NAMI’s new graphic resource provides information about major depressive disorder and important myths vs. facts – with quotes from real people.
Feelings of sadness are common human emotions. When more severe symptoms like lack of energy and hopelessness develop in multiple areas of a person’s life along with persistent sadness over at least two weeks, they may be experiencing a condition known as major depressive disorder (MDD). MDD is sometimes also referred to as clinical depression. Fortunately, with early identification, diagnosis and a treatment plan that can include a combination of medication, psychotherapy and healthy lifestyle choices, many people with depression can and do get better.
Some will only experience one depressive episode in their lifetime, but for most, the episodes recur. Without treatment, episodes may last a few months to several years.
About 15.5% of U.S. adults experience major depressive disorder in a given year. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does appear to be more prevalent in some groups than others.
Depression does not have a single cause. Symptoms can begin to appear following a life crisis, physical illness or something else—but they can also occur for no reason at all. Researchers have identified several factors that can contribute to depression:
In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on major depressive disorder that offer insights from individuals, family members and mental health professionals. Read the transcript.
Note: Content includes discussions on topics such as suicide attempts and may be triggering.
Reviewed and updated June 2025
A diagnosis of major depressive disorder requires two weeks of depressed mood or loss of interest in daily activities plus at least 5 of these symptoms that cause a decrease in the person’s functioning. The symptoms include:
It can be difficult to recognize these symptoms in ourselves, and many find it helpful to use a screening tool such as the PHQ-9, Patient Health Questionnaire. Many treatment professionals will ask people to complete a PHQ-9 as part of a regular health screening. It can help identify the potential presence and severity of depression. Consider talking with your treatment professional about a screening or look for one online that you can take in your own time.
Reviewed and updated June 2025
Major depressive disorder (MDD) is a common but serious mental health condition. Diagnosis is based on a thorough evaluation by a trained medical or mental health professional—such as a primary care doctor, psychiatrist, psychologist, or licensed therapist. There is no single test, like a blood test or brain scan, that can confirm depression. Instead, diagnosis relies on a careful review of symptoms, medical history, and how daily life is being affected.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), to be diagnosed with MDD, a person must experience at least 5 of the symptoms mentioned above most of the day, nearly every day, for at least two weeks, and one of the symptoms must be either depressed mood or loss of interest or pleasure in most activities. These symptoms must cause significant distress or interfere with everyday life—such as work, school, or relationships—and cannot be explained by another medical condition, medication side effect, or substance use.
Diagnosing depression involves more than just checking symptoms off a list. A healthcare provider will typically:
Screening tools, such as the PHQ-9 or the Beck Depression Inventory, are short questionnaires that ask about a person’s recent experiences with symptoms of depression. These tools help providers not only detect whether someone is likely experiencing depression, but also measure how severe the symptoms are—ranging from mild to moderate to severe. This information helps guide treatment decisions, such as whether therapy, medication, or a combination of approaches is most appropriate. Providers may also repeat the screening over time to track progress and adjust treatment plans as needed.
If the person has experienced manic or hypomanic episodes (periods of extremely elevated mood or energy), the diagnosis may instead be bipolar disorder, which requires a different treatment approach. A family history of bipolar disorder should also inform treatment options.
Early recognition and diagnosis of depression can make a major difference. It helps people access the support and treatment they need—whether that’s therapy, medication, lifestyle changes, or a combination of these. Without diagnosis and care, depression can persist for months or years and increase the risk of other health problems, including suicide.
Reviewed and updated June 2025
Although major depressive disorder can be a challenging illness, it often responds to treatment. The key is to get a thorough evaluation and treatment plan. Safety planning is important for people who have thoughts of self-harm and/or suicide. After an assessment rules out medical and other possible causes, a person-centered treatment plan can include any one or a combination of the following:
Many treatment options are available for depression, but how well treatment works depends on the type of depression, its severity and the person themselves. For most people, a combination of psychotherapy and medication gives better results than either alone, but this is something to review with your mental health care provider.
Psychotherapy (or talk therapy) has an excellent track record of helping people with depressive disorder. While some types of psychotherapies have been researched more than others, many can be helpful and effective. A good relationship with a therapist can help improve outcomes.
Many clinicians are trained in more than one kind of psychotherapy, and it’s important to ask your clinician what kind of psychotherapy they practice and how it can help you. A few examples include:
Psychoeducation involves teaching individuals about their illness, how to treat it and how to recognize signs that their symptoms may be coming back or worsening. Family psychoeducation is also helpful for family members who want to understand what their loved one is experiencing.
Support groups, meanwhile, offer participants an opportunity to share experiences and coping strategies. Support groups may be for the person with a mental health condition, for family/friends or both. Mental health professionals lead some support groups, but groups can also be peer-led.
Explore NAMI’s nationwide offerings of free, peer-led educational programs and support groups that provide outstanding education, skills training and support.
For some people, antidepressant medications may help reduce or manage symptoms. Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to reach full effect. Most people will have to try different doses and/or medications to find what works for them. It’s important to be aware that if there is an underlying bipolar condition, the use of antidepressant medications can initiate a manic episode. Sharing family history with the treating professional is important in identifying this and other potential risks. Here are some antidepressants commonly used to treat depression:
Selective serotonin reuptake inhibitors (SSRIs) act on serotonin, a brain chemical. They are the most common medications prescribed for depression.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase serotonin and norepinephrine availability in the brain.
Norepinephrine-dopamine reuptake inhibitors (NDRIs) increase dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes fewer (and different) side effects than other antidepressants. For some people, bupropion causes anxiety symptoms, but for others it is an effective treatment for anxiety.
Tetracyclic antidepressants, like Mirtazapine (Remeron), target serotonin and norepinephrine receptors in the brain, increasing the activity of several brain circuits. Mirtazapine is used less often than newer antidepressants (SSRIs, SNRIs and bupropion) because it is associated with more weight gain, sedation and sleepiness. However, it appears to be less likely to result in insomnia, sexual side effects and nausea than SSRIs and SNRIs.
Second-generation antipsychotics (SGAs), or “atypical antipsychotics,” treat schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental illnesses. SGAs can be used for treatment-resistant depression.
Tricyclic antidepressants (TCAs) are older medications, rarely used today as initial treatment for depression. They work similarly to SNRIs but have more side effects. They are sometimes used when other antidepressants have not worked. TCAs may also ease chronic pain.
Monoamine oxidase inhibitors (MAOIs) are less used today because of newer medications with fewer side effects. These medications can never be used in combination with SSRIs. MAOIs can sometimes be effective for people who do not respond to other medications. There are also dietary restrictions associated with MAO inhibitors that should be discussed with your treatment professional.
Other medications have been developed in recent years and work differently than those traditionally used to treat depression. Each of the following are approved for use in MDD:
For some, brain stimulation therapies may be effective, typically after other treatments have not been effective.
Light therapy involves sitting close to a specialized light box that generates intense artificial light to mimic sunlight. These devices can be helpful for depression with a seasonal dimension. Usually, people use them in the morning. Some devices are covered by insurance even though they are not FDA approved.
As with antidepressants, if you experience manic or hypomanic symptoms (rare with light therapy) this should be immediately discussed with your provider as bipolar disorder requires a different approach.
Relying solely on CAM methods is not enough to treat depression, but they may be useful when combined with psychotherapy and medication. Discuss your ideas of CAM interventions with your health care professional to be sure they will not cause side effects or adverse reactions.
The National Center for Complementary and Integrative Health reviews research on complementary treatments. You can search for each intervention on their website.
In recent years, new types of medications have emerged that offer hope for people whose depression has not improved with traditional treatments like SSRIs or therapy. One of the most promising is ketamine, along with a growing number of similar, fast-acting medications that target the brain in different ways. These treatments can be helpful for people with treatment-resistant depression, meaning they have not responded to at least two other antidepressants as well as those experiencing severe depressive symptoms or suicidal thoughts.
Drug Administration
Reviewed and updated June 2025
Living with depression isn’t just about medical treatment – how you support yourself, a family member or a friend in other ways can also make a big difference.
There’s a lot you can do to understand your own symptoms and what you need to feel supported:
When someone you love experiences symptoms of mental illness, you face unique challenges yourself, including complex family dynamics, social isolation and often unpredictable behavior. Getting support for yourself is essential for you to be helpful to the person you care about.
Reviewed and updated June 2025
NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “NAMI” to 62640, or email. In a crisis, call or text 988 (24/7).
