Contents
Introduction – Depression: Types, Symptoms, and Treatment
It is normal in life to feel sad or down at times. Our mood is affected when faced with increased stress or an adverse life event such as the death of a loved one. But when we are sad most of the time and stop being able to function in our life, we may be experiencing clinical depression.
Depression is a common but serious mood disorder. The World Health Organization (WHO) reports that as many as 5% of the world’s population experience depression. That is 280 million people—the WHO cites depression as one of the leading causes of disability worldwide. And depression can be deadly, with an estimated 700,000 people dying by suicide each year. According to suicide.org, depression is the leading cause of suicide.
Often referred to as clinical depression, the American Psychiatry Association (APA) defines depression as a medical condition affecting how you think, feel, and act. Depressive disorders are characterized by feelings of sadness and a loss of interest in activities you previously enjoyed. The condition can lead to emotional and physical symptoms that have a negative impact on your ability to function in life and at work.
Symptoms of Clinical Depression
Professionals diagnose clinical depression using symptoms defined in the Diagnostic and Statistical Manual (DSM-V-TR). Symptoms of depression can range from mild to severe. The symptoms must be present for more than two weeks and have a negative impact on how you previously functioned. Not all symptoms must be present for a diagnosis of depression, but the person must be experiencing at least five of the following symptoms:
- Feeling sad or experiencing a depressed mood
- Loss of interest in activities
- Change in sleep, both insomnia or sleeping too much
- Change in appetite, including eating too much or too little
- Loss of energy
- Increased fatigue
- Increased feelings of worthlessness or guilt
- Difficulty in thinking or making decisions
- Impaired concentration
- High physical activity such as pacing or visible slowed movements or speech
- Thoughts of death or suicide
Types of Depression
There are many different types of depression. Some of these may be caused by events that happen to us in life. Others might be caused by an imbalance in the chemicals in our brains. People with a family member with a history of depression may be at higher risk of also developing depression. Research suggests that around 50% of the cause of depression is genetic, and the other half is related to psychological or physical causes.
If you recognize signs of depression, the first step is to discuss it with your doctor or mental health professional. They can help diagnose the cause of your symptoms and help to identify the best course of treatment to get you back to yourself. Sometimes medical conditions can have symptoms that mimic depression, so it is essential to seek help from a professional. Physical health conditions like hypothyroidism can have similar symptoms, but the treatment is very different.
Understanding the type of depression that is impacting your life can be very helpful in your recovery.
Major Depression
Major Depressive Disorder (MDD) is characterized by the symptoms mentioned above, which must persist for at least two weeks. This type of depression is debilitating, not just sadness. MDD makes it hard to go to work and interact with people in your life. People often experience severe problems in essential areas of life, such as losing a job or social isolation. Typically MDD is a result of a chemical imbalance in the brain. A depressed person may be genetically predisposed to experience these symptoms in response to a stressor, whereas another person may not.
Symptoms of MDD may vary in different people. For example, some people experience increased anxiety; others may feel agitated and angry. Some people “check out,” struggling to get out of bed or attend to their responsibilities. While other people may feel restless, over-active, and may act impulsively. Within the criteria, patterns of depression can be unique to the person.
Persistent Depressive Disorder (PDD)
Persistent Depressive Disorder (PDD) is also known as Dysthymia. This occurs when a person has experienced symptoms of clinical depression for more than two years. PDD was previously known as Chronic Major Depression.
The most effective treatment for PDD is medication in combination with therapy.
Bipolar Depression
Previously known as Manic Depression, Bipolar Disorder can result in symptoms of depression. People who experience symptoms of bipolar may encounter swings in their mood from intense highs or mania to extreme lows or depression. Bipolar disorder can be complex to diagnose accurately as there are many different types of Bipolar disorder. For some, these swings are milder and characterized by more agitation. For others, Bipolar can result in extreme, manic behaviors that can put the person in harm’s way. A mental health professional can help you get the correct diagnosis and better treat the symptoms you experience.
Bipolar depression is treated with the use of a mood-stabilizing medication and is best paired with therapy to help manage the symptoms experienced. Often one of the most important skills a person gains in therapy is the ability to recognize warning signs their depression is worsening before it becomes too severe. This ability promotes a better quality of life.
Seasonal Affective Disorder (SAD)
Seasonal Affective Disorder (SAD) is a form of depression that presents with the symptoms of major depression. This type of depression occurs most commonly in the winter months when the days are shorter, and we get less sunlight.
SAD typically improves in the spring and summer without any additional treatment. An antidepressant and light therapy can help eliminate the symptoms during the winter months.
Schizoaffective Disorder
Schizoaffective disorder is a psychiatric illness that impacts both thinking and feeling. At times, depression can become so severe that the person begins to lose touch with reality. They may experience symptoms of paranoia, like believing people are “out to get them.” They might also start to believe things that are not true, defined as delusions. Usually, once the symptoms of depression improve, these other symptoms will also improve.
The most effective treatment for psychotic depression is a combination of medication and therapy. Often, this will require more than one type of psychiatric medication to effectively treat these symptoms, such as adding Abilify or Seroquel.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder is not PMS. With PMDD, a woman will experience symptoms consistent with clinical depression just before and during their period. These symptoms are severe enough to cause significant disruption in their lives and make it difficult to function. People who know someone experiencing PMDD may feel like they are two different people at different times based on their menstrual cycle.
The most effective treatments include an antidepressant or, if that proves ineffective, a hormone therapy such as a gonadotropin-releasing hormone (GnRH) agonist that suppresses menstruation.
Postpartum Depression
Most women experience the baby blues after giving birth. Major hormonal shifts occur in the body after the baby is born, so feeling down, a bit anxious, and experiencing crying spells is common. During postpartum depression (PPD), the woman meets the criteria for clinical depression. PPD can affect up to 15% of women. These symptoms make it difficult for the mother to care for herself and, sometimes, even her new baby.
The best treatment for this is the use of antidepressant medications and counseling. Having a solid support system can also be helpful, as new motherhood is challenging without the added burden of depressive symptoms.
‘Situational’ Depression
Life at times will throw a curveball we did not anticipate. Perhaps this is a divorce or the death of someone we love. Sometimes losing a job or when experiencing a miscarriage. There are at times events that will result in symptoms of depression. These generally are not as severe as those identified in Major Depression, or perhaps you are only experiencing one or two of the symptoms required for a diagnosis of depression. This is situational depression, or in clinical terms, Adjustment Disorder.
Often as the life situation improves, so do these symptoms. It can however be beneficial to seek counseling to help talk through the emotional impact this life change has had.
What to do When Traditional Treatment Does Not Help
Sometimes, medication and counseling do not improve the symptoms of depression. Treatment Resistant Depression (TRD) is not all that rare with 10-30% of people with MDD experiencing a lack of response to treatment. The consequences can be significant, with an increased risk of poor quality of life and potentially suicide. When this occurs, it is essential to see a specialist like a psychiatrist for re-evaluation to ensure you have the right diagnosis and explore other options for treatment. Some people with TRD have also found relief with Electroconvulsive Therapy (ECT). There are new advancements in treatment options for TRD. One such option is the use of Eskatamine, a medication that functions differently than traditional antidepressants. Another approach is Vagus Nerve Stimulation (VNS), which uses electrical stimulation through an implant. Finally, Transcranial Magnetic Stimulation (TMS) uses magnetic fields to stimulate the nerves in the brain and appears to be effective in helping some people with TRD.
Depression is treatable. Seek help from your doctor or a mental health professional if experiencing symptoms of depression.
Featured Image Credit: Photo by Engin Akyurt (Pexels)
References
- https://www.who.int/news-room/fact-sheets/detail/depression
- http://www.suicide.org/suicide-causes.html
- https://www.psychiatry.org/patients-families/depression/what-is-depression
- https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
- https://my.clevelandclinic.org/health/treatments/17598-vagus-nerve-stimulation
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/esketamine-for-treatment-resistant-depression
- https://www.psychiatry.org/patients-families/ect
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/
- https://womensmentalhealth.org/posts/ovarian-suppression-pmdd-new-study-suggests-long-term-effectiveness-tolerability
- https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Quetiapine-(Seroquel)
- https://www.abilify.com
- https://med.stanford.edu/depressiongenetics/mddandgenes.html
- https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/
- https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
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