Major depressive disorder (MDD), also known as unipolar depression, is one of the mood disorders as characterized by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5). Various studies conducted across the world manifest diversified percentage of life time prevalence of MDD with majority of results in the range of 8% till 25%. Whereas, the mean age at onset shows less variation ranging from 24.8 – 34.8 years.

Diagnosis of major depression requires at least 5 out of the following mentioned symptoms present nearly every day for at least 2 weeks



S – sleep change

I – loss of Interest/ pleasure (anhedonia)

G – guilt/ worthlessness

E – lack of Energy

C – loss of Concentration

A – appetite change

P – psychomotor agitation or retardation/ inability to function

S – suicidal plan or ideation of self harm

Why do we get depressed?


Identical twins (monozygotic twins) when reared apart show 60% more concordance for depression than fraternal twins (dizygotic twins)

Stressful events:

widowed, separated, or divorced; loss of job, abused as a child, child birth

Vulnerability factors:

Being female; middle-aged ;  illness ; low income

Biological correlates


Gross abnormalities- abnormally high glucose metabolism in amygdala and smaller hippocampus.

Neurochemical changes- decreased levels of norepinephrine, serotonin and dopamine


Increased levels of glucocorticoids and decreased levels of most hormones


60% of depressed people have suicidal ideation and 15% actually die by suicide.


Patients can have superimposed depression on bereavement and can end up having serious consequences of major depression especially suicide.

DSM 5 makes the difference between MDD and bereavement less clear (as the condition occurs shortly after bereavement and the difference is often not clear, in practice).

‘Although such (depressive) symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and cultural norms… ‘


‘A total loss of who you are.’

‘Cancer of the soul’

‘Just wanting to stand in a field and scream your head off—but you don’t know why.’

‘It’s a thief … it takes everything from you and leaves you to die.’


● Psychotherapy: for example cognitive therapy is considered as a mandatory step to treat depression (may be that’s the only thing required by a person with mild depression).

●  Pharmacotherapy: antidepressants like selective serotonin reuptake inhibitors (considered as 1st line therapy), tricyclic antidepressants and monoamine oxidase inhibitors; Hypericum (st john’s wort); omega 3 supplements may reduce suicidal ideation.

●  Electroconvulsive therapy: when patient is suicidal or worried about medication or the condition is refractory to pills


Kaplan lecture notes

Ocford handboo if clinical specialities

Videos of Paul Bolin- youtube