Types of Depression
Major Depressive Disorder - The patient has symptoms of depression most of the day, nearly every day for at least two weeks, that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes. Major Depressive Disorder is sometimes called depression, clinical depression, or unipolar depression.
Persistent Depressive Disorder- This disorder used to be called Dysthymia. It’s a chronic depressed mood that lasts for at least two years. The disorder may include periods of major depression and also less severe symptoms. Typically, symptoms include low self-esteem, low energy, poor concentration, feeling hopeless, difficulties sleeping and eating. These symptoms look similar to major depressive disorder. Still, their duration is much longer, and they are also less severe than major depressive disorder. An episode can occur only once in a person’s lifetime, but more often, they have several episodes.
Seasonal Affective Disorder - This type of depression occurs during the winter months when there is less natural sunlight. The depression generally lifts during spring and summer.
Disruptive Mood Dysregulation Disorder - This is a newer disorder that wasn’t defined until the publication of the DSM-5. It’s similar but different from Intermittent Disruptive Disorder. The clinical picture includes explosive outbursts of rage. They are usually irritable and angry.
Vascular Depression - See Seniors and Depression.
Depression and Dementia - See Seniors and Depression
Depressive Disorder Due to Another Medical Disorder - This type of depression is caused by chronic diseases, like heart disease, cancer, and multiple sclerosis.
Post Partum Depression - See Depression in Women
Treatment Resistant Depression - This diagnosis is given to patients who don’t respond well to medications or counseling. Despite treatments that would work on 99.9% of patients, treatment doesn’t help them.
Substance/Medication-Induced Depression Depressive Disorder - This is caused by using alcohol, benzodiazepines, opiates, and other drugs.
Psychotic Depression -This type of depression occurs when a person has severe depression plus some form of psychosis, such as delusions and or hallucinations. Technically, the term “Psychotic Depression” is very outdated and not an official diagnosis. Insurance companies would not pay for a diagnosis of “Psychotic Depression” any more than they would the diagnosis of “alcoholic” or “nervous breakdown.” Diagnostic terms have changed over the decades, and presently, the contemporary diagnostic labels for a patient who simultaneously presents with symptoms of depression and psychosis are Major Depressive Disorder with Psychotic Features, Bipolar Disorder with Psychotic Features, and Schizoaffective Disorder. Since all three diagnoses have mood and psychotic features, accurate diagnosis is complicated and requires a highly competent clinician who is capable of performing a very complex assessment. A thorough review would look at which symptoms, either the mood or psychotic symptoms, presented first in the patient’s development.
If the patient had depression and later developed psychosis, then their accurate diagnosis would be “Major Depressive Disorder with Psychotic Features.” If the patient had depressive symptoms with mania and later developed a psychosis, they would accurately be diagnosed as “Bipolar Disorder with Psychotic Features.” If the patient was initially diagnosed with a psychotic disorder and later developed a mood disorder, the accurate diagnosis would be “Schizoaffective Disorder.” Diagnosis becomes even more complicated since many bipolar patients are misdiagnosed as depressed because they only see a doctor when they are feeling depressed. Somehow, the mania of bipolar is missed.
Diagnosis becomes even more complicated; for example, when the same patient is diagnosed by ten different doctors and presents with depression, delusions, and hallucinations, there is a good chance some mental health professionals would diagnose the patient as having “Major Depressive Disorder with Psychotic Features,” others with, “Bipolar Disorder with Psychotic Features,” and others might make the diagnosis of, “Schizoaffective Disorder.” It is difficult for a mental health professional to catch these subtle distinctions because patients don’t often have much insight into their minds’ interior movements. In addition, they don’t always present coherently.
Atypical Depression - The clinical picture for Atypical Depression is different than regular depression. It’s a type of depression that does not follow what is the typical presentation of the disorder. Unique to the distinction of atypical depression is heaviness in the arms and legs, oversleeping, and overeating. Also, they may have relationship problems and are especially sensitive to interpersonal rejection, and their mood spontaneously improves when something good happens to them. At other times, they meet the diagnostic criteria for depression but aren’t sad.
Adjustment Disorder with Depressed Mood - This is an official diagnosis. The patient’s disorder is triggered by a lot of overwhelming stress. The death of a loved one, divorce, losing a job, etc., can trigger this disorder.
Depressive Episode with Insufficient Symptoms - To be diagnosed with depression, a patient must present with five of the nine symptoms. This diagnosis is given when a patient doesn’t meet the diagnostic criteria for the major depressive disorder diagnosis because they only have 3 or 4 of the depression’s nine symptoms.
How is Depression Treated?
Treatment for depression may require dietary and lifestyle changes, talking with a physician or counselor, and possibly taking medications. If you or someone you know is very depressed and/or suicidal, call 911 ASAP or get to an emergency room ASAP.
The best practice is to combine counseling with antidepressant medications. Whether it’s a physician, psychiatrist, scientific counselor, or pastoral counselor, when combined with the proper medicine at the appropriate dosage, the healing synergy is much more effective than either one by itself. Yet medication without counseling or counseling without medication can be beneficial.
Counseling can often help you to manage your depression. You may become less sad, sleep and concentrate better, have less negative self-talk, cry less, be less irritable, have more energy, and be less angry and disappointed. Once these depressive symptoms lessen, you may find that your stress level is significantly decreased, and you are more happy in your marriage, work, and life in general.
Antidepressants are often beneficial but come with some suicidal risks for children, teens, and young adults. When beginning or weaning off, suicidal thoughts or suicide attempts can increase. Discuss this with your doctor, and always follow the doctor’s recommendations. Pay very close attention to your child during these critical periods.
There are also more aggressive treatments like electroconvulsive shock. In this treatment, an electric current is passed through the brain to relieve depression. Ketamine is also being used to treat stubborn depression.
Many non-medical treatments fall under the homeopathic umbrella, like St. John’s Wart, Omega-3 Fatty Acid, SAM-e, etc. It’s essential to check with your physician and pharmacist before taking these supplements because they may dangerously interact with the prescribed medications you are taking.
Depression in Women
Women have depression more often than men. Life cycle and hormonal factors unique to women possibly cause their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
Certain types of depression are unique to women and occur at different stages in a woman’s life. These include:
Premenstrual Dysphoric Disorder - This disorder is less common but much more severe than PMS’s symptoms. It is a serious condition with disabling symptoms such as irritability, anger, depressed mood, sadness, suicidal thoughts, appetite changes, bloating, breast tenderness, and joint or muscle pain.
Peri menopausal Depression - Transitioning into menopause can cause irritability, anxiety, sadness, loss of enjoyment, abnormal periods, problems sleeping, hot flashes, and mood swings.
Post-partum Depression - After childbirth, mothers can experience extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves, their child, or their family. Post-partum depression does not occur because of something a mother does wrong or because she failed to do something necessary. After childbirth, hormone levels quickly drop. When hormonal changes combine with the responsibility of motherhood, it can be overwhelming and cause depression. Depression affects not only the mother but also her relationship with her baby, the child’s development, the mother’s relationship with her spouse, and other members of the family. Some unique post-partum depression symptoms are not commonly found in other depressions. They include having trouble bonding or forming an emotional attachment with her baby, persistently doubting her ability to care for the baby, and thinking about harming herself or her baby. Left untreated, post-partum depression can last for months or years.
Post Abortive Depression
There are authentic and genuine psychiatric disorders that are directly caused by the abortion experience. Depression is often a post-abortion consequence. Unprocessed grief due to the loss of the baby can cause depression. Post-abortive depression nearly always includes at least some of the following: sadness, boredom, despondency, fatigue, anger, concentration difficulties, weight or sleep problems, crying or being on the verge of tears, loneliness, low motivation, apathy, guilt, despair, discouragement, negativism, defeatism, suicidal thinking, focus on morbidity, sadness, hopelessness, and/or helplessness. It does not help that depression often robs the person suffering from the energy sorely needed to get out of it.
A woman’s hormonal chemistry continues to unfold even after an abortion. The body does not distinguish between an abortion and a birth, and it is not rare to see post-partum depression in women post-abortion. It has been shown that for a woman who has a miscarriage (spontaneous abortion), the hormones have already dropped before the loss, and the body is physically recovering or achieving homeostasis from the loss of the child. With an abortion (termination), the body is shocked into the loss and is not ready. This can leave the hormonal levels in disarray, sometimes for a few weeks and sometimes for as long as the expected due date of the lost child.
Men with Depression
While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in prior pleasurable activities, and have difficulty sleeping. Men may turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, angry, and sometimes abusive. Some men may throw themselves into their work to avoid talking about their depression with family or friends. When a man has depression, he has trouble with daily life and experiences diminished interest in anything for weeks at a time. Many men don’t recognize their depression or seek help for their depression because they feel embarrassed to talk about how they are feeling. Depression is a treatable mental illness.
Depressed Christians
There are many good, spiritually mature, practicing Christians who live with depression as well as other psychiatric disorders. Probably on any Sunday at any church, there are people in the congregation who are on psychotropic medications to control their depression, anxiety, etc. For some, they are ashamed of having depression and double embarrassed about taking drugs like Zoloft, Effexor, Lexapro, or Prozac to ease their suffering. So, they suffer in secret. There are also other Christians who understand that having depression isn’t a shameful illness any more than having the flu or having a heart attack or stroke. They also believe that antidepressants are a gift from God to help hurting souls suffer less. Until the scientific discovery of helpful antidepressants, those suffering from depression had very few options for relief. Some would ingest St. John’s Wort. Even today, studies have mixed results about the efficacy of St John’s Wort. It’s always a good idea to pray to God for relief.
Depression in College Students
College can be very stressful and trigger depression. The student may be leaving home for the first time, learning to live independently, taking challenging classes, meeting new people, and sleeping less. Depression is the most common mental health problem for college students. If depression is interfering with the ability to succeed in school, get help right away. Depression usually gets better with care and treatment. Don’t ignore the bad feelings. If you neglect professional help, you may begin self-medicating with alcohol. Most colleges provide low-cost mental health services through their counseling centers.
Depression with Seniors
Depression in older adults can be challenging to recognize because older folks may show less evident and different symptoms. Sometimes, older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Depression is not a normal part of aging, and like younger people, they also need treatment to feel better. They could be helped by seeing a physician for medications and a therapist for counseling. Interestingly, some older adults prefer counseling instead of drugs to treat their depression. This could be because they have someone to talk with in counseling, alleviating loneliness. Before starting a medication, older adults and their families should speak with a doctor about whether a drug can affect alertness, memory, or coordination and how to help ensure that prescribed medications do not increase the risk of falls.
Vascular Depression - Vascular Depression (sometimes called Subcortical ischemic depression) - You will not be able to find Vascular Depression in the DSM. Its diagnosis is from Magnetic Resonance Imaging and autopsies. The concept correlates late-onset depression with brain vascular disease, lesions, cerebrovascular damage, blood vessel hardening, micro leaks, etc. These, as well as other very technical medical terms, describe different ways normal blood flow to the brain is interrupted and causes depression. But there is nothing scientifically conclusive, so vascular depression is controversial.
Depression and Dementia - Depression combined with dementia is often observed in older adults. They seem to go together like two sides of the same coin, but not always. Notably, many people with histories of depression never get dementia. Some do and some don’t. Still, many people with dementia have depression. As people get older, they undergo many changes, like retirement, the death of loved ones, stressful life events, or medical problems. Feeling uneasy, stressed, or sad about these changes is common. But after adjusting, many older adults feel well again.