According to the National Institute of Mental Health, about 16 million American adults suffer from depression every year. Although we typically talk about depression as if it were one condition, it is actually an umbrella term that includes many related conditions. It may be helpful to know something about these different subtypes, since they often have different symptoms and require different kinds of treatment.
A single depressive episode is the most common form of depression. It is typically caused by some major life stress, such as the death of a loved one, a divorce, or losing a job. What begins as stress or grief eventually turns into an episode of major depression, lasting anywhere from a few weeks to a several months. Symptoms include sadness, loss of motivation, hopelessness, fatigue, poor concentration, aches, sleep disturbance, and thoughts of death or suicide. These symptoms must persist for at least two weeks for a diagnosis of depression. People who get help for an episode of major depression typically don’t experience another episode.
If you’ve had two or three episodes of major depression, there’s a good chance it might become recurrent. With recurrent depression, and episode may begin for no particular reason. Typically, these episodes happen regularly, every 18 months or so. A form of psychotherapy called mindfulness based cognitive therapy, or MBCT has been shown to be especially effective for people with recurrent depression.
There are several features that make atypical depression atypical. First, positive events may temporarily lift the depression, whereas with typical depression, things you would normally enjoy are just gray and bland like everything else. Atypical depression also increases your appetite instead of reducing it, which might lead to weight gain.The other feature that distinguishes atypical depression is that it tends to make you sleep a lot, whereas depression typically causes insomnia or waking up in the middle of the night.
Dysthymia is a long lasting, low intensity form of depression. Whereas a normal depressive episode may last several months, dysthymia lasts two years or more. Although it lasts longer, the symptoms are not as intense. Instead of feeling intensely bad for a few weeks or months, people with dysthymia feel pretty bad for years. In fact, they often forget what it’s like to feel good and assume their mildly depressed mood is normal. There is also a condition called double depression, which is when people with dysthymia suffer an episode of major depression. Someone suffering double depression needs treatment for both the depressive episode and the underlying dysthymia.
Bipolar disorder is often mistaken for unipolar depression. It is misdiagnosed in more than half of cases and it takes an average of 10 years to get the right diagnosis. People with bipolar disorder experience episodes of major depression and manic or hypomanic episodes, which are characterized by feelings of grandiosity, paranoia, abundant energy, little need for sleep, and reckless behavior. These intense manic episodes are particularly characteristic of bipolar I, whereas bipolar II typically features milder, hypomanic episodes that might be mistaken for a good mood. Bipolar disorder requires different medication from unipolar depression. It is typically treated with a combination of an antidepressant and a mood stabilizer.
Psychotic depression is a severe form of depression that can occur in people with both unipolar and bipolar depression. People with psychotic depression suffer from delusions and sometimes hallucinations. These delusions tend to be related to intense feelings of worthlessness, exaggerated feelings of guilt, and fears of financial ruin or disease. These delusions persist in the face of contradictory evidence. Often, people with psychotic depression have to be institutionalized. Because they are out of touch with reality, they are often a danger to themselves. Psychotic depression is typically treated with antipsychotic medication in addition to antidepressants and psychotherapy.
Seasonal affective disorder
Seasonal affective disorder, or SAD, is a form of major depression triggered by a change of seasons. Most people experience SAD in the fall or winter months, probably triggered by lower levels of sunlight. In addition to the regular symptoms of depression, people with winter SAD often experience the atypical symptoms of excessive sleep and increased appetite. Some people also experience summer SAD, which is characterized by insomnia, loss of appetite, and anxiety or agitation. Summer SAD seems to be caused by excess sunlight, which disrupts the circadian rhythm. People with bipolar disorder are especially sensitive to disruptions in their circadian rhythms and are therefore more vulnerable to both summer and winter SAD.
Postpartum depression affects about one in seven new mothers. While many women experience the “baby blues” after giving birth, postpartum depression is more severe, a full episode of major depression. Pregnancy and childbirth cause massive changes in hormones which affect mood and energy. On top of that, giving birth is physically traumatic and women have to recovery while sleeping erratically. Having a child creates new responsibility and financial stress, which may aggravate an already low mood and feeling overwhelmed. These feelings are often compounded by the new mother feeling like she should be happy about her new baby and guilt that she isn’t. Postpartum depression is one reason depression rates are higher among women. However, new dads can experience postpartum depression as well. They are also affected by the stress and lack of sleep caused by a new baby and this can develop into depression, especially if they are closely involved with the child’s care.
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