OBJECTIVES To investigate medication usage patterns, health-care resource utilization and direct medical costs of patients with Major Depressive Disorder (MDD) in Beijing, China. METHODS Data were randomly extracted from Beijing Urban Employee Basic Medical Insurance Database. Patients who were aged ≥18 years, with at least 1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder or cancer within the study period were excluded. Descriptive statistics were used to describe patient profiles, medication usage, health-care resource utilization and costs. RESULTS A total of 8484 patients were included with mean (±SD) age of 57.15 (±15.34) years, 63.02% female and 94.47% having co-morbidities. 71.35% of patients were treated with antidepressant medications, including 60.53% of patients with SSRIs, followed by NaSSA (8.96%) and SNRIs (8.26%). Concomitant medications were prescribed for 76.78% of patients. Only 0.42% of patients experienced ≥1 MDD-related hospitalizations during the 1-year follow up and the average annual number of hospitalization was 1.22 (±0.64) for those hospitalized patients. The length of stay was 33.38 (±30.6) days per hospitalization and 36.61 (±40.04) days per patient-year. All patients had ≥1 MDD-related outpatient visits. The mean annual number of outpatient visits was 3.06 (±2.99). The mean annual direct medical cost for all MDD patients was 1694.05 (±2513.71) RMB with 48.54% for antidepressant medications, and that for hospitalized patients was 21290.97 (±16121.61) RMB with 15.03% for antidepressant medications and 66.45% for non-drug medical costs. CONCLUSIONS In Beijing China, most MDD patients also had co-morbid conditions and were mainly treated in the outpatient setting. SSRIs were the most commonly used antidepressants. The economic burden of MDD was considerable.