It’s not uncommon for people to use the term “clinical depression” as if there is only one type. What most people don’t realize is that, just like anxiety, there are several different types of depression. While the majority of symptoms overlap between these various types of depression, they are still distinct diagnoses, each with their respective criteria.
The differences in the different types of depressive disorders may pertain to severity of symptoms, co-occurring symptoms, precipitating events, and other related factors. Understanding the difference is important because the treatment should correlate with these other factors. In other words, treatment for each type of depression is not a “one-size-fits-all” endeavor.
Following are descriptions of the most common types of depression: Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder with Depressed Mood, Seasonal Depression
Major Depressive Disorder (MDD)
Major depressive disorder afflicts millions of individuals. Its onset is often sudden, although it can be gradual. A key aspect of this type of depression is that the symptoms, which can be anywhere from mild to severe, must occur for at least a two-week period. They can, and often do, persist for much longer periods of time.
MDD can be a one-time event in a person’s life, but in many cases the episodes are recurrent. An individual with MDD must have at least 5 of the following symptoms, which occur almost daily and either cause significant distress or interfere with functioning:
- Depressed mood
- Loss of interest or pleasure in most or all activities
- Significant weight loss (without dieting) or weight gain, or change in appetite
- Insomnia or hypersomnia (sleeping excessively)
- Physical agitation or feeling slowed down
- Loss of energy
- Inappropriate guilt or feelings of worthlessness
- Difficulties thinking, concentrating, or making decisions
- Frequent thoughts of death or suicide, or a suicide attempt or plan
MDD can be caused by different things, but is most likely due to a combination of factors including genetic predisposition, hormones, brain chemistry imbalances, irrational thought patterns, and / or environmental factors such as stressful life events.
Treatment for MDD typically includes either psychotherapy or medication, or a combination of both. Cognitive behavioral therapy is one of the best types of therapy for MDD.
Dysthymia is different than MDD in that the symptoms are generally less severe, and must be present for at least two years. Symptoms often persist for many years if not treated.
In addition to depressed mood most of the time, a person must have at least 2 of the following symptoms for dysthymic disorder:
- Low appetite or eating too much
- Sleep problems – insomnia or hypersomnia
- Low self-esteem
- Low energy or fatigue
- Sense of hopelessness
- Problems with concentration or decision making
The potential causes and treatment for dysthymia are essentially the same as for MDD.
Bipolar Disorder with Depressed Mood
Sometimes referred to as bipolar depression or manic depression, this type of depression is the same as MDD, except that the person has a history of at least one manic episode or one hypomanic episode. Both mania and hypomanic are characterized by symptoms that include an unusually high level of energy, very limited need for sleep, grandiosity, and engaging excessively in activities that are highly pleasurable.
With bipolar disorder, the depressive episode often occurs soon after a manic (or hypomanic) episode.
Bipolar disorder seems to have a strong genetic component. Manic and hypomanic episodes are often triggered by stress. They may also be triggered by antidepressant medications as well as other medications.
Treatment for bipolar disorder often involves ongoing use of mood stabilizers (for mania and hypomania), as well as antidepressant medication. Psychotherapy is also an important part of effective treatment.
Although not an official clinical term, seasonal depression is part of Seasonal Affective Disorder (SAD). This diagnosis is given when major depressive episodes (or bipolar episodes) occur with a regular seasonal pattern.
For many individuals, seasonal depression coincides with the winter months. This may be due to hormonal changes associated with changes in the seasons, as well as the psychological impact of gray, dreary weather. However, some people have the opposite pattern, with their depressive episodes coinciding with spring or summer.
Treatment for this type of depression typically includes phototherapy (light therapy), psychotherapy, and / or medication.
Postpartum depression – sometimes referred to as the “baby blues” often involves the same symptoms as MDD, but the precipitating event is recent childbirth. The symptoms start within a month after the baby is born. The exact causes of postpartum depression are not known, but are likely a combination of hormonal changes and other physical changes associated with childbirth, emotional factors (e.g. feeling overwhelmed by the responsibility of a new baby), and stressors related to having a new baby (e.g. exhaustion from lack of sleep or not having a supportive partner).
In severe cases, a woman with postpartum depression may become psychotic. This means she has essentially lost touch with reality, and may be experiencing delusions (e.g. believing her children are evil and must die) or hallucinations (e.g. hearing voices telling her to harm herself or others). Andrea Yates, the woman who drowned all 5 of her young children in 2001 just a few weeks after having her 5th child, was believed to have postpartum depression with psychosis.
The treatment more postpartum depression may include psychotherapy, medication, and hormone therapy. When psychosis occurs, hospitalization is necessary.
Adjustment Disorder with Depressed Mood
Life is full of stressful events. While many people manage to handle them reasonably well, some individuals become depressed due to the significant event. Their symptoms are problematic enough to interfere with their life or cause a higher than expected amount of distress, but don’t meet the criteria for major depression. Hence, the term “adjustment disorder”, because the person is having a difficult time adjusting to the situation.
Many people who develop this type of adjustment disorder have experienced a painful loss, such as the end of a significant relationship. The disorder may be caused by one event or several events. In some cases, anxiety or behavioral issues (such as acting out) may also occur with the depression.
Psychotherapy is generally the best treatment for an adjustment disorder. However, short-term medication may also be beneficial if needed.
As you can see, the symptoms of each of these types of depression have significant overlap. Yet, they each have distinctive differences. Although psychotherapy and / or medication are part of the treatment for each of these types of depression, the type of medication as well as the type of (or focus of) psychotherapy is often different. Additional therapies (e.g. light therapy) may be necessary as well, which is why understanding the type of depression is particularly important when it comes to determining the most effective treatment.
If you or a loved one is struggling with symptoms of depression, it’s important to have an evaluation by an experienced mental health professional. From there, the best course of treatment can be determined. In most cases, treatment is very beneficial and will significantly improve your life.