# Different types of depression



## David Baxter PhD (Mar 27, 2004)

Types Of Depression (InteliHealth)
Depression always involves a noticeable change in mood. In fact, many mood disorders include depression as a key part. Sadness is part of the experience, but the word "depression" usually implies a profound gloom that goes beyond ordinary unhappiness. A depressed person may become irritable or stop taking pleasure in everyday activities. People with mood disorders are also likely to have other problems, such as changes in appetite, sleep or energy. (Some medical conditions can also lead to these changes, so it is important that you work with your health-care provider to identify the problem.)

Some mood disorders that include depression as part of the picture include:
o Major Depression
o Dysthymia 
o Bipolar Disorder 
o Cyclothymia 
o Seasonal Affective Disorder

*Major Depression*
The key feature of major depression is at least one extended period (at least two weeks) of very low mood, called a major depressive episode. In addition to low mood, there are typically many other symptoms, such as insomnia, fatigue, weight loss, poor concentration and feelings of worthlessness or guilt.

*Dysthymia*
Dysthymia, also called dysthymic disorder, shares the same features of major depression. However, in dysthymia, the low mood and other symptoms are less intense than those in a major depressive episode, but they last longer at least two years in adults and one year in children and teen-agers.

*Bipolar Disorder*
A person with bipolar disorder has had at least one manic or mixed episode an extended period (at least one week) of high, expansive or elated mood the opposite of major depression. A person in a manic state feels energetic and active, has little need for sleep and may behave recklessly and overoptimistically. A person in a mixed state has symptoms of both a major depressive and a manic episode that occur alternately, or sometimes the symptoms overlap in confusing ways.

*Cyclothymia*
Just as dysthymia is a less severe version of major depression, cyclothymia, or cyclothymic disorder, is a less severe but often longer lasting version of bipolar disorder. A person with cyclothymia has periods of both high and low mood never as severe as either major depression or mania over a period of at least two years.

*Seasonal Affective Disorder*
Seasonal affective disorder is characterized by moods that shift with the seasons. The most common pattern is a decrease in mood in the fall or winter (as days get shorter) and an improvement in mood in the spring. However, a few people have the opposite pattern, with depression in the summer.


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## harmony58 (May 15, 2004)

There is one "type" of depression that is not listed. Many people experience what is known as "situational" depression. In other words, the depression is linked to a specific event or feeling. Some examples would be "loss" of a loved one or friend, loss of a job, change is responsibilities, a new situation (marriage, divorce, changes in living situations.) Many times the feelings that accompany this type of situation work themselves out. 

Situational depression should not be confused with mental illness. These are normal reactions to life changes. If the feelings escalate with time and do not remit, that is when outside help such as brief therapy may help.

Also, some of the "symptoms" of depression are also indicative of biomedical illness. Misdiagnosis of depression can have severe consequences if biomedical testing is skipped or ignored. If symptoms such as tiredness, inability to concentrate, sleep disruption are not accompanied by such "symptoms" as guilt or loss of pleasure chances are that it is not depression at all, that biomedical illness may be indicated. 

Often times a person may have a biomedical illness and depression is secondary and usually situational to consequences of the illness itself.  Counseling and therapy with the goal of increased resilence, coping skills, and attitudinal changes are all helpful, but they do not cure biomedical illness.


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## David Baxter PhD (May 15, 2004)

Hello, *harmony58* - welcome to _PsychLinks Online_.

You are correct in that often a Major Depressive Episode is situational or "reactive" in nature.  In fact, that is probably true for the majority of the clients I see with depression. Twenty to thirty years ago, psychiatrists and psychologists used to distinguish between "endogenous depression", where the cause was presumed to be something phsyiological or biological (i.e., internal), and "exogenous depression", which was depression caused by external events or circumstances. For a variety of reasons, this distinction has proved to be less useful than previously believed - once a person is experiencing a major depression, the symptoms are the same, both phsyically and psychologically, which means that many of the effective treatments are the same regardless of what specifically triggered the depression. It is probably also true that most if not all instances of major depression involve both external triggers and a vulnerability to depression, with the latter based on personality as well as biological (e.g., neurochemical) factors.

I don't like the term "mental illness" - other than perhaps when it is used to refer to a major psychotic disorder like schizophrenia, the term is almost meaningless now.  For the vast majority of individuals who suffer from anxiety disorders, OCD, depression, etc., it seems to me to be both demeaning and unhelpful.  Personally, I think it's much more helpful to talk about the individual in terms of the specific challenges facing that individual.

I would also agree fully that there are some physical illnesses that can produce symptoms which mimic depression, mania, and other syndromes. One well-known and very common such illness is hypo- or hyper-thyroidism: the symptoms of an underactive thyroid are easily mistaken for depression, while the symptoms of an overactive thyroid can be mistaken for mania or a schizophrenia-like illness at its extreme. As recently as the 1980s and maybe the 1990s, it was standard practice on admission to any psychiatric hospital to order a full blood analysis including thyroid and other endocrine functioning - today, this practice for reasons I don't understand is not as common, but when I first see a client diagnosed with depression or exhibiting other unusual symptoms without a clear external trigger, one of the first things I inquire about is the last date of a complete physical including thyroid function.


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## harmony58 (May 16, 2004)

*great clarity*

Thank you for your great reply. The plethora of specialized terms involved in psychology is, I think, very baffling for the layman, which is the case for many of us. 

Kate


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## David Baxter PhD (May 16, 2004)

I'm glad to hear you found it helpful.

The concept of "vulnerability to depression" has some positive implications as well as the obvious negative ones.

People who are more prone to (i.e., vulnerable to) depression also tend to be sensitive, empathic, introspective, caring, and creative, among other attributes.  As I often say to clients, if you think about those qualities, those are exactly the qualities that one would look for in a good friend or intimate partner/spouse... so the upside is that having those qualities means that many people will tend to be attracted to you as a person; the obvious downside is that you may feel things and react to things more intensely than others, which is part of that vulnerability to depression.

Over the short-term, treatment is about managing symptoms and addressing the factors in your life which triggered depression.  But the key over the long term may involve managing vulnerability - not changing who you are, but getting a little better at setting boundaries, recognizing early precursors to a depressive episode, and learning ways to intervene (partly through cognitive restructuring or reframing, aka Cognitive Behavior Therapy) in the depressive thinking patterns that tend to feed a depression.


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## foghlaim (Oct 30, 2006)

"situational" depression" just wondering if this is the same as reactive depression.. i've just remembered a nurse thought that this should be my diagnosis.. 

can't find any links to this here tho..maybe tis an uuncommon diagnosis.. if there is any more info on this.. can some one point me inthe right direction.

thanks.


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## David Baxter PhD (Oct 30, 2006)

Yes... situational depression and reactive depression mean the same thing, i.e., that the depression is a relatively immediate and short-term reaction to life circumstances.


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## foghlaim (Oct 30, 2006)

thank you David... hmm guess it's not relative to me then based on what little i have read about this particular diagnosis.


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## Into The Light (Dec 26, 2006)

i've suffered from depression twice now, both seemed to be reactive as i suffered a major loss in both situations. they also were in a post-partum period (but i was not depressed in another post-partum period). this brings up the following questions for me.
- is depression for me linked only to situational triggers?
- is depression for me only linked to major hormonal changes?
- what are the chances of me becoming depressed again without it being situational?

i've seen the statistics on the likelihood of suffering depression again - have any statistics taken previous cbt treatment into consideration? ie - are these numbers purely for those who don't get treatment and thus do not have the coping skills in subsequent episodes? or do these numbers also count for those who have been taught how to recognize distorted thinking and can be on the watch for symptoms?


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## ThatLady (Dec 26, 2006)

How long did your depressions last, ladybug? Did they continue long after the distressing events, or did they begin to dissipate as the stress in your life was relived?

It's not all that odd, in my experience, for someone to suffer depression after one pregnancy but not after another. A lot has to do with how the hormones come back into balance, and what's going on around you during this sensitive time. Did you get therapy for the depression in either, or both cases, and what kind of therapy were you given?

I find I can pretty much tell when I'm heading into a slump and can work with the tools I've learned to help relieve the stress that's building up in my life, thereby relieving the depression or, at least, getting it to manageable proportions.


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## David Baxter PhD (Dec 26, 2006)

The statistics may vary according to who provides them but we do know this:


risk for relapse is greatest when there has been an episode of major depression that was not treated
treatment with medication alone or psychotherapy (including CBT) alone is less effective in preventing relapse than a combination of medication and psychotherapy
longer-term treatment with medication (i.e., 1 to 2 years) is more effective in preventing relapse than a short (3 to 6 months) course of medication, even though the short-term use may result in relief of immediate symptoms

As I've said before, I think it's helpful to think about depression (and other disorders) in terms of vulnerability - whether you actually experience a major depression depends on the interaction of that vulnerability with other factors, including life experience (e.g., triggers for depression), hormones, and even nutrition/diet.


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## Into The Light (Dec 26, 2006)

tl, the first one lasted about a year and was untreated. the second one, hard to say if that was a one year or two year episode - there was a break in the middle of a couple of months, the break based purely on circumstances, and the return of feeling off when those circumstances changed again. after the break it went on for about 6 months before i realized something was really wrong. i got treatment then (cbt and meds).

good to hear you can tell when you're headed down that road, i guess i wasn't sure how easily recognizable it is, especially since both experiences of depression seemed quite different to me. i certainly want to be alert, and not have it sneak up on me.

thanks for the info david, very good to know.


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