Different types of depression

by Martin

in Depression Diagnosis

Understanding the different types of depression is helpful in enabling you to see whether you or your loved one might be suffering from a recognized depressive illness. If you think that you might be, then that can signal that you may need to seek some professional help.

Of course, it’s normal to get the blues sometimes; to feel unhappy, ‘down in the dumps’, sad or miserable now and again. We all do, because life presents us with difficulties and challenges, such as job losses, relationship breakdowns and bereavement that we have to face and try to overcome.

Feeling unhappy or sad about those kinds of situations is the normal and expected reaction. It is when those unhappy feelings become especially strong, last for a long time and/or are associated with other particular features that depression may be the cause.

Incidentally, it is also absolutely normal to suffer depression too. It is an illness that probably affects us all in some way – whether by suffering from it ourselves or by having friends or family who do. According to figures from the National Institute of Mental Health, over 20% of US adults (that’s one in every 5) will suffer from a mood disorder during the course of their lifetime. Also one in ten adults (10%) will suffer from depression in any given year ( the America Psychiatric Association).

The difference is that depression is an illness that can and should be treated whilst the blues are the blues – part of everyday life that we endure and deal with and that make the good bits worth waiting for.

Major Depression

Major or severe depression (also known as clinical depression or unipolar disorder) occurs when, in broad terms, feelings of a depressed, low mood together with a loss of interest in the normal pleasures and activities of life persist for a period of more than two weeks.

To signify major depression, the effect of the symptoms of severe depression must be substantial and cause clear distress or the inability to carry out normal functions. The symptoms must also be a clear change from the person’s normal state of mind and not be related to any external causes such as drugs or alcohol.

This is a serious condition and when major depression affects a person for a long period, it can be severe enough to cause suicidal thoughts. Often major depression will also affect your ability to sleep or cause you to sleep too much.

Signs of major depressive disorder may also include:

  • weight gain or loss due to major changes in appetite
  • feelings of fatigue and a general lack of energy
  • emotions of hopelessness, self-hate, anger, worthlessness, guilt and helplessness
  • agitation, irritability and restlessness
  • an inability to experience pleasure or enjoy any activities at all

Complications that may arise with this type of depression include excessive use of alcohol or drugs in a bid to alleviate symptoms. Drug and alcohol use will only increase depressive symptoms. Physical health problems due to substance abuse or complications due to weight gain or loss can also occur.

Different types of depression - alcohol abuse

Depression may lead to alcohol abuse, as the sufferer tries to blot out his misery

Treatment for major depression usually includes a combination of prescribed medication and therapy. The most common depression medications for major depressive disorder, as well as for some of the other different types of depression, are selective serotonin re-uptake inhibitors (SSRIs) or serotonin noreprinephrine re-uptake inhibitors (SNRIs).

SSRIs used to treat depression include:

  • Prozac (fluoxetine)
  • Lexapro (escitalopram)
  • Zoloft (sertraline)
  • Celexa (citralopram)
  • Paxil (paroxetine)
  • Luvox (fluvoxamine)

SNRIs used to treat depression include:

  • Pristiq (devenlafaxine)
  • Cymbalta (duloxetine)
  • Effexor (venlafaxine)





In the past, monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) were also used to treat different types of depression. They are less often prescribed these days due to the risks and side effects associated with those particular drugs.

When a person starts taking major depression medications, the condition can start improving within a few weeks. However, it may require nine months or more for the full benefit of the treatment to be felt. In some cases a particular medication may not be effective which may mean that a different medication may be tried.

Dysthymia

Dysthymia or chronic depression is quite different to major depression, although they could be characterized as different points on the same spectrum.

Dysthymia is considered to be present when a person has been experiencing low, dark or sad moods on most days for two years or longer.

It is often hereditary and is more prevalent in women than in men. It is often difficult to diagnose because the person has been functioning under it for so long.

Symptoms of dysthymia include being overly critical of one’s self, of others or of circumstances in general, not being able to have fun and constantly complaining. As with other types of depression, there is usually a lack of interest in common activities, feelings of hopelessness, lack of self-esteem and a general lack of productivity. Sleep patterns may be interrupted due to lack of or too much sleep. There may be low energy and changes in appetite along with poor concentration.

Diagnosis is of dysthymia is carried out by evaluating mood history and other symptoms. Blood and urine tests may be given to rule out other medical causes of symptoms. Antidepressants and talk therapies are used for treatment of dysthymia, but medication is often less effective in treating milder forms of depression such as this and, if it works at all, may take longer to alleviate symptoms.

Cognitive behavioral therapy (CBT) is one of the therapies most often used to help treat dysthymia. CBT helps people to recognize behaviors and patterns of thinking that may be causing them to hold a negative world-view and experience low moods. CBT tries to instill new behaviors and ways of thinking to combat this.

Another of the therapies used to treat dysthymia and other depressions is psychodynamic psychotherapy. Less often used in the present day than CBT, psychodynamic therapy tries to help people understand the underlying factors and triggers which may be behind their depressive patterns and symptoms.

Depression and anxiety

Anxiety is a heightened reaction to ordinary stress. Anxiety and depression commonly occur together. In fact people who experience depression often also experience some type of anxiety. Unfortunately, this can be a potent combination and means that the impact on the sufferer is much greater than where one or the other condition exists alone.

Depression and anxiety symptoms include depression’s feelings of hopelessness and sadness compounded by anxiety’s feelings of fear and panic. There may be a sense that something bad might happen, accompanied with physical symptoms such as tightness in the chest, difficulty breathing, dizziness, and numbing in the fingers and toes.

Several different anxiety disorders can combine depression and anxiety. These include panic disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder and phobias.

Anxiety depression treatment usually involves SSRIs and sometimes SNRIs. In severe cases, anti-seizure medications may be used if the symptoms of anxiety are not fully relieved by antidepressants. Benzodiazepines such as Xanax (alprazolam), Avitan (lorazepam), or Klonopin (clonazepam) may be prescribed.

Depression and anxiety treatment may also include CBT. In addition to the ways in which CBT can help with depression, CBT can also help anxiety sufferers recognize panic-causing attitudes and behaviors and enable the sufferer to find ways to remove those triggers from their customary thoughts and actions. Other depression and anxiety treatment includes proper rest, exercise and nutrition.

Psychotic Depression

This type of depression occurs in persons who are experiencing depression in combination with psychosis. Psychosis occurs when a person suffers from hallucinations, which is seeing or hearing things that are not there or when they can suffer from irrational fears and thought processes called delusions.

Symptoms of psychotic depression include agitation and anxiety. Insomnia is common and can actually cause or make psychosis worse. People who suffer from psychotic depression may experience physical immobility or constipation. There may be intellectual impairment such as the inability to concentrate or reason. Most important to the diagnosis of this condition are the symptoms of psychosis themselves.

When psychosis is initially diagnosed, hospitalization is a general recommendation in order for doctors to monitor and stabilize the patient. Anti-depressants are given to treat the depressive side of this disorder while anti-psychotic medications are administered in order to eliminate hallucinations and delusions and help bring the patient back in touch with reality. Psychosis is treatable, with most people recovering from it within a year. For more severe or long-term psychotic depression, electro-convulsive therapy (ECT) is sometimes used as a treatment.


Simplified diagram of the relationships between the different types of depression

Different types of depression graphic


Bipolar Disorder

Bipolar disorder was formerly known as manic depression. There are in fact three main types of bipolar disorder.

Bipolar I disorder is the more severe form of the disease that can severely affect careers, relationships and the lives of others, especially family.

In its classic form, Bipolar I is characterized by extreme mood swings – from mania to severe depression. The ‘manic’ state involves feeling elated, often with racing thoughts, and can lead to risky behaviors such as promiscuity, spending sprees or substance abuse. These manic states can last several days or several weeks and they are followed by a period of severe depression.

Bipolar II disorder differs from bipolar I in that sufferers of this type of disorder have never experienced true mania. Instead they experience ‘hypomania’ alternately with periods of depression. Hypomania is a period of elevated mood, not as intense as mania, but which may still lead to excessive risk taking and regrettable decisions. A person in a hypomanic state may talk rapidly, change quickly from one idea, activity or subject to another, appear hyperactive and have much less need for sleep.

The final form of bipolar is a mild form known as cyclothymia that often is misdiagnosed as simply depression. Cyclothymic disorder typically involves cycling between hypomania and mild depression, but each cycle or state lasts two years or more at a time.

Whilst diagnosis may involve a bipolar test, treatment for bipolar disorder usually involves the prescription of a mood stabilizer such as carbamazapine, lamotigine, lithium, or valproate. Sometimes anti-seizure medications are used in conjunction with mood stabilizers to help stabilize mood. Antidepressants may be prescribed, but only in conjunction with a mood stabilizer, as there is some evidence that antidepressants alone in a bipolar system can trigger manic episodes.

Atypical Depression

Atypical depression is so called because it can be subject to improvement where the sufferer experiences something positive in their life. In typical forms of depression, external events will not affect mood substantially in this way.

Some experts believe this type of depression to be linked to dysthymia, while others think it is a milder form of cyclothymia.

Symptoms include sleeping or eating too much with weight gain, a sensitivity to rejection or criticism that interferes with personal and professional relationships, feelings of being weighed down or paralyzed.

Treatment for atypical depression is generally by the administration of SSRI antidepressants.

Postpartum Depression (post-natal depression)

In the same way that major depression differs from simple sadness or unhappiness, postpartum depression differs from the baby blues that affect 80% of new mothers.

Postpartum depression usually occurs from 1-3 months up to a year after delivery of the baby. Symptoms of postpartum depression are similar to those for other types of depression.

Treatment for this type of depression includes SSRI antidepressant medications and therapy. CBT and interpersonal talk therapies are used extensively for the treatment of postpartum depression.

Conclusions

Understanding the different types of depression is really just a starting point in your exploration and alleviation of depression. It is useful to put the various forms of depression in context and alongside one another so that the different characteristics of each different type of depression are clear.

This will also help you as you engage with the doctors and other health care professionals you will deal with as it will enable you to more fully understand their diagnoses and treatment suggestions.





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About the Author

Father, husband, writer and website publisher, discontented in his day-job, he writes here about depression - his own and in general. You can follow Too Depressed on Twitter. Please share the content on this site with all your friends, followers and contacts using the buttons above.

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Last revised on October 2, 2011

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