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Major depressive disorder

Depressio maior · Depresivní porucha

What it is

A persistent illness of mood, drive and pleasure — not a mood swing.

Symptoms & signs

  • Low mood most days
  • loss of interest
  • sleep and appetite change
  • guilt
  • poor concentration
  • thoughts of death

🚩 Get help if…

  • call 112 / 911 now Thoughts or plans of suicide, or self-harm
  • call 112 / 911 now Hearing voices or believing things that are not true
  • see a doctor soon Not eating or drinking, or not getting out of bed for days
  • see a doctor soon Low mood for over 2 weeks that stops daily life

Where it strikes

Medical treatment

  • SSRIs and SNRIs — clear benefit in severe depression, close to placebo in mild; stopping them brings withdrawal symptoms in about a third (a sixth after placebo), long played down mixed evidence
  • CBT and behavioural activation trials support
  • Mirtazapine for sleep mixed evidence
  • ECT in severe or life-threatening depression, with memory loss as the price trials support
  • Esketamine — fast but short-lived, trials run by the maker early / small studies
  • Transcranial magnetic stimulation — FDA-cleared 2008 for depression that has not responded to drugs mixed evidence

Natural & lifestyle

  • Aerobic exercise 3×/week (effect size close to drugs)
  • bright light therapy
  • sleep repair
  • omega-3 EPA
  • social contact
  • behavioural activation

Emerging & experimental

  • Psilocybin-assisted therapy
  • ketamine
  • anti-inflammatory adjuncts
  • deep brain stimulation in refractory cases

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • St John's wort — trials show it works about as well as SSRIs in mild to moderate depression; it interacts with many drugs, including the pill trials support
  • Saffron — small trials comparable to SSRIs mixed evidence
  • Acupuncture — trials disagree mixed evidence
  • Probiotics ('psychobiotics') — small trials early / small studies
  • Psilocybin microdosing — a self-blinded study found placebo explained the benefit not confirmed in trials

ICD codes