Types of depression

Many different terms are used when describing depression, which can make it difficult to understand. These terms often relate to the intensity and duration of symptoms. The term ‘clinical depression’ is used very frequently. All this means is that the depression has been diagnosed by a health professional.

People also talk about reactive and endogenous depression. Depression is said to be reactive if it occurs in response to an event or situation. Sometimes a specific event or situation is easy to identify but often depression is the result of a variety of life events or situations that have occurred over time. This can make identifying the cause(s) extremely difficult, and many people feel like their depression has appeared from nowhere.

‘Endogenous’ means ‘arisen from within’, so when people talk about endogenous depression they are implying that there is no external cause, and that the depression has resulted from biochemical changes. Little is known about why such biochemical changes would suddenly take place and the most likely reasons are illness or injury.

True endogenous depression is thought to be extremely rare, while the overwhelming majority of episodes of depression are a reaction to stressful life events. However, some distinct types of depression have been categorised using the most prominent symptoms and/or causes. These include:

• Atypical Depression
• Bipolar Depression
• Brief Recurring Depression
• Dysthymia
• Post and perinatal depression
• Psychotic Depression
• SAD-Seasonal Affective Disorder
• Treatment-Resistant Depression

The most important thing to remember is that all depression can be managed or overcome with the correct support, treatment and self-help activities.

Atypical Depression

Depression usually involves insomnia and loss of appetite. However, in a minority of cases, depression will involve over-sleeping and over-eating (comfort eating).

Atypical depression is treated in the same way as depression, although additional support may be provided to help with diet and sleeping habits.

Bipolar disorder (manic depression)

Bipolar disorder involves extreme mood swings, from highs of feeling elated to lows of feeling depressed. Thoughts and behaviour are also affected. The severe highs and lows may alternate with periods of stability between them. During a ‘high’ you may feel extremely energetic, be hyperactive and survive on not much sleep. You may have lots of ideas that are unfeasible to carry out or lose touch with reality. During a low you can plunge into the depths of depression and sometimes feel suicidal.

The causes of bipolar depression are not fully understood. Stressful life events and situations as well as physical illness can trigger an episode. Some research has suggested that genetics may also play a part.

Treatment for bipolar depression attempts to alleviate the mood cycle; addressing both the mania and the depression. It may include mood stabilisers, antipsychotic drugs and/or antidepressants alongside talking therapies and self-help techniques.

Brief Recurring Depression

A small group of people experience frequent but short-lived episodes of depression, which can become severe. However, diagnosis is a problem for this group, as the symptoms only last for a few days.

This form of depression affects mainly women, which has led to the suggestion that the episodes are related to the menstrual cycle. However, a small number of men are affected, and there have been suggestions that this may be the result of allergic reactions.

Although much more research is needed into this condition, if you feel that you are affected, you should speak to your doctor.

Dysthymia

Dysthymia is a chronic form of depression that has the same symptoms as depression, but these are often milder.  While Dysthymia may seem less serious than depression, it can be more of a problem because those affected may be more inclined to struggle on alone, and may be less likely to seek formal help. Also, people with Dysthymia are at significant risk of developing major depression if their condition goes untreated.

Talking therapies and self-help are effective for Dysthymia, and antidepressants may also sometimes be used.

Post and perinatal depression

Research has shown that around 10-15% of women develop post-natal depression (PND) in the weeks following childbirth, and a similar number experience depression during pregnancy (perinatal depression). Recent research has suggested that a significant number of men may also be affected.

The causes of PND are not fully understood but pregnancy, giving birth and having a new child are all stressful and life changing events.
Many of the symptoms of PND can be written off as normal feelings associated with giving birth, often called the ‘baby blues’, so PND often goes unrecognised. It is important to be aware of the symptoms of PND and be ready to recognise when help is needed.

Treatments for PND include talking therapies, self-help, and medication.

Pychotic Depression

In a minority of instances, depression can be accompanied by symptoms associated with psychosis, such as delusions, hallucinations, paranoia and sensory distortions. Although psychotic depression is usually thought to be a “severe illness”, psychotic symptoms can accompany mild and moderate depression.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a specific type of depression, which affects 1 to 2 percent of people during the winter months. The onset can be as early as September and can last through to April but is particularly prevalent during December, January and February.

Current research suggests that SAD is the result of a chemical imbalance in an area of the brain called the hypothalamus caused by the shortness of daylight hours and lack of sunshine during the winter months. The link with daylight is confirmed be data showing that cases of SAD increase the further away from the Equator people live.

A diagnosis of SAD can usually be made after three consecutive winters of symptoms.

There are a number of things you can do to treat SAD. Trying to get as much daylight as possible can help. Light boxes have proved to be very effective - you need to sit by a box for around 90 minutes a day to alleviate most symptoms. It is also thought that avoiding too many carbohydrates (bread, pasta, rice, potatoes, etc) can help.

Treatment for SAD can also involve medication, talking treatments and self-help.

Treatment-Resistant Depression

In a small minority of cases, talking therapies and medication may not be effective. These patients will be defined as “treatment resistant”, and will be referred to a specialist mental health team where they can receive a wider range of treatments more intensively. Most treatment-resistant depression is treated in the community, but in some instances attendance at a day unit or a spell in hospital may be required.

Co-Morbid Depression

Because depression usually occurs in response to major life events, people with other mental and physical illnesses may also become depressed.

It is essential that co-morbid depression is treated, because depression can have a negative impact on other conditions and is also a major cause of physical illnesses such as cancer, type-2 diabetes, heart disease and strokes.

Alcohol, Drugs and Depression

Persistent alcohol and/or drug use can cause depression, or cause depression to become more severe. This is a particular problem where people seek to “medicate” their depression with these substances – often this amounts to trading your long-term well being for a temporary quick-fix.

People with alcohol and/or drug problems may also experience depression as a result of their condition and situation. It is essential that this co-morbid depression is properly treated.