An introduction to the different types of depression
Depression is a mental disorder which requires the attention of your doctor. It is distinct from episodes of low mood which may be associated with many of the same symptoms, especially a feeling of sadness, lack of confidence and motivation, but to a lesser degree.
Many types of ‘true’ depression have been described. This article provides information on some of these – but bear in mind that these descriptions overlap considerably.
A better understanding of the type of depression you are experiencing is important as it will give you an insight into your condition, with more knowledge and information to be able to find the most effective treatment for you.
Feeling low in mood
Many people describe themselves as feeling depressed when they actually mean they are feeling a bit low in mood.
Low mood is part of the normal range of human emotions. However, if these episodes become excessive, persist for more than two weeks or occur alongside other symptoms such as unexpected weight changes, feelings of guilt, worthlessness or thoughts of suicide, then it could be that we are looking at depression.
This is a term used by doctors to describe a person suffering from ‘true’ depression rather than someone who is just feeling a bit low in mood or ‘down in the dumps’.
The term does not give an indication of the severity of depression nor the character of symptoms experienced, but makes a distinction between a medical or psychiatric condition and normal episodes of low mood.
Depression can be described at various levels of severity – mild, moderate and severe.
Feelings of being low in mood merge with that of mild depression and the two conditions are not always easily distinguishable. The causes and triggers are similar and, in reality, it is difficult to determine where one condition ends and the other begins.
People have different personalities and reactions to stress and events. We know that some of this can be explained by the different levels of neurotransmitters we naturally have in our brains.
For instance, failing an exam will cause many people to feel terrible, down or low. Most will be able to recover their confidence and pass at a re-sit. However, a few may react to the failure with a loss of confidence, general unhappiness and other similar emotions, with a persistence of low mood which, if prolonged, may also be described as mild depression.
In a way, this explains why people might use the phrase ‘I am feeling so depressed’ when they actually mean that they are feeling unhappy, sad or fed-up.
Just as low mood can merge with mild depression, the latter can worsen in severity giving rise to moderate depression.
Episodes of moderate depression can come about without any apparent cause or arise as a response to a trigger. Spending time with others or going out in public (even to the supermarket) can seem like a major ordeal. This is not helped by a general lack of motivation.
As with mild depression or dysthymia, people with moderate depression can appear to their family or friends as being completely normal, especially if their excuses not to meet people or go out are accepted over time as being ‘just the way they are’.
Severe or major depression
This is the most debilitating and life-threatening form of depression. Many people in this situation are unable to communicate with others, feel worthless and rejected.
Often, people suffering severe or major depression experience problems sleeping (early morning wakening), have little or no appetite with consequent weight loss, a complete lack of interest in what is going on around them and at times, phantom aches and pains.
People with severe depression may entertain thoughts of suicide. They may also suffer delusions or hallucinations - known as psychotic depression.
The word ‘dysthymia’ is derived from Ancient Greek for ‘melancholy’. It refers to a mood disorder similar in character to depression.
People suffering this problem seem to have low mood or mild depression which lasts for several years or even for most of a lifetime. Symptoms are expressed in the personality – people with dysthymia may be described by others as a bit ‘grumpy’ or ‘moody’ with a more negative or cynical attitude to life.
Although symptoms of depression are mild, they can interfere with daily routine and people suffering dysthymia may withdraw from normal activities such as work, social events and going to the shops. Most, however, find that the problem does not interfere too much with day-to-day living and appear to live a normal life. This is the reason that mild cases are not easily recognised and remain untreated – people ‘just live with it’.
This type of depression is the reaction to a specific trigger such as bereavement, serious illness, the stress of a difficult house move, personal or relationship difficulties. All of these give rise to emotional stress and a negative reaction of body and mind.
Although these reactions are natural, they can lead to a variety of consequences. It may start off with a feeling of being fed-up, sad or low in mood. This is normal and most people work out that what they are going through is part of life’s normal challenges and pick themselves up.
If stresses do not resolve and if the mind is unable to overcome the negativity, with time, these events may lead to depression in reaction to the trigger factor.
For some people with reactive depression, the emotions persist even when the trigger is removed and the situation improves – for example, losing a job and then being offered a new one.
Symptoms of reactive depression are similar to symptoms of normal depression and can last for months or years. If the trigger event is highly significant (eg. bereavement) some never completely recover.
This is a sub-type of severe or major depression. It is characterised by the extreme ‘downs’ of severe depression accompanied by some kind of psychosis (disorder of the mind), either in the form of delusions or hallucinations.
Delusions are irrational thoughts such as the feeling that you are an evil or bad person, when everybody else thinks you are perfectly normal. Hallucinations are when you see or hear things that are not really there. These experiences can make some people feel that their thoughts are not really their own, but implanted by someone else, which can be, understandably, distressing and scary.
This is another sub-type of severe depression associated with extreme and uncontrollable mood fluctuations or mood swings. Everyone experiences different moods, some happy, some sad. The moods experienced by a manic depressive exceed the boundaries of normal mood fluctuations.
They experience extreme highs which cause them to act excessively confidently, foolishly or dangerously as they believe that nothing can harm them; and extreme lows, where they feel in a dark and inescapable tunnel.
This type of depression affects women just after they have had a baby and can last up to a year. Feeling a bit ‘down’ after a baby is considered to be a normal reaction. Around 80% of women experience the ‘baby blues’ after giving birth. This tends to be a reaction to a major change in their life exacerbated by changes in the hormones. Most feel back to normal within a few days or at most, a couple of weeks.
However, in some women, these ‘normal’ feelings of low mood are amplified and persistant. Those suffering from post-natal depression tend to find difficulty connecting or bonding with their baby, and are unable to carry on easily with everyday life.
Women may also suffer from ante-natal depression – or depression during their pregnancy, prior to childbirth. This is often caused by hormone fluctuations, and will either disappear once the baby is born or develop into postnatal depression.
Seasonal Affective Disorder
Seasonal Affective Disorder, also known as SAD, occurs when a person feels depressed at a particular time of year, usually during the winter months, but feels normal for the rest of the year. It may cause changes in the sleep pattern and energy levels as well as in mood.
It is thought that SAD is the remnant of a hibernation instinct in humans. A reduction in exposure to sunlight during the winter months reduces the amount of serotonin (making you feel less happy) and increases the levels of melatonin (making you more sleepy) in the brain.
It is important not to mix up Seasonal Affective Disorder with the normal changes in mood which naturally occur with the changing seasons. These changes are probably the result of the same changes to the neurotransmitters in the brain, but occur to a lesser degree, leading to the common feelings of being more tired during the winter months as well as feeling a bit low in mood or the ‘winter blues’ at the start of each year.