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Major depressive disorder (MDD) is a common mood disorder characterized by persistent sadness, loss of interest, and a range of emotional and physical symptoms that impair daily functioning.
Quick Answer
Major depressive disorder (MDD) is a common mood disorder characterized by persistent sadness, loss of interest, and a range of emotional and physical symptoms that impair daily functioning. Dr. Ruja Shrestha (NMC 19766, Experienced clinical practice in psychiatry and mental health) evaluates major depressive disorder at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal — evidence-based, medically reviewed.
MDD is defined by episodes of depressed mood or loss of interest lasting at least two weeks, accompanied by changes in sleep, appetite, energy, concentration, and self-worth. It is a leading cause of disability worldwide and increases risk of suicidality. MDD has strong neurobiological underpinnings involving monoamine neurotransmitter systems, HPA-axis dysregulation, and inflammatory pathways. Evidence-based treatment includes psychotherapy, pharmacotherapy, and neuromodulation in severe cases.
Clinical diagnosis based on DSM-5 or ICD-11 criteria: five or more symptoms during the same two-week period, including at least one of depressed mood or loss of interest. PHQ-9 is a validated screening tool. Medical evaluation should exclude hypothyroidism, vitamin B12 deficiency, and medication side effects. Risk assessment for suicidality is essential at presentation.
First-line treatment includes CBT and/or antidepressant medication (SSRIs as first choice, SNRIs as alternatives). For treatment-resistant depression, augmentation strategies (lithium, atypical antipsychotics), ECT, or repetitive transcranial magnetic stimulation (rTMS) may be considered. Psychoeducation, lifestyle modification, and safety planning are integral to management.
Management is individualized and discussed with benefits, limitations, and follow-up.
Maintaining social connections, regular physical activity, adequate sleep, early treatment of subsyndromal symptoms, and ongoing monitoring for recurrence in those with prior episodes. Psychological interventions targeting rumination and maladaptive thinking patterns can reduce relapse risk.
Clinical sadness is a normal, transient response to life events. MDD involves persistent symptoms (two or more weeks) that significantly impair daily functioning and quality of life.
Antidepressants (SSRIs, SNRIs) are not addictive, but discontinuation symptoms can occur if stopped abruptly. Tapering under medical supervision is recommended.
CBT and behavioral activation are well-supported, with response rates comparable to medication in mild to moderate depression. Combining therapy and medication is often more effective than either alone in moderate to severe cases.
Yes � recurrence rates are approximately 50% after a first episode and higher with subsequent episodes. Maintenance treatment and relapse prevention strategies are important for those with recurrent depression.
Yes � Dr. Jitendra Prasad Yadav (NMC 8029) provides depression assessment and treatment at Kathmandu Neurology Clinic & Cognitive Center.
Treatment optimization may involve dose adjustment, switching medications, or adding psychotherapy. ECT and rTMS are options for treatment-resistant depression. Discuss options with your clinician.
Comprehensive psychiatric evaluation for mood, anxiety, psychosis, and other mental health concerns, including medication assessment and long-term care planning.
Structured, evidence-based cognitive behavioral therapy for anxiety, depression, insomnia, and related conditions.
Evaluation and treatment for major depressive disorder, persistent depressive disorder, and depressive episodes associated with medical conditions.
Generalized anxiety disorder (GAD) involves persistent, excessive worry about everyday matters that is difficult to control and may cause physical symptoms.
Bipolar disorder is a chronic mood condition characterized by alternating episodes of mania or hypomania and depression, causing significant disruption to daily life.
Substance use disorder (SUD) is a chronic condition involving compulsive use of a substance despite harmful consequences, characterized by loss of control over use and continued use despite adverse effects.
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Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-09-04
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.
Doctor — medically reviewed
Dr. Ruja Shrestha
Consultant Psychiatrist & CBT Therapist • MBBS, MD (Psychiatry) • NMC 19766
This condition guide was medically reviewed by Dr. Ruja Shrestha.
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