title: Major depressive disorder.
abstract: 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.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Otte
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité University Medical Center, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.|Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Gold
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Penninx
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Etkin
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Alan F
authors.initials: AF
authors.lastname: Schatzberg
mesh_terms: D000302:Adrenal Cortex / Q000002:abnormalities / Q000503:physiopathology; D000313:Adrenal Medulla / Q000002:abnormalities / Q000503:physiopathology; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D015306:Biogenic Monoamines; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007031:Hypothalamus / Q000002:abnormalities / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000187:drug effects / Q000502:physiology; D015995:Prevalence; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents; D015306:Biogenic Monoamines