Forms of Depression

Depression can take many forms and the diagnosis is dependent on the intensity and duration of the mood disturbance, its accompanying symptoms, and the degree to which it interferes with a person’s functioning in both social and occupational settings.

The most common forms of depression are Major Depressive Disorder and Dysthymic Disorder. Forms of depressive disorder that include unique characteristics or develop under unique circumstances include: Psychotic Depression, Postpartum Depression, and Seasonal Affective Disorder (SAD).

Clinical depression occurs in episodes, which may last from days to months, or in the most severe cases — years. A Major Depressive Episode is the core syndrome of clinical depression. Major Depressive Episodes, chained together over time, lead to a full-blown Depressive Disorder. Major Depressive Disorder is diagnosed when someone experiences one or more Major Depressive Episodes.

For approximately 2 to 3 percent of the population, Major Depressive Episodes can occur within a cycle of mood disturbances of extreme highs (mania) to extreme lows (depression) known as Bipolar Disorder (formerly called manic-depression). In addition to depression, Bipolar Disorders can include Manic, Mixed, or Hypomanic Episodes.

About 5 to 10 percent of individuals with Major Depressive Disorder subsequently develop a Manic Episode. It’s important to note that people with a bipolar disorder can be misdiagnosed as Major Depressive, particularly if they have prominent depression and mild mania or hypomania. If you notice mood shifts from slightly elevated to depressed, contact a physician or psychiatrist for a complete assessment.

Dysthymic Disorder or Dysthymia is chronic, long-term depression, characterized by at least two years of depressed mood for more days than not. Because people with dysthymia often suffer quietly and are not severely disabled, their depression may go unnoticed and undiagnosed if it doesn’t escalate into a Major Depressive Episode. In fact, upon successful treatment, a dysthymic person may seem to observers to have suddenly undergone a “complete personality change” because a daily dose of depression was the norm.

Seasonal Affective Disorder (SAD) is characterized by the onset of depression during certain seasons. For most SAD sufferers, depression occurs during the winter months, when there is less natural sunlight. Winter depressive may report symptoms such as physical pain or craving for carbohydrates.

Some severe and rare cases of Major Depression may include psychotic symptoms. During psychotic depression, the depressed person loses contact with reality, which might include hearing, smelling or feeling things that others can’t detect (hallucinations); and having strong beliefs that are false, such as believing that the devil is speaking to you (delusions). Hallucinations and delusions in people with depression are usually transient and not as elaborate as those of full-blown people suffering from full-blown psychosis, such as is the case with Schizophrenia). People with depression may, for example, claim to hear voices scolding them for their “sins” or “flaws.”

Psychotic features can be either mood-congruent (involving typical depressive themes; e.g., the person feels so guilty about a minor infraction that she imagines she has committed a heinous sin) or mood-incongruent (no apparent relationship to typical depressive themes; e.g., a man suddenly decides that he’s being investigated by the CIA).

Mood-congruent psychotic features involve delusions or hallucinations consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. For example, delusions of guilt may drive a man to decide that it’s his fault a loved one died. Disease delusions might include believing that one has cancer, or that one’s body is “rotting away.” Delusions of deserved punishment could involve deciding that one is being punished for some transgression.

Mood-incongruent psychotic features, which are less common, might include persecutory delusions such as thought broadcasting (“My thoughts are not my own”), thought insertions (“Other people can hear my thoughts.”) or delusions of control.

A person with mood-incongruent psychotic features has a poorer long-term prognosis, is at higher risk for suicide, and needs immediate professional help.

While giving birth can be a remarkable, life-changing event for a woman, some women are particularly vulnerable to depression after giving birth. Raging hormones and physical changes, added to the new responsibility of caring for a newborn, can overwhelm them. After childbirth, around 80 percent of new mothers experience brief “baby blues.” Baby blues is a transient condition that occurs within 3 – 10 days following childbirth. For women who have a strong emotional support system, the baby blues vanish.

But 12 to 16 percent of new mothers develop Postpartum Depression (PPD), also referred to as Post-Natal Depression (PND). PPD is a more serious depression that requires active treatment and emotional support, especially since PPD can serve as the onset of lifelong Major Depression. In rare cases, extreme postpartum episodes can also include psychotic or delusional behavior, which should be treated immediately as psychosis increases the risk for suicide and, for the baby, injury or death.

Postpartum depression is a serious condition. If symptoms are extreme, it is important to seek immediate intervention.

Antenatal depression doesn’t get as much attention as postpartum depression, but the truth is that 10 to 20 percent of women struggle with symptoms of depression during pregnancy, and one-fourth to one-half of them will experience symptoms of Major Depression. While pregnancy is a happy, optimistic period for many women anticipating the birth of a baby, some women feel stressed, apathetic, confused, fearful, sad or depressed. Then they feel guilty for having those feelings because they’re “supposed to feel happy.”

Unfortunately, antenatal depression often goes undiagnosed, perhaps written off as “just a hormonal imbalance.” But early diagnosis and treatment is critical because depression impacts the health of both the mother and the baby. A mother-to-be who is depressed may not have the energy and desire to adequately care for herself and her developing baby. Untreated depression can lead to poor nutrition, drinking, smoking, or other self-damaging behaviors that can cause premature birth, low birth weight, and developmental problems that could follow the child into adulthood.

It is important for expectant mothers to talk to others about what they are feeling.

• Family or personal history of depression
• Relationship problems
• Previous pregnancy loss
• Infertility treatments
• Stressful life events
• Pregnancy complications
• History of abuse or trauma

(For detailed diagnostic criteria for each disorder, see Diagnosing Depressive Disorders.)