When most people think about depression, it’s likely that they are only imagining a single diagnosis. But it’s often much more complicated than that. Not only is every case of depression individually unique, but there are different types of depression that require different treatments and a wholly different approach due to certain considerations and differences from type to type.
Depression is more than a single face or a set of symptoms, it’s a spectrum of symptoms with a large variety of possible causes and reasons, all of which are taken into consideration when alleviating a patient’s symptoms. To understand depression, it’s important to differentiate the disease from the feeling, and it’s important to recognize that depression is not a state of mind or an emotion, but a mental illness with a specific set of characteristics.
Depression and Depressive Symptoms
When people speak about depression, most of them refer to major depressive disorder. As far as we know, this is the most common form of depression, and the broadest. Major depressive disorder can have a variety of different causes and is characterized by a consistently and severely low mood for at least two consecutive weeks, absent other symptoms or possible causes that might categorize the depression as another type.
Rather than just sadness, depression is a disorder that causes an individual to exhibit and experience an abnormal mood disconnected from reality, in the sense that nothing must trigger the negativity inherent in depression. The symptoms arise on their own, sometimes in the form of episodes that wax and wane.
As part of a greater network of disorders, major depressive disorder is the first and most common in a series of illnesses categorized as mood disorders. Mood disorders are conditions characterized by abnormal changes in a person’s mood, most often depressive symptoms, or manic symptoms.
Previously known as manic depressive disorder, a bipolar disorder is characterized by periods of depression and/or mania. These periods typically last several weeks to several months. A person with bipolar disorder typically only experiences two cycles a year, with manic episodes towards the early months of the year and/or fall, but experiences also vary extremely. A person’s episodes or ‘phases’ may only last days, or an entire year.
Contrary to popular belief, bipolar disorder is not necessarily characterized by wild and sudden mood swings. ‘Rapid cycling bipolar’, which is a form of bipolar disorder that features faster mood swings than normal, is diagnosed if a person experiences more than four different episodes in a year. Sometimes, a person with bipolar disorder may experience a mixed state wherein they are going through both mania and depression at the same time, rather than switching wildly.
Bipolar disorder is typically split into different subtypes, depending on a person’s episodes. An episode is usually either characterized by symptoms of depression, symptoms of mania, symptoms of hypomania, or a mixed state.
Persistent Depressive Disorder
Previously diagnosed as dysthymia, persistent depressive disorder is a chronic depression characterized by milder symptoms, lasting at least two years. Unlike major depressive disorder or other forms of depression, persistent depressive disorder has less acute depressive symptoms, including problems with productivity, low self-esteem, and general apathy, but no thoughts of self-harm, suicidal ideation, or other signs of severe depression.
It’s important to note that cases of chronic depression are not always persistent depressive disorder. Other depressive disorders can also become chronic, in the sense that they are ongoing for a significant period or recurring despite treatment.
Seasonal Affective Disorder
Characterized by depressive symptoms tied to the turning of the seasons, most cases of seasonal affective disorder occur in the winter in countries with temperate climates, which is why it’s also known as winter depression. Potentially caused by several things, seasonal affective disorder is often exacerbated by a lack of sunlight over the winter months, combined with a general poor diet of the holidays, the stress of dealing with the social and financial pressures of the holiday season, and the physical and mental effects of stress eating. Other potential factors include binge drinking, increased work obligations leading up to or during the holiday season, poor sleep, the stress of shopping, and more.
Treatments for seasonal affective disorder often include light therapy, wherein a person is exposed to artificial sunlight early in the day using a lightbox to help the brain maintain a regular circadian rhythm, as well as alleviate some of the health risks associated with a lack of sunlight. Therapy and stress management techniques will often address issues caused by the negative side of the holiday spirit.
Characterized by depressive symptoms occurring before or after labor, peripartum depression is also known as postpartum depression and affects roughly 10-20 percent of mothers and expecting mothers. Different from well-known “baby blues” which affect up to 80 percent of mothers, peripartum depression is characterized by severe depressive symptoms including feelings of hopelessness and total emotional withdrawal, frequent bouts of anxiety, thoughts of self-harm or harm directed at the baby and avoiding the baby/having trouble forming a bond with the baby.
Premenstrual Dysphoric Disorder
A more severe form of premenstrual syndrome, PMDD is a collection of depressive symptoms occurring in tandem with the premenstrual phase of a woman’s cycle. PMDD may occur on its own, or it may be diagnosed with a separate case of anxiety and/or depression.
PMDD is often chronic and occurs in about 5 percent of women. Symptoms are often severe enough that they can negatively impact relationships, work responsibilities, and other daily tasks. Aside from severe depressive symptoms including suicidal ideation, irritability, self-esteem problems and severe fatigue, a woman with PMDD may also experience physical symptoms (including cramps, muscle pains with no identifiable origin, nausea, and bloating), as well as skin issues, fainting, and more.
More Than One Treatment
Antidepressants are often the first line of treatment against depressive disorders, but they are meant to help relieve symptoms enough to help a patient make progress in their lives to prevent or combat depressive symptoms in the future, including making lifestyle changes and seeking alternative ways to deal with the stresses of depression. In some cases, antidepressants are crucial for daily function and a patient will have to take them for years, decades, or a lifetime.
However, medication does not always work. Alternative treatments to address depressive symptoms and help alleviate them enough for other treatments to begin to do work include treatments such as transcranial magnetic stimulation. Depression is not something that can be cured with a single treatment, however. A multimodal approach is needed in most cases to effectively treat someone, and often, that treatment means helping a person manage their disorder and live a fulfilling life despite it, rather than sending it into complete remission. While we have learned much about depression in the past few decades, there is still much to understand, including its complex origins and the neurobiology of the condition.