9 Types of Depressive Disorder
What follows is a broad overview of the most common depressive disorders as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Please note that this list is merely a guide to help you understand depression. It is not offered for you to self diagnose. If you have some of these symptoms, don't focus on how many symptoms you have. Instead, talk to your doctor about how you have been feeling, to see if he/she can help.
• Major depression
• Dysthymia
• Manic-Depression
• Cyclothymia
• Post-partum depression
• Seasonal affective disorder (SAD)
• Existential depression
• Mood disorders due to a medical condition
• Medication-induced depression
• Substance-induced mood disorder
Major depression may manifest only once in a life, the result of a significant psychological trauma, respond to treatment. This is known as single episode depression. Some experience recurring depression, with episodes of depression followed by periods of several years without depression, followed by another episode, usually in response to another trauma. This would be a recurrent depression. In general, the treatment is similar, except that treatment usually is over a longer time period for recurrent depression.
Professional debate continues regarding whether some people develop "endogenous depression" without any identified psychological causes. An endogenous depression is a biologically caused depression, due presumably to either genetic causes or a malfunction in the brain chemistry. But, all depression involves some changes in brain chemistry, even when the cause is clearly a psychological trauma. After psychological treatment and recovery from depression, the brain chemistry returns to normal, even without medication. To date, there is no hard research evidence to support the notion of endogenous depression. Sometimes this term is used to describe people who do not respond well to treatment, and sometimes it is a rationale to prescribe medication alone, and not to offer any psychological treatment for the depression. In general, the majority of people who require antidepressant medication for their depression respond to treatment better when psychotherapy, particularly cognitive-behavioral psychotherapy, is provided in addition to the medication. Medication treats the symptoms of depression, and is often a vital part of the treatment program, but it is essential to treat the psychological problems that caused the depression.
A first person description of Major Depression
"It takes the greatest effort to get out
of bed in the morning. I am tired all day, yet when night comes,
sleep evades me.
I stare at the ceiling, wondering what has happened to my life,
and what will become of me. Nothing is getting done
at work. I have projects to complete, but I can't think. I try
to focus on my work, and I get lost. I keep wondering when
the boss will discover how little I have accomplished. My wife
does not understand. She keeps telling me to "snap out of
it."
I'm irritable all the time, and yell at the kids, then I feel
terrible later. Nothing is fun any more. I can't read, and the
music I used to enjoy so much does nothing for me. I am bored,
but I feel like doing nothing. There are times, when I'm alone,
that I think that life is hopeless and meaningless, and I can't
go on much longer."
Research has shown that cognitive therapy is the an effective treatment for major depression. However, many people respond better to a combination of medication and cognitive therapy. Some respond positively to psychotherapy, but plateau at a mild level of depression without complete recovery from all of the symptoms. Often, these individuals are maintained on antidepressant medication after they have completed psychological treatment. Remember, only physicians are qualified to prescribe medication. Your psychologist will refer you to your primary care physician, or to a psychiatrist, for a medication evaluation, if it appears to be indicated.
Some of the most prominent symptoms of dysthymia are:
• depressed mood for most of the day, for more days
than not, for at least two years.
• difficulties in sleeping.
• difficulty in experiencing pleasure.
• a hopeless or pessimistic outlook.
• low energy or fatigue.
• low self-esteem.
• difficulty in concentrating or making decisions.
• persistent physical symptoms (such as headaches,
digestive disorders or chronic pain) that do not
respond to treatment.
A dysthymic disorder is characterized not by episodes of illness but by the steady presence of symptoms. Because dysthymia does not incapacitate like major depression, as a rule, dysthymic people do well in psychotherapy (although medication can also be used). During stressful times, a person with dysthymia may be catapulted into a major depressive episode, called "double depression."
Dysthymic disorder is a common ailment, affecting about 3-5 percent of the general population. Unfortunately, because dysthymia is not as severe as clinical depression, the condition is often undiagnosed or dismissed as a case of psychosomatic illness.
| • optimism • euphoria • little need for sleep • little need for food • irritability • inflated self concept • grandiose schemes • unrealistic thinking • poor judgment • loss of inhibition • delusional thinking • increased sexual activity |
•
impulsivity • spending large amounts of money • socially inappropriate behavior • heightened sense of awareness • flight of ideas • pressured speech • tremendous energy • enhanced creativity • hyperactivity • feeling that nothing can go wrong • outbursts of anger • alcohol and drug abuse |
When you're high it's tremendous. The ideas and feelings are fast and frequent like shooting stars and you follow them until you find better and brighter ones. Shyness goes. The right words and gestures are suddenly there, the power to captivate others is a felt certainty. Feelings of ease, intensity, power, well-being, financial omnipotence and euphoria pervade one's marrow.
Upon hearing
this description of mania, people often respond, "If this is a
disease, where do I sign up for it?" The problem with mania,
however, is that due to the impulsivity and poor judgment that it
brings, an episode can wreak havoc on family, friends, the community
and the law. Moreover, when the high inevitably wears off, the
individual comes crashing down into a state of total darkness and
despair. As Jamison describes: A floridly psychotic mania was
followed, inevitably, by a long and lacerating black, suicidal
depression. Everything -every thought, word and movement-was an
effort. Everything that once was sparkling now was flat. I seemed to
myself to be dull, boring, inadequate, thick brained, unlit,
unresponsive, chill skinned, bloodless, and sparrow drab. I doubted,
completely, my ability to do anything well. It seemed as though my
mind had slowed down and burned out to the point of being totally
useless.
A well-known myth that perfectly describes the manic depressive's
fall from grace is the myth of Icarus. Icarus, son of the Greek
inventor Daedalus (who built the labyrinth), was given wings of wax
by his father. Enamored of his new found ability to fly to great
heights, Icarus ignored his father's warning and in a moment of
ecstasy flew too close to the sun. The heat of the sun melted the
wax which held his wings together, and Icarus crashed into the sea.
The
alternation of mania and depression illuminates a second aspect of
manic depression-its cyclic nature. Periods of creativity,
productivity and high energy alternate with times of fatigue and
apparent indifference. Mania leads to depression, which leads to
mania which becomes depression, etc. This extreme flip-flop of mood
between peaks and valleys is extremely dangerous, as shown by the
fact that 20 to 25 percent of untreated manic depressives (including
many of the artists listed earlier) commit suicide.
Fortunately,
manic depression is highly treatable, due to the discovery of
lithium, a simple salt that in 1949 was accidentally found to have a
mood-stabilizing effect on bipolar individuals. The downside of
lithium treatment is that therapeutic levels of lithium are
dangerously close to toxic levels. Lithium poisoning affects the
brain and can cause coma and death. Thus, in the initial stages of
treatment, lithium concentration in the blood must be frequently
monitored. After the lithium blood level stabilizes, levels can be
checked every six months.
The side
effects of lithium can include hand tremors, excessive thirst,
excessive urination, weakness, fatigue, memory problems, diarrhea,
and possible interference with kidney function. Lithium is often
ineffective in treating bipolar patients who are rapid cyclers-those
who experience four or more manic-depressive cycles per year. For
these and other patients who fail to stabilize on lithium, the drugs
Depakote and Tegretol (originally anti-seizure medications) are also
available. Some doctors prefer natural lithium (for example;
Symmetry nasal spray) as it is considered safer.
In addition to
taking medication, bipolar individuals can employ a number of
preventive strategies to decrease the likelihood of having a
full-blown manic attack.
1) Recognize the early warning signs of mania-e.g., insomnia, surges
of energy, making lots of plans, grandiose thinking, speeded-up
thinking, overcommitment, excessive euphoria, spending too much
money, etc. Let friends and family know of these symptoms so that
they can also become alerted to the start of a manic episode.
2) Create a stable lifestyle in which you keep regular sleep hours.
Studies show that intervals between manic episodes are considerably
longer in those people who live in stable environments. In addition,
eat a diet that is high in complex carbohydrates and protein,
avoiding foods such as simple sugars that can cause ups and downs.
Alcohol and caffeine should also be avoided.
3) Use planning and scheduling to stay focused and grounded. Make a
list of things to do and stick to it.
4) Try to engage in a daily meditative activity which focuses and
calms the mind. If you are too restless for sitting meditation, go
for a leisurely walk, taking long, deep breaths along the way.
5) Refrain from taking on too many projects or becoming over-
stimulated. If you feel an excess of energy starting to overtake
you, channel it into productive physical activities such as doing
the dishes, mopping the floor, cleaning out the basement, weeding a
garden, etc.
6) Psychotherapy and support groups can help you to explore the
emotional aspects of the illness, as well as provide support during
times of stress.
7) If you feel that things are getting out of hand, call your doctor
or therapist. This is especially true if you start losing sleep, as
sleep deprivation is one of the major contributors to mania.
8) Ask a good friend or family member to track your activity level.
Sometimes a manic episode can "sneak up on you," and an
objective person may be able to spot it before it gets out of hand.
- recognizing and accepting the disorder.
- breaking negative thought patterns.
- creating support systems.
- reducing stressors in one's life.
- exercise and right diet.
- medication (antidepressants and antianxiety drugs).
- psychotherapy.
People with Seasonal Affective Disorder (SAD) tend to experience depressive symptoms during a particular time of the year, most commonly fall or winter. They often begin in October or November and remit in April or May. The symptoms of SAD, also known as "winter depression," are listed below.
- Altered sleep
patterns, with overall increased amount of sleep.
- Difficulty in
getting out of bed in the morning and getting going.
- Increased lethargy
and fatigue.
- Apathy, sadness
and/or irritability.
- Increased
appetite, carbohydrate craving and weight gain.
- Decreased physical
activity.
SAD
is generally believed to be caused by a reduction in
daylight hours which desynchronizes the body clock and disturbs
the circadian rhythms. Treatment is often synergized with
morning exposure to bright sunlight light By providing
appropriately timed light exposure, the body's circadian rhythms
become resynchronized and the symptoms of SAD resolve. It is
important for the person with SAD to get as much natural light as
possible. Here are some suggestions:
- Light up your
homes as much as you need to. Use white wallpaper and
light-colored carpet instead of dark paneling and dark carpet.
- Choose to live in
dwellings with large windows.
- Allow light to
shine through doors and windows when temperatures are
moderate. Trim hedges around windows to let more light in.
- Exercise outdoors.
- Set up reading or
work spaces near a window.
- Ask to sit near a
window in restaurants, classrooms or at your workplace.
- Arrange a winter
vacation in a warm, sunny climate.
- Put off large
undertakings until the summer.
Although the most common form of recurrent seasonal depressions in northern countries is the winter SAD, researchers at the National Institute of Mental Health have uncovered a type of summer depression that occurs during June, July and August. Summer SAD tends to occur more in the southern states such as Florida, as well as in Japan and China. Summer depressives frequently ascribe their symptoms to the severe heat of summer, although in some instances the depressions may be triggered by intense light.
- Endocrine
conditions (hypothyroidism, low adrenals, underperforming
pituitary and or pineal glands, low sex drive, etc . .
.).
- Neurological
disorders such as brain tumors.
- Encephalitis.
- Epilepsy.
- Diseases
that cause structural damage to
the brain.
- Viral
and bacterial infections.
- Inflammatory
conditions such as rheumatoid arthritis and lupus, heart
disease, stroke, diabetes, kidney disease, MS, cancer
- Vitamin deficiencies (especially vitamin B12, vitamin C, folic acid and niacin).
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