9 Types of Depressive Disorder
There are many types of depressive disorders, each of which contains a multitude of symptom patterns and representations.
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.
Types of Depressive disorders
• Major depression
• Post-partum depression
• Seasonal affective disorder (SAD)
• Existential depression
• Mood disorders due to a medical condition
• Medication-induced depression
• Substance-induced mood disorder
The most severe category of depression, major depression can result from a single traumatic event in your life, or may develop slowly as a consequence of numerous personal disappointments and life problems. Some manifest this form without any obvious life crisis.
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.
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.
Though far less severe, this type of depression is crippling in its own way. Dysthymia is the long-term, chronic form of depression whose symptoms do not disable, but keep one from feeling good enough to functioning optimally. It is like a chronic low-grade infection. One never develops the full-blown illness, but always feel a little run down.
Although dysthymia implies having an inborn tendency to experience a depressed mood, it may also be caused by childhood trauma, adjustment problems during adolescence, difficult life transitions, the trauma of personal losses, unresolved life problems, and chronic stress. Any combination of these factors can lead to a enduring case of the blues.
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.
Though less common than major depression, bi-polar depression maintains a high profile because of the many creative artists who have suffered from it. They include; Edgar Allen Poe, Tennessee Williams, Ezra Pound, Virginia Woolfe, Vincent Van Gogh, Alfred Tennyson, Cole Porter and Robert Schumann. In recent times, celebrities such as Abbie Hoffman, columnist Art Buchwald, actress Patty Duke, actress Margot Kidder, the self-help guru Peter McWilliams, and CNN's Ted Turner have also been similarly afflicted.
Manic depression has two distinct sides-the depressive state and the manic state. Mania is a seemingly heavenly state of mind in which all the world is beautiful and everything seems possible. Here are some of the most common characteristics of mania:
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.
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
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.
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.
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.
Cyclothymia is a milder form of manic depression, characterized by hypomania (a mild form of mania) alternating with mild bouts of depression. The symptoms are similar to those of bipolar illness but less severe. Many cyclothymic disorder patients have difficulty succeeding in their work or social lives since their unpredictable moods and irritability create a great deal of stress, making it difficult to maintain stable personal or professional relationships.
Cyclothymic persons may have a history of multiple geographic moves and alcohol or substance abuse. Nevertheless, when their creative energy is focused towards a worthwhile goal, they may become high achievers in art, business, government, etc. (The cycles of cyclothymia are far shorter than in manic depression.) The ability to work long hours with a minimum of sleep when they are hypomanic often leads to periods of great productivity.
If you identify with the diagnosis of cyclothymia, you may use the wellness strategies described for manic depression to elevate and stabilize your mood. If your highs and lows begin to intensify, seek treatment with a psychiatrist or mental health professional.
Many women experience a type of emotional disturbance or mental dysfunction after giving birth called Postpartum depression. Commonly known as "Baby blues" this form is characterized by grief, tearfulness, irritability and clinging dependence. PPD has been ascribed to the woman's rapid change in hormonal levels, the stress of childbirth, and her awareness of the increased responsibility that motherhood brings.
In some cases, PPD may take on a life of its own, lasting weeks, months and even years. When this occurs it may appear very much like a major depressive disorder. Occasionally accompanied by anxiety and panic, in extreme cases, symptoms may include psychotic features and delusions, especially concerning the newborn infant. There may be suicidal ideation and obsessive thoughts of violence to the child.
It is estimated that approximately 400,000 women in the United States experience postpartum depression, usually six to eight weeks after giving birth. Postpartum depression is a treatable illness that responds to the following modalities:
Seasonal Affective Disorder (Winter depression)
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.
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:
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.
Existential depression is thought to be brought on by a crisis of meaning or purpose in one's life. Any significant transition, especially a change of roles in family or work, can trigger this crisis in meaning. A well-known account of existential depression occurred in the life of the famous Russian novelist Leo Tolstoi. In mid-life, while enjoying health, wealth, and great literary fame, Tolstoi fell into a deep despair as he asked himself, "Is this all there is?" Out of his quest for something more, Tolstoi underwent a religious conversion and formulated a philosophy of nonviolence, renunciation of wealth, self-improvement through physical work, and nonparticipation in institutions that created social injustice. Tolstoi's ideas had a profound influence on many social reformers, including Mahatma Gandhi and Martin Luther King, Jr.
The importance of dealing with existential issues should not be underestimated. A number of clinicians have reported that depression (as well as Chronic Fatigue Syndrome) has a strong connection with a person's lack of success in finding his passion-i.e., not being involved in work/activities that feed the core self. After all, Sigmund Freud defined mental health as "the ability to work and to love." If either of these two essential needs is missing, even a person with normal brain chemistry is going to feel out of kilter.
Clinical depression commonly co-occurs with general medical illnesses, though it frequently goes undetected and untreated. While the rate of major depression in the community is estimated to be between 2-4 percent, among primary care patients it is between 5-10 percent. For inpatients, the rate increases to between 10-14 percent.
Treating the co-occurring depressive symptoms can improve the outcome of the medical illness while reducing the emotional and physical pain and disability suffered by the patient. Here are some medical conditions that have been implicated as triggering depressive symptoms:
Anyone who suffers from one of these disorders should treat the underlying illness medically and pursue psychotherapy or counseling if depression accompanies the physical illness.
Substance-Induced Mood Disorder
Depressed individuals are more likely to use alcohol and other drugs to "self medicate" their feelings. Ironically, alcohol and other drugs are likely to exacerbate feelings of depression, as they have shown a tendency to mitigate our production of serotonin, the well known feel good neurotransmitter. This is know as dual diagnosis.
Though a dual diagnosis is somewhat more complicated, (One has to overcome two major illnesses in order to get well), there are many outpatient and resident treatment centers that specialize in treating individuals with this affliction. Moreover, these centers are often covered by insurance and are able to offer long-term treatment. Check with your local hospital or mental health clinic to learn who offers dual diagnosis treatment in your area.