Depression can present itself in several ways. It can be mild or severe, and it can be short-lived or chronic. Special circumstances, like the birth of a baby or the changing of the seasons, can trigger depressive symptoms.
Understanding the type of depression a person is experiencing helps healthcare providers determine treatment. And for people who are diagnosed with depression, having information about their specific disorder can be beneficial.
"Folks seem comforted in knowing what's going on for them," said Sarah Noble, DO, a psychiatrist with the Einstein Healthcare Network in Philadelphia. "At least they have an answer for why they're experiencing what they're experiencing." Here's what you should know about the different types of depression.
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In 2020, approximately 21 million American adults had experienced at least one major depressive episode, according to the National Institute of Mental Health (NIHM). Under diagnostic criteria published by the American Psychiatric Association, people must have at least five symptoms persisting for two weeks or longer to be diagnosed with major depressive disorder. Those symptoms can include:
- Feelings of sadness, emptiness, worthlessness, hopelessness, and guilt
- Loss of energy, appetite, or interest in enjoyable activities
- Sleep habit changes
- Thoughts of death and suicide
Major depressive disorder has two subtypes: "atypical depression" and "melancholic depression." People who fall into the former category tend to sleep and eat a lot. They are emotionally reactive and very anxious, Dr. Noble explained. Those in the latter category have trouble sleeping and tend to ruminate over guilt-ridden thoughts, Dr. Noble added. Young adults tend to present with atypical depression, and the melancholic type is seen more often in older adults.
Most cases are highly treatable and may consist of pharmacological options (medication), therapy, or lifestyle changes per the National Library of Medicine (NLM). However, individuals with major depressive disorder may begin with psychotherapy and medications as their treatment.
Sometimes people with major depressive disorder don't readily respond to treatment—their depression stubbornly hangs on. "Maybe it's genetic, maybe it's environmental," Dr. Noble said. "Their depression is just tenacious."
According to researchers of a January 2020 Neuropsychiatric Disease and Treatment study, for a person to be diagnosed with treatment-resistant depression, they need to have gone through two unsuccessful pharmacotherapy trials. In other words, patients have tried two different medications, and neither worked for their symptoms.
Helping people overcome treatment-resistant depression begins with a thorough workup to ensure a proper diagnosis and identify other psychiatric and medical causes of their symptoms. Patients are counseled on proper dosage and duration of treatment.
If a medicine isn't working, healthcare providers will try switching to a similar drug or one from a different class. Patients may benefit from adding a second antidepressant from a different class and perhaps another type of medicine, such as an antipsychotic.
A person who has depressive symptoms but doesn't quite check all the boxes for a diagnosis of major depression may be deemed "subsyndromal." In other words, they may have an other specified depressive disorder, as indicated by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). For example, the person might have less than five symptoms or experienced depression for less than the two-week minimum.
"Rather than look at symptoms, I usually look at functionality," Dr. Noble added. Is the patient able to go to work and take care of day-to-day responsibilities? If the person is struggling, they may still benefit from treatment, including with medication, Dr. Noble said.
People with persistent depressive disorder (PDD)—formely known as dysthymia—have "a low, dark, or sad mood on most days" and at least two additional symptoms of depression lasting two years or more per MedlinePlus. In children and teens, PDD may be diagnosed if symptoms of irritability or depression persist for a year or more. "It may wax and wane in intensity, but generally it's a low level of depression," Dr. Noble explained.
To be diagnosed with this type of depression, people must also have two of the following symptoms:
- Sleep problems (too much or too little)
- Low energy or fatigue
- Low self-esteem
- Poor appetite or overeating
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Usually PDD requires treatment with a combination of medication and psychotherapy.
Up to 16% of people of childbearing age experience premenstrual dysphoric disorder (PMDD), according to a 2016 article published in American Family Physician. This severe form of PMS can trigger depression, sadness, anxiety, or irritability, as well as other extreme symptoms, in the week before a person's period.
"It can be really uncomfortable, disabling, and interfere with a woman's day-to-day life," said Dorothy Sit, MD, associate professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine in Chicago.
Scientists believe these people may have an abnormal sensitivity to hormonal changes during their menstrual cycle. Taking antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), in the two weeks before their period or throughout the month can be very effective, Dr. Sit said. Certain types of contraception and pain relievers may help with symptoms too.
Wide swings in mood and energy, from elation to hopelessness, are the signatures of depressive episodes in bipolar disorder. To be diagnosed with this form of depression, a person must have experienced at least one bout of mania (a period of time with energetic behavior).
Bipolar disorder commonly shows up in young adulthood. Bipolar disorder usually worsens without treatment but can be managed with mood stabilizers, antipsychotic medicines, and talk therapy. The depressive symptoms specifically can be treated with antidepressants, according to the NIMH.
Screaming and temper tantrums can be features of disruptive mood dysregulation disorder (DMDD), a type of depression diagnosed in children who have difficulty regulating their emotions. Other symptoms include an irritable or angry mood most of the day nearly every day and trouble getting along in school, at home, or with their peers.
"These are the kids with strong emotional outbursts," Dr. Noble said. "They're just not able to contain their emotions," so they "act out and act on" their feelings.
According to the NIMH, DMDD is treated using medications, psychotherapy, and parent training on how to effectively deal with a child's irritable behavior.
The birth of a baby brings enormous joy but can sometimes lead to postpartum depression (PPD), a type of sadness also called the "baby blues," according to the Office on Women's Health (OWH). While these feelings of emptiness and emotionlessness are typical in the first three to five days after giving birth, the OWH reports that they can become PPD if they last for longer than two weeks.
And PPD is fairly common. The OWH reports that one in nine females will experience PPD. In people who recently gave birth, postpartum depression is likely triggered by shifts in hormones, fatigue, and other factors.
Postpartum depression can begin any time in the first year following a child's birth, although it usually appears soon after the new arrival. Intense feelings of sadness, anxiety, and exhaustion become overwhelming and can interfere with daily life.
When these feelings become extreme, they can provoke thoughts of hurting yourself or your baby, along with other symptoms. This is known as postpartum psychosis, according to the OWH.
Compared to the "baby blues"—which is a mild, short-lived, and extremely common condition causing anxiety and depressive symptoms in the immediate wake of a baby's birth—PPD usually requires treatment with antidepressants, talk therapy, or both. BetterHelp is one top-reviewed online therapy option to help guide new mothers through challenging times and provide treatment options.
Seasonal affective disorder (SAD), or seasonal depression, is a recurring type of depression that usually strikes in the fall or winter, but can also occur in summer. Along with a change in mood, individuals with SAD tend to have low energy. They may overeat, oversleep, crave carbs, gain weight, or withdraw from social interaction.
Females, younger adults, and individuals who live in places with shorter daylight hours are at higher risk of developing SAD, according to the NIMH. SAD can also run in families. And symptoms of SAD may increase after resetting the clock for Daylight Savings Time.
SAD is diagnosed after at least two years of recurring, seasonal symptoms. While the exact cause is unclear, research has suggested it may be related to an imbalance of the brain chemical serotonin. An overabundance of the sleep hormone melatonin and insufficient levels of vitamin D may also play a role, per the NIMH.
Treatments for SAD include a daily dose of light therapy and sometimes medication.
People with psychotic depression have severe depression accompanied by psychosis, which is defined as losing touch with reality. Symptoms of psychosis typically include hallucinations (seeing or hearing things that aren't really there) and delusions (false beliefs about what's happening). Additionally, psychotic depression is considered to be another subtype of MDD.
One of Dr. Noble's patients, two years after beginning treatment, confessed that she had a year during which she would not eat anything her father cooked because she thought he was poisoning her. The woman was otherwise lucid; she was just dealing with psychotic depression that had not been fully treated.
Healthcare providers usually prescribe antidepressants and antipsychotic medicines together to treat psychotic depression. However, not everyone responds to these treatments.
To treat psychotic depression, researchers are also looking into electrotherapy, a therapy that sends small currents of electricity to the brain while a person is under anesthesia, per the National Alliance on Mental Illness (NAMI). According to a November 2020 Psychotherapy and Psychosomatics article, electroconvulsive therapy (ECT) was found to be somewhat effective as well (though more effective in non-community settings).
Coping with a serious chronic disease, like heart disease, cancer, multiple sclerosis, and HIV/AIDS, can be depressing in and of itself. Researchers of a September 2021 BMC Psychiatry study found that patients who had been diagnosed with chronic diseases were more susceptible to depression.
Disease-related inflammation may also play a role in the onset of depression. Inflammation causes the release of certain chemicals by the immune system that cross into the brain, leading to brain changes that can trigger or worsen depression in certain people, Dr. Noble explained. Antidepressants may help prolong their life and improve their ability to function, Dr. Noble said, and therapy can help many patients cope with mental and physical illnesses.
