major depressive episode major depressive episode a major depressive episode (mde) is a period characterized by the symptoms of major depressive disorder. those affected primarily have a depressed mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, problems concentrating, remembering details, making decisions, and thoughts of suicide. insomnia or hypersomnia, aches, pains, or digestive problems that are resistant to treatment may also be present. major depressive episodespecialtypsychiatryalthough the exact origin of depression is still not clear, it is believed to involve biological, psychological, and social aspects. factors like socioeconomic status, life experience, genetics, and personality tendencies play a role in the development of depression and may represent an increased risk of developing a major depressive episode. there are many theories as to how depression occurs, one interpretation is that neurotransmitters in the brain are out of balance, resulting in feelings of worthlessness and despair. magnetic resonance imaging shows that the brains of people who have depression, look different than the brains of people not exhibiting signs of depression. a family history of depression increases the chance of being diagnosed. emotional pain and economic costs are associated with depression in many cases. in the united states and canada, the costs associated with major depression are comparable to those related to heart disease, diabetes, and back problems and are greater than the costs of hypertension. according to the nordic journal of psychiatry, there is a direct correlation between a major depressive episode and unemployment. treatments for a major depressive episode include psychotherapy and antidepressants, although in more serious cases, hospitalization or intensive outpatient treatment may be required. signs and symptoms the criteria below are based on the formal dsm-5 criteria for a major depressive episode. a diagnosis of a major depressive episode requires the patient to have experienced five or more of the symptoms below, one of which must be either a depressed mood or loss of interest or pleasure (although both are frequently present). these symptoms must be present for at least 2 weeks and represent a change from the patient's normal behavior. depressed mood and loss of interest (anhedonia) either a depressed mood or a loss of interest or pleasure must be presented for the diagnosis of a major depressive episode. depressed mood is the most common symptom seen in major depressive episodes. interest or pleasure in everyday activities can be decreased; this is referred to as anhedonia. these feelings must be presented on an everyday basis for two weeks or longer to meet dsm-v criteria for a major depressive episode. in addition, the person may experience one or more of the following emotions: sadness, emptiness, hopelessness, indifference, anxiety, tearfulness, pessimism, emotional numbness, or irritability. in children and adolescents, a depressed mood often appears more irritable. there may be a loss of interest in or desire for sex or other activities once found to be pleasant. friends and family of the depressed person may notice that they have withdrawn from friends, neglected, or quit doing activities that were once a source of enjoyment. sleep major depressive episodes are known to cause sleep disturbance such as hypersomnia, which cause excessive sleep patterns, or sleep deprivation, like insomnia. insomnia is the most common type of sleep disturbance for people who are clinically depressed. symptoms of insomnia include trouble falling asleep, trouble staying asleep, or waking up too early in the morning. the most common symptom of insomnia is waking up in the middle of the night, and having trouble falling back asleep. hypersomnia is a less common type of sleep disturbance. it may include sleeping for prolonged periods at night and into the morning or increased sleeping during the daytime. the sleep may not be restful, and the person may feel sluggish despite many hours of sleep, which may amplify their depressive symptoms and interfere with other aspects of their lives. this type of sleep disorder may make it hard for a person to fall and stay asleep at night versus during the day. hypersomnia is often associated with atypical depression as well as seasonal affective disorder. feelings of guilt or worthlessness depressed people may have feelings of guilt that go beyond a normal level, or are delusional. these feelings of guilt, and/or worthlessness are excessive and imagined. major depressive episodes are notable for a significant, often inexplicable, drop in self-esteem. the guilt and worthlessness experienced in a major depressive episode can range from subtle feelings of guilt to frank delusions or shame and humiliation. additionally, self-loathing is common in clinical depression, and can lead to a downward spiral when combined with other symptoms. a lot of people with depression have distorted thought patterns, and genuinely believe that they're not good for anything or anyone. they tend to have severe self-esteem issues, and don't recognize their value as a human being. they also begin to feel as though their life has no meaning or purpose. loss of energy individuals going through a major depressive episode often have a general lack of energy, as well as fatigue, and tiredness, nearly every day for at least 2 weeks. a person may feel tired without having engaged in any physical activity, and day-to-day tasks become increasingly difficult. it becomes very difficult for someone with depression to get things done during the day. even small tasks, like showering, become exhausting, causing a lot of people with depression to stop taking care of themselves entirely. decreased concentration nearly every day, the person may be indecisive or have trouble thinking or concentrating. these issues cause significant difficulty in functioning for those involved in intellectually demanding activities, such as school and work, especially in difficult fields. depressed people often describe a slowing of thought, inability to concentrate and make decisions, and being easily distracted. in the elderly, the decreased concentration caused by a major depressive episode may present as deficits in memory. this is referred to as pseudodementia and often goes away with treatment. decreased concentration may be reported by the patient, or observed by others. since depression makes it more difficult to stay concentrated, a lot of people will notice that they aren't doing well in school or at their job, which makes their depression even worse. change in eating, appetite, or weight in a major depressive episode, appetite is most often decreased, although a small percentage of people experience an increase in appetite. a person experiencing a depressive episode may have a marked loss or gain of weight (5% of their body weight in one month). a decrease in appetite may result in unintentional weight loss, or when a person is not dieting. feelings of low self-worth make them not desire to eat anymore. some people experience an increase in appetite and may gain significant amounts of weight. they may crave certain types of food, such as sweets or carbohydrates. low self-worth in this instance can lead to self-soothing through eating. in children, failure to make expected weight gains may be counted towards this criteria. overeating is often associated with atypical depression. when people have depression, they usually will stop taking care of their bodies and "wither away." a lack of healthy eating habits is a tell-tale sign of classic depression. motor activity nearly every day, others may see that the person's activity level is not normal. they might notice that the person takes longer to complete simple tasks, or that they're doing a lot at once. people with depression may be overly active (psychomotor agitation) or very lethargic (psychomotor retardation). psychomotor agitation is marked by an increase in body activity, which may result in restlessness, an inability to sit still, pacing, hand wringing, or fidgeting with clothes or objects. this could also be linked to anxiety, since depression and anxiety are often seen together. psychomotor retardation results in a decrease in body activity or thinking. in this case, a depressed person may demonstrate a slowing of thinking, speaking, or body movement. they may speak more softly or say less than usual. this is because they don't have the energy to expend as a normal person would. to meet diagnostic criteria, changes in motor activity must be so abnormal that it can be observed by others. personal reports of feeling restless or feeling slow do not count towards the diagnostic criteria. thoughts of death and suicide a person going through a major depressive episode may have repeated thoughts about death (other than the fear of dying) or suicide (with or without a plan), or may have made a suicide attempt. suicidal ideation can be common amongst victims of depression, which is where a person often thinks about not being alive anymore, but they don't yet have a plan to carry out. the frequency and intensity of thoughts about suicide can range from believing that friends and family would be better off if one were dead, to frequent thoughts about committing suicide (generally related to wishing to stop the emotional pain), to detailed plans about how the suicide would be carried out. those who are more severely suicidal may have made specific plans and decided upon a day and location for the suicide attempt. when this happens, they often keep to themselves about it, and may do it when and where they think no one would suspect. comorbid disorders major depressive episodes may show comorbidity (association) with other physical and mental health problems. about 20–25% of individuals with a chronic general medical condition will develop major depression. common comorbid disorders include: eating disorders, substance-related disorders, panic disorder, and obsessive-compulsive disorder. up to 25% of people who experience a major depressive episode have a pre-existing dysthymic disorder. some persons who have a fatal illness or are at the end of their life may experience depression, although this is not universal. causes the cause of a major depressive episode is not well understood. despite its longstanding prominence in pharmaceutical advertising, the myth that low serotonin levels cause depression is not supported by scientific evidence. there are usually many factors that play into a person's depression. the mechanism is believed to be a combination of biological, psychological, and social factors. a major depressive episode can often follow an acute stress in someone's life, such as the death of a loved one, or being fired from a job. evidence suggests that psychosocial stressors play a larger role in the first 1–2 depressive episodes, while having less influence in later episodes. people who experience a major depressive episode often have other mental health issues. other risk factors for a depressive episode include: early childhood trauma family history of a mood disorder lack of interpersonal relationships personality (insecure, worried, stress-sensitive, obsessive, unassertive, dependent) postpartum recent negative life events studies show that depression can be passed down in families, but this is believed to be due to a combined effect of genetic, and environmental factors. other medical conditions, like hypothyroidism, for example, may cause people to experience similar symptoms as a major depressive episode, however this would be considered a mood disorder due to a general medical condition, according to the dsm-v. for some people, depression runs in their family so it's likely that the depression will be passed down to them. for other people, depression might be completely environmental. it could also be a mix of both. diagnosis criteria the two main symptoms of a major depressive episode are a depressed mood and a loss of interest or pleasure. from the list below, one bold symptom and four other symptoms must be presented for at least 2 weeks for a diagnosis of a major depressive episode. these symptoms must be causing significant distress or impairment in functioning. change in appetite change in body activity (psychomotor changes) change in sleep depressed mood feelings of worthlessness and excessive or inappropriate guilt indecisiveness, confusion, or a decrease in concentration loss of energy loss of interest or pleasure suicidal ideation to diagnose a major depressive episode, a trained healthcare provider must make sure that: the symptoms are not due to any direct physiological effect of a substance (e.g., abuse of a drug or medication) or a general medical condition (e.g., hypothyroidism). the symptoms do not meet the criteria for a mixed episode.