Managing Major Depressive Disorder (MDD)

By Gaea Marelle Miranda, M.Sc.Reviewed by Dr. Jennifer Logan, MD, MPH

Major Depressive Disorder (MDD) is a psychiatric condition characterized by depressed mood or anhedonia (significant loss of interest or pleasure). It can be managed using therapies such as CBT, or pharmacological intervention.

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The World Health Organization estimates that 300 million persons are affected by MDD worldwide. The large burden of disease has resulted in an increased demand for effective management practices that can mitigate the adverse effects of the condition.

As clinical depression may be caused by various environmental and biologic forces, interventions for the condition are also developed using various frameworks and mechanisms. Research shows that psychotherapeutic approaches, pharmacologic interventions, and neurologic assessment may be used in the management of MDD.

Psychotherapeutic approaches

Psychotherapy is a psychological intervention that addresses cognitive, affective, or behavioral issues associated with a certain mental health condition. There are various types of psychotherapeutic approaches for MDD, which vary depending on the general psychological framework they follow (e.g., psychodynamic, humanistic, or behavioral). In the case of MDD, cognitive-behavioral and humanistic therapies are used most commonly.

Cognitive-behavioral therapy (CBT)

CBT is a psychotherapeutic intervention that aims to help patients disregard irrational thoughts and beliefs and facilitate the adaptation of more appropriate strategies in dealing with stressful stimuli.

A wide range of studies support the effectiveness of cognitive-behavioral therapy in addressing and managing depression and other psychiatric conditions, making the method a primary therapeutic option for clinicians and psychologists.

Methods in CBT include assignments, worksheets, psychoeducation, and graded activities. These allow clinicians and therapists to quantitatively assess their patients’ progress and determine more specific issues or challenges in therapy. There are numerous empirical evidences suggesting that appropriate use of CBT activities, even without pharmacological intervention, can significantly improve clinical depression.

Person-centered therapy

Person-centered therapy, also known as client-centered therapy, is a therapeutic intervention promulgated by positive psychologists and humanistic psychotherapists that aims to provide patients with the insight that they are valued, important, and significant members of society.

This therapeutic approach reframes a patient’s affective and cognitive perceptions to value their therapeutic relationship with the therapist, act as a result of intrinsic motivation, and develop positive insights about the human potential.

Research has found that client-centered therapy could enable individuals to develop positive lifestyle changes, promote health, and value social relationships. Furthermore, clinical studies utilizing client-centered therapy as a primary treatment modality for clinical depression suggest that the method provides high levels of positive outcomes and low levels of relapse. This finding implies the effectivity of client-centered therapy in addressing and managing major depressive disorder.

Pharmacological interventions

Drugs and medications that are prescribed for MDD are usually given by physicians to regulate neurochemical imbalances (e.g. low serotonin levels) that cause MDD. Pharmacological or psychotherapy may be used as first-line treatment for  clinical depression. A combination of medication and talk therapy is commonly used, as it is likely to improve outcomes more than medication alone.

One reason to limit pharmacological intervention in favor of psychotherapy is to avoid  adverse effects of medications. Obtaining a proper medical history prior to using pharmacologic management is essential, as medications used to treat certain mental illnesses can worsen other mental illnesses.

It is also important to consider any possible adverse effects on other body systems and to choose the most appropriate and safe anti-depressant for each patient. Although no particular anti-depressant can be viewed as superior, researchers continuously evaluate drug effectiveness and tolerability.

Brain imaging for MDD management

Neurologic assessment involves screening strategies such as magnetic resonance imaging (MRI) to identify any  structural abnormalities in the brain that would affect the progress, prognosis, or severity of depression. Recently, researchers have found the MRI useful in determining structural variations in people with depression and anxiety in comparison with healthy persons.

In particular, specific gray matter changes in the brain’s salience network were perceived cause the condition. These gray matter changes may promote compensatory mechanisms of inflammation, coping, or regulation in the area that results in the development of depression.

Although there is a need to generate more empirical research on the utility of MRI in diagnosing, understanding, and treating depression, continued evaluation of brain function should improve our understanding of MDD.

Further Reading

• All Depression Content
• Clinical Depression: Diagnosis, Causes & Treatment
• Causes of Depression
• How Does Your Diet Affect Depression?
• Depression Diagnosis