive Episode
  • To be diagnosed, a person must experience the following for most of the time during a 2-week period:
    • At least five or more of the first nine symptoms below, in addition to the last two:
    1. Depressed mood most of the day
    2. Markedly diminished interest or pleasure in most or all daily activities
    3. Significant unintended weight loss or unusual increase or decrease in appetite
    4. Insomnia or hypersomnia
    5. Psychomotor agitation or retardation observable by others
    6. Fatigue or loss of energy
    7. Feelings of worthlessness or excessive or inappropriate guilt
    8. Difficulty maintaining concentration or making decisions
    9. Recurrent thoughts of death, suicidal thoughts, plans, or attempts
  • In addition to the above symptoms:
    • The symptoms are not attributable to a medical condition or substance use.
    • The symptoms cause significant distress or impairment.
  • Clinicians may rate the severity of a depressive disorder using specifiers of mild, moderate, or severe. This rating indicates:
    • The number of symptoms present beyond the minimum for diagnosis
    • The degree of functional disability resulting from the disorder.
Epidemiology and Statistics
  • Major depressive disorder is one of the priority conditions recognized by the World Health Organization (WHO), ranking as the third-leading cause of disability worldwide.
  • The estimated global prevalence is 14.3 percent (James et al., 2018).
  • Individuals with major depressive disorder face an increased risk of suicide.
Prevalence in the United States
  • The lifetime prevalence of major depressive disorder in the U.S. is approximately 20.6 percent among the adult population, with most cases rated as moderate or severe.
  • Breakdown of lifetime prevalence among different demographics:
    • Women: 26.1 percent
    • Men: 14.7 percent
    • Native Americans: 28.2 percent
    • Whites: 23.1 percent
    • Blacks: 15.2 percent
    • Hispanics: 16.2 percent
    • Asians/Pacific Islanders: 12.2 percent (Hasin et al., 2018).
Black-White Paradox
  • The Black-White paradox (Barnes & Bates, 2017) refers to the finding that, despite greater exposure to stress and discrimination, Blacks are less likely to be diagnosed with major depressive disorder.
  • The prevalence rates among older adults (65+) are lower, at 14.4 percent, possibly reflecting that depressive symptoms in older adults may be reported as physical rather than psychological concerns (Schaakxs et al., 2017).

Major Depressive Episode Prevalence Data

  • According to the National Institute of Mental Health (2023), the 1-year prevalence of a major depressive episode in the U.S. is an estimated 8.3 percent of adults, with comparable patterns to lifetime prevalence estimates.
  • Notably, this represents an increase from the 7.1 percent reported in 2021, potentially linked to the impact of COVID-19.
  • Despite the rising prevalence rates, treatment rates have not increased correspondingly, contributing to an ongoing mental health crisis (Goodwin et al., 2022).
Figure 1: Past Year Prevalence of Major Depressive Episode Among U.S. Adults (2021)
  • Data provided by SAMHSA shows prevalence rates segmented by sex, age, and race/ethnicity:
    • Higher prevalence rates observed among females (10.3%) than males (6.2%).
    • Age group differences show that younger adults (18-25) have higher rates than older adults (50+).
    • Differences by race/ethnicity highlight:
    • Hispanic: 8.3%
    • White: 7.9%
    • Black: 6.7%
    • Asian: 5.1%
    • American Indian/Alaskan Native: 4.5%
    • Native Hawaiian/Others: 4.8%
    • Two or More Races: 6.2%

Mini Case: Major Depressive Disorder, Recurrent Episode

  • Patient Background: Daryll is a 37-year-old African American married gay cisgender man.
  • Recent Events: Daryll was taken to a psychiatric facility by his husband for evaluation due to sudden severe disturbance and depression.
  • Symptoms at Admission:
    • Highly agitated, dysphoric, and exhibiting suicidal ideation (purchased a gun for suicide).
    • Exhibited significant changes in appetite and sleep patterns, including loss of appetite and insomnia over the preceding 3 weeks.
    • Experienced increasing fatigue and difficulty concentrating, feeling disinterested in activities and relationships.
    • Noted hypersensitivity to perceived criticism from peers and family.
  • Previous History: This is Daryll's second episode; the first occurred 5 years earlier due to job loss in a massive layoff.