Disorders of the mind are often hard to quantify or fit into a box. What is completely soul-crushing to one person can feel like “just the blues” to another. It can even be hard to admit you may be suffering from some form of depression yourself.
When anyone is diagnosed or treated for depression, it is categorized as unipolar or major depression. And this can be broken down into more specific types of depression.1 The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, defines and details the different categories of depression. The DSM is used as the guideline for research and treatment in the United States.2
Most symptoms of depression begin gradually. In fact, it can take a while before someone realizes that something is wrong. Symptoms of major depression range from feelings of sadness and hopelessness to a growing lack of interest in things that were once enjoyable. Some of the psychological symptoms of depression include feelings of guilt, irritation, low self-esteem, lack of motivation, and even thoughts of suicide. Physical symptoms include a lack of appetite, constant fatigue, sleeping problems, irregular menstrual cycles, and various aches and pains. Social symptoms of depression include problems at work, lack of interest in social activities, and problems with family and friends.
Mild, Moderate, And Severe Depression
Depression varies in severity from mild to severe forms.
With mild depression, a person may have just the minimum number of symptoms, say two or three, required for a doctor to make the diagnosis. What they’re feeling may not be overpowering but it still affects their quality of life. The person continues with their usual activities, but with a lot of effort.
With moderate depression, the severity of the symptoms is a little higher, and the person invariably has difficulty functioning normally.
With severe depression, a person experiences almost all the symptoms. They are nearly unable to lead a normal life. Going to work, taking care of children, or even leaving the home is a huge effort or may feel impossible.
Specific Types Of Depression
Major depression can be further categorized into more specific types, some of which we discuss here.
A person with dysthymia will feel mildly depressed for years. They will often feel down, fatigued, and upset, though not enough to become debilitating. This form of depression can last for a few years before it is diagnosed.3
According to the American Psychiatric Association, a person with dysthymia feels mildly depressed most of the time for around two years. They also have at least two of the following symptoms:
- Fatigue or low energy
- Low self-esteem
- Overeating or a poor appetite
- Indecisiveness or poor concentration
- Insomnia or excessive sleep
- A feeling of hopelessness
Dysthymia often runs in families. There is almost a 50% chance that more than one family member will show signs of dysthymia. It comes on gradually and is rarely linked to any one life-altering event. About 75% of dysthymia patients usually have some kind of chronic illness or psychiatric disorder such as alcoholism, drug addiction, or anxiety.4
2. Bipolar Depression
Depression arising from bipolar disorder is called manic depression. A person with this disorder experiences phases of “mania” and “depression.” In the manic phase, the person may be unusually peppy and feel on top of the world. When depressed, they may feel completely devastated and that they don’t deserve to live.5
The symptoms of bipolar disorder are far more severe and different from the normal ups and downs of everyday life. They are so severe that people can damage relationships, perform badly at work or school, or even attempt suicide. Some people may start using drugs, drink excessively, or take sleep medications. A manic mood is diagnosed when this “different” behavior lasts for a week or more. Sufferers can also develop psychotic symptoms such as hallucinations and delusions. The psychotic symptom usually reflects whatever extreme mood state the person is going through.6
Some people have a version of bipolar disorder called cyclothymic disorder, where a milder form of mania and depression sets in and lasts several years.7
3. Postnatal Depression
Many people confuse the baby blues with postnatal depression. Nearly 80% of all new moms have the baby blues. As their hormones readjust, they will feel sad or experience mood swings. This should settle on its own in a few days’ time.8 In some cases, however, these “blues” can progress into full-on depression, accompanied by hostile feelings toward the newborn. In extreme cases, the patients may have thoughts of harming themselves or their newborn.9
A more severe but rare form of postnatal depression is postpartum psychosis. It hits suddenly, within two to three week of delivery. There appears to be a loss of touch with reality. Other symptoms can include hallucinations or delusions, suicidal thoughts, mood swings, thoughts of harming the baby, and periods of hyperactivity. Postpartum psychosis requires immediate treatment and should be treated as an emergency.10
4. Psychotic Depression
If we were to look at just the symptoms, this is the most extreme form of depression. Not only does the patient present all symptoms of depression, they also have psychosis, which involves delusions or hallucinations that confirm their feelings of guilt or worthlessness. Such people may even “hear” nonexistent people talking down to them.11
5. Seasonal Affective Disorder
A person may experience Seasonal Affective Disorder (SAD) when they don’t get enough exposure to daylight. This can be especially prevalent in regions where the sun sets as early as late afternoon in the winter. Sometimes referred to as “winter depression,” SAD often disappears in spring and summer.12 People may experience increased sleep and weight gain, and may feel less inclined to socialize. When these feelings repeat each year, the person may be diagnosed with SAD.13
6. Premenstrual Dysphoric Disorder
Premenstrual Dysphoric Disorder (PMDD) is a very extreme form of premenstrual syndrome (PMS), in which the suffering woman may experience anxiety and severe depression a few days before her menstrual period. The severity of PMDD symptoms is far more intense than those of PMS.
Symptoms of depression are generally found to be worse in the second half of the menstrual cycle. In fact, suicidal tendencies and suicides among women with depression are more likely to happen during this time. PMDD may also be associated with eating disorders and smoking.
The reasons for PMDD are unknown, although hormones are believed to play a role. Cutting out alcohol and caffeine, eating healthy, and exercising regularly can help alleviate the symptoms of PMDD.14
7. Adjustment Disorder
Commonly known as situational depression, this form of depression occurs when a person has a hard time coping with a major change. Any difficult life event, like losing a family member or dealing with financial struggles, can cause adjustment disorder.
Symptoms will typically show up within three months of the event and can include crying, nervousness, twitching, or showing defiance.15
8. Atypical Depression
This form is called “atypical” because the symptoms and treatment are not quite like those of other forms of depression. In atypical depression, people often exhibit increased sleep and appetite and may feel heaviness in the legs and arms. They are also extremely sensitive to rejection and may avoid social situations for this reason.
While tricyclic antidepressants are often used to treat moderate to severe depression, atypical depression requires another type of antidepressant called monoamine oxidase inhibitors, prompting the belief that a different part of the brain is affected in this form of depression.16
9. Substance-Induced Mood Disorders
Cocaine, opioids, nicotine, and even everyday substances such as caffeine and alcohol can cause mood disorders in some people. The only way to distinguish between this disorder and other forms of depression is by studying what lifestyle changes a person has made in the past months.
Treatment naturally involves eliminating the offending substance and waiting for results. In case of addictive substances such as nicotine and drugs, counseling may be required.17
The Road To Recovery
Antidepressant medication, of which there are many types, is often prescribed for treating various forms of depression. Antidepressants work by affecting the neurotransmitters or brain chemicals that regulate our moods.18 While these medicines are helpful for managing symptoms, they may not, by themselves, help resolve the issue. However, this doesn’t mean a person should stop taking their medication in favor of an alternative treatment. They must always use one in conjunction with the other.
Treatment Comes In Many Forms
Mild depression: Patients with symptoms of mild depression are usually advised to wait and be vigilant of their symptoms, which will often go away on their own. They may be advised to exercise, which can boost their mood naturally, or to talk out their frustrations, either with someone they are comfortable with or by joining a self-help group.19
Mild to moderate depression: These symptoms can usually be treated with talking therapy, including cognitive behavioral therapy and counseling.20
Moderate to severe depression: Doctors usually prescribe antidepressant medication for those experiencing symptoms of moderate to severe depression. Doctors may also combine medication with talking therapy such as cognitive behavioral therapy. Severe cases may also be referred to mental health teams comprising psychiatrists, psychologists, specialist nurses, and occupational therapists.21
Fighting Depression With Alternative Treatments
Aside from medication, these alternative or complementary steps can help alleviate symptoms of depression.
In cognitive behavioral therapy, therapists work to resolve and reshape the negative thought patterns governing the patient’s life. The patient learns to question negative thoughts and understand the effects on their emotional health, and works on ways to alter these self-defeating patterns.22
Counseling aims to help patients face their problems and find ways to deal with them. As a form of therapy, counseling is best for people who are generally healthy but need help coping with a current crisis.23
Regular exercise and physical activity can be very effective in dealing with major depression and anxiety. In fact, studies indicate that exercise can play a role in the clinical treatment of panic disorder and major depression. Clinical use is still in the early stages, though.24
Low levels of vitamin B12 and folic acid and high levels of plasma homocysteine are common symptoms of most types of depression. Check with your doctor about these deficiencies and take the necessary supplements.25
In Ayurveda, extracts of ashwagandha (Withania somnifera) have been found to have antidepressant effects. However, you must be careful to take them in the prescribed dosage and form, as herbs may have side effects.26
Aromatherapy with rose and lavender essential oils has been found to be a safe, non-intrusive method of helping with postnatal depression. A month-long study tested the effects of the oils on 28 women who had delivered a baby in the past 0-18 months. All the subjects showed significant improvements in symptoms without any adverse effects.27
Whatever the mode of treatment advised, it is important to follow through on your doctor’s advice. Stopping medication or other treatment paths may only aggravate the situation. If you or someone you know is suffering from depression, get help immediately. Often, timely intervention can save and change a person’s life.
|↑1||Bipolar Depression vs. Unipolar Depression. ULifeline.|
|↑2||Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association.|
|↑3, ↑5, ↑7, ↑9, ↑11, ↑13||Depression. National Institute Of Mental Health.|
|↑4||Dysthymia. Harvard Health Publications.|
|↑6||Bipolar Disorder. National Institute Of Mental Health (DHHS). 2001.|
|↑8, ↑10||Baby Blues. American Pregnancy Association.|
|↑12||Seasonal affective disorder (SAD). NHS, U.K.|
|↑14||Premenstrual dysphoric disorder. U.S. National Library Of Medicine.|
|↑15||Adjustment disorder, U.S. National Library Of Medicine.|
|↑16||Singh, Tanvir, and Kristi Williams. “Atypical depression.” Psychiatry (Edgmont) 3, no. 4 (2006): 33-39.|
|↑17||Sacks, Stanley, Richard K. Ries, and Douglas M. Ziedonis. “Substance abuse treatment for persons with co-occurring disorders.” (2005).|
|↑18||Depression: FDA-Approved Medications May Help. FDA.|
|↑19, ↑20, ↑21, ↑23||Treating clinical depression. NHS, UK.|
|↑22||Psychotherapies. National Institute Of Mental Health.|
|↑24||Ströhle, Andreas. “Physical activity, exercise, depression and anxiety disorders.” Journal of neural transmission 116, no. 6 (2009): 777-784.|
|↑25||Coppen, Alec, and Christina Bolander-Gouaille. “Treatment of depression: time to consider folic acid and vitamin B12.” Journal of Psychopharmacology 19, no. 1 (2005): 59-65.|
|↑26||Bhattacharya, S. K., A. Bhattacharya, K. Sairam, and S. Ghosal. “Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study.” Phytomedicine 7, no. 6 (2000): 463-469.|
|↑27||Conrad, Pam, and Cindy Adams. “The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman–a pilot study.” Complementary therapies in clinical practice 18, no. 3 (2012): 164-168.|