Understanding Types of Depression

Classifying major depression disorders can help chart a patient's treatment course.

By Dr. Sanjay Gupta

Everyone knows what it means to feel down in the dumps once in a while. But nearly 15 million American adults live with major or chronic depression, which disrupts their ability to work, sleep, eat, and enjoy themselves.

“Major depressive disorder impairs daily functions,” said Kristin Kuntz, PhD, assistant professor of clinical psychiatry at Ohio State University. “If someone’s feeling depressive symptoms but they’re able to go to work and maintain relationships, or if they say ‘I’ve been feeling down but trying to keep my spirits up and do other things,’ that’s not major depressive disorder.”

Up to 90 percent of people diagnosed with major depressionrespond well to treatment. Understanding the characteristics of a patient’s depression can help determine the best course for managing it. “Classifying different types of depression may give you an idea of what the course of the disease will be like,” said Kuntz. “The diagnosis guides treatment, and having that specific type guides us toward the best treatment.”

Defining types of depression can be tricky. “It’s not as easy to divide up mental conditions as it is for physical ones,” said Simon A. Rego, PsyD, a cognitive and behavioral psychologist at Montefiore Medical Center. The hope is that “further refinement [of these definitions] might lead to customized intervention” for each patient.

“We’re trying to make a diagnostic manual for the mind just like we make diagnoses for diseases of the body,” said Rego.

The following are some common types of depression.

Dysthymia, or persistent depressive disorder, “is a milder yet longer form of depression,” said Rego. Though its symptoms are less severe than typical major depressive disorders, they persist for more than two years. Low self-esteem, loss of interest in daily activities, sleep problems, and poor appetite or overeating are common symptoms. “If someone gets diagnosed with a chronic illness while suffering from dysthymic disorder, that can also exacerbate the symptoms,” said Kuntz.

Postpartum depression is a disorder that affects as much as 15 percent of new mothers. Much more serious than the “baby blues” many women experience after giving birth, postpartum depression is marked by intense feelings of sadness, guilt, and anxiety. It usually sets in within the first month or two of giving birth, but can develop a year later.

“It can creep up,” said Jacqueline Gollan, PhD, associate professor in psychiatry and behavioral sciences at Northwestern University. “It can be lovely and wonderful to have these babies, but many women feel on their own in some ways. They think, ‘I should be feeling happier about this, and I’m not.’”

Women with postpartum depression can have harm obsessions – “not self-harm but extreme worry about harming the baby,” said Gollan. “They get very scared that they have that capacity and don’t talk to their partners about this.”

Research suggests that social support during pregnancy can reduce the risk for postpartum depression. A study this year in the journal Clinical Psychological Science found that pregnant women with strong social support networks had lower levels of a certain stress hormone — pCRH (placental corticotropin-releasing hormone) — which made them less likely to develop postpartum depression.

Seasonal Affective Disorder (SAD) usually strikes in the fall and winter when daylight hours are shortest – though it does rarely occur in the spring-summer months. Less exposure to light results in lower levels of serotonin, a brain chemical that affects mood; while darkness triggers production of the hormone melatonin, which promotes sleep.

As a result, millions of Americans experience mild to severe SAD symptoms that include feelings of depression, anxiety, loss of energy, and difficulty concentrating.

“Particularly for those with seasonal affective disorder, the timing or the pattern of the depression has major implications for treatment,” said Kuntz. With patients who have fall and winter SAD, “we know they’ll be fine once March or April rolls around, and doctors will tailor medications to that cycle.”

Other types of depression include:

• Melancholic depression, which “represents an extreme loss of pleasure, the decimation of it,” said Rego. “It’s a loss of pleasure in just about all activities.”
• People with atypical depression can be temporarily cheered up, but the depression returns. Symptoms include oversleeping, weight gain, and extreme sensitivity to social rejection. “It’s kind of the opposite of melancholic, in that these people do show mood reactivity,” said Rego.
• Psychotic depression, one of the most severe forms of major depressive disorder, involves delusions or hallucinations. Patients suffer from insomnia, hypochondria, and anxiety, and have a much higher risk of suicide.
• Catatonic depression is marked by excessive, involuntary physical movement or inactivity where the person remains still as if paralyzed. According to Rego, it’s usually associated with severe psychotic disorders like schizophrenia.

Definitions like these can help doctors form an initial diagnosis and treatment plan. But managing major depression is an ongoing process that’s different for every patient.

“Even though we classify depression, the diagnosis may change as you treat them. They can lose or gain symptoms that could change how we define and treat them,” said Kuntz. “You can’t look at the diagnosis in a vacuum, you have to look at the patient’s entire history and experience.”