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Major Depressive Disorder

Prevalence

The prevalence in 18- to 29-year-old individuals is threefold higher than the prevalence in individuals aged 60 years or older.
Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence.

Risk factors

Temperamental

Neuroticism (negative affectivity): high levels appear to render individuals more likely to develop depressive episodes in response to stressful life events.

Environmental

Adverse childhood experiences, particularly when there are multiple experiences of diverse types.
Stressful life events.

Genetic and physiological

First-degree family members of individuals with major depressive disorder have a risk for major depressive disorder two- to fourfold higher than that of the general population.
Heritability is approximately 40%, and the personality trait neuroticism accounts for a substantial portion of this genetic liability.

Course modifiers

Essentially all major non mood disorders increase the risk of an individual developing depression.
Chronic or disabling medical conditions also increase risks for major depressive episodes (e.g., diabetes, morbid obesity, and cardiovascular disease).

Symptoms

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning:
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another medical condition.
There has never been a manic episode or a hypomanic episode.

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