Psychotic features occur only alongside a major depressive episode.Psychotic features, such as delusions and hallucinations, which are usually mood-congruent ( delusions and hallucinations are often about worthlessness, guilt, death, and hopelessness).Features of MDD (see diagnostic criteria for major depressive disorder).Clinical features: See “ Major depressive episode” and “ Psychotic features” for details.Etiology: overactivity of the hypothalamic-pituitary-adrenal axis (increased dopamine activity) is believed to play a major role.Definition: major depression accompanied by psychotic symptoms.Major depressive disorder with psychotic features MAO inhibitors can be effective although not commonly prescribed due to their side effects.Diagnostic criteria: two or more of the clinical features are present.Mood reactivity: brightening of mood in response to positive events, which is usually not the case in classical MDD.Interpersonal rejection sensitivity that leads to social and occupational impairment.Leaden paralysis (legs and arms feel heavy).Epidemiology: most common variant of MDD.Major depressive disorder with atypical features Treatment: Bright light therapy has been shown to improve symptoms.Diagnostic criteria: Symptoms must be present for ≥ 2 consecutive years and for the majority of years in a lifetime.See “ Major depressive episode” for details.Patients present with typical symptoms of MDD alongside atypical ones, such as weight gain and requiring more sleep.Epidemiology: occurs in a yearly, season-specific pattern (commonly in fall or winter).Definition: a subtype of major depressive disorder characterized by ≥ 2 depressive episodes associated with a seasonal pattern (e.g., the winter season) over ≥ 2 years.Major depressive disorder with seasonal pattern ( seasonal affective disorder, winter depression) Treatment of all forms of MDD is multifaceted and often requires psychotherapy, pharmacotherapy (most commonly SSRIs), and lifestyle changes.
Presentations may also vary in special patient groups, e.g., pregnant patients, older patients, children and adolescents, and patients receiving palliative care. MDD with atypical features is additionally characterized by weight gain and increased appetite, while MDD with psychotic features is characterized by hallucinations and delusions. Subtypes of MDD are characterized by additional symptoms. Other symptoms of MDD include sleep disturbance, loss of appetite, and thoughts of suicide. Reduced levels of neurotransmitters ( serotonin, noradrenaline, dopamine) are believed to be the pathophysiological basis in most cases. The etiology is multifactorial, including both biological and psychological factors. The peak age of onset is the third decade. Women have a higher risk of developing MDD than men. Major depressive disorder (MDD) is an episodic mood disorder primarily characterized by depressed mood and anhedonia lasting for at least two weeks.
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