Major Depressive Disorder

Christian Otte, Stefan M. Gold , Brenda W. Penninx, Carmine Maria Pariante, Amit Etkin, Maurizio Fava, David C. Mohr, Alan Schatzberg

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Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD. No established mechanism can explain all aspects of the disease. However, MDD is associated with alterations in regional brain volumes, particularly the hippocampus, and with functional changes in brain circuits, such as the cognitive control network and the affective–salience network. Furthermore, disturbances in the main neurobiological stress-responsive systems, including the hypothalamic–pituitary–adrenal axis and the immune system, occur in MDD. Management primarily comprises psychotherapy and pharmacological treatment. For treatment-resistant patients who have not responded to several augmentation or combination treatment attempts, electroconvulsive therapy is the treatment with the best empirical evidence. In this Primer, we provide an overview of the current evidence of MDD, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment.
Original languageEnglish
Article number16065
Number of pages20
JournalNature Review Disease Primers
Publication statusE-pub ahead of print - 15 Sept 2016


  • DEPRESSION, Neurological Disorders
  • Psychiatric Disorders


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