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The Different Forms of Depression

Disclaimer: If you or someone you know is contemplating harming themselves, please call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. 

Sadness is a normal emotion that we all experience, however, if someone feels sad most of the time and it’s impacting their daily life, they may have a form of clinical depression. It’s a condition that’s usually treatable with a combination of medication, therapy, and lifestyle changes.

Depression can have many causes and comes in different forms from life circumstances to chemical imbalances. Regardless of the cause, if a patient is experiencing depressive symptoms they should reach out to their doctor and let them know how they’re feeling. Their doctor might choose to refer them to a psychiatrist or therapist for diagnosis to discover which treatment plan is right for them.

Major Depressive Disorder

Major depression, or major depressive disorder, is what most people think of when they think of depression. This is a condition where the patient feels depressed most of the time.

Other symptoms can include:

●      Trouble falling asleep

●      Weight loss or weight gain

●      Feeling worthless or guilty

●      Thoughts of suicide or suicidal ideation

●      Trouble concentrating or making decisions

●      Loss of interest in activities they used to find pleasure in

●      Feeling tired or lethargic (or contrarily feeling restless and agitated)

A patient with five or more of these symptoms, if the symptoms persist for at least two weeks, might be diagnosed with major depression.

Therapy, like group or talk therapy, can help patients cope with major depression. If therapy isn’t helpful enough on its own, antidepressant medication may be prescribed.

Persistent Depressive Disorder

Depression that continues for two years or longer is considered a persistent depressive disorder. This term encompasses two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

Symptoms may include:

●      Fatigue

●      Low self-esteem

●      Feeling of hopelessness

●      Sleeping too much or too little

●      Trouble concentrating or making decisions

●      Change in appetite (not eating enough or overeating)

Patients with persistent depressive disorder can also be treated with talk therapy, medication, or a combination of both.

Bipolar Disorder

Someone with bipolar disorder, also known as manic depression, suffers from extreme mood shifts. These mood episodes range from periods of low depressive energy to episodes of mania (extremes of high energy.)

During the low depressive phases, patients experience symptoms of major depression. 

The FDA has approved three medications to treat the depressed phase of bipolar disorder:

●      Seroquel

●      Latuda

●      Olanzapinefluoxetine combination

Medications, like mood stabilizers, can help mitigate mood swings regardless if the patient is currently experiencing a high or low period. 

Sometimes doctors prescribe medications that weren’t specifically created for bipolar depression, such as the atypical antipsychotic Vraylar or the anticonvulsant lamotrigine.

Traditional antidepressant medications are not usually the first resort when treating bipolar depression. This is because there’s no evidence that these medications are any more helpful than a placebo is when treating bipolar depression. 

Additionally, traditional antidepressants, that are taken without a mood stabilizer, can increase the risk of increasing the frequency of extreme mood episodes in patients with bipolar disorder.

As with most types of depression, talk therapy is typically recommended to monitor symptoms and provide moral support for the patient.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is a type of depression that is triggered by seasonal changes. These depressive episodes typically occur in the winter months, when there is less sunlight and the days are shorter. The symptoms then usually ease up during the spring and summer months. 

Symptoms can include:

●      Temporary fatigue

●      Depression

●      Hopelessness

●      Social withdrawal

Antidepressants, vitamins, talk therapy, and/or phototherapy (light therapy) can help patients with this disorder. Many patients find relief from sitting about 16 – 24 inches in front of a 10,000-lux light therapy box for 20 to 30 minutes a day. Patients who find success with lightbox therapy may be recommended to use this device year-round. Others may only use it during the fall and winter months. 

Psychotic Depression

Patients with psychotic depression have symptoms of major depression along with symptoms of psychosis, like:

●      Delusions (false beliefs)

●      Hallucinations (seeing or hearing things that aren’t there)

●      Paranoia (wrongly believing that others are trying to harm them)

A combination of antidepressant and antipsychotic drugs can typically be used to treat psychotic depression.

Postpartum (Peripartum) Depression

Mothers who have a major depression episode following childbirth could have postpartum depression, also referred to as Peripartum Depression or PPD. If left untreated, this condition can go on for months or even years. Treatment can include talk therapy, support groups, antidepressant medications, and/or hormone therapy. 

Symptoms can include:

●      Insomnia

●      Loss of appetite

●      Intense irritability

●      Difficulty bonding with their baby

Antidepressant drugs can help with PPD similarly to the way they do when they are prescribed to treat other forms of depression. It’s important to note that patients who develop PPD also have a greater risk of developing major depressive disorder later in their life. 

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder (PMDD) is a severe extension of premenstrual syndrome (PMS). Although PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can sometimes disrupt a patient’s life.

Women with PMDD have depression along with other symptoms at the start of their menstrual cycle.

Along with feeling depressed, patients may also experience:

●      Fatigue

●      Anxiety

●      Irritability

●      Mood swings

●      Feeling overwhelmed

●      Trouble concentrating

●      Change in appetite or sleeping habits

Medications like antidepressants, or oral contraceptives, can be used to treat the symptoms associated with PMDD.

Post- Hysterectomy Depression

After a hysterectomy, patients experience changes in their bodies. This surgery can help treat patients’ uncomfortable symptoms, like pain and heavy bleeding. Getting rid of these symptoms often provide patients with feelings of relief and relaxation. 

However, some patients find that the surgery can take an emotional toll as well. A hysterectomy can also trigger feelings of depression and loss. Losing the ability to become pregnant can be a relief for some women but for many women, it can be hard to accept. Some women feel “changed” and mourn the loss of their fertility, especially if they wanted to get pregnant in the future. It’s important to remember that while it’s completely normal for a patient to grieve her fertility, women are not defined by whether or not they have the ability to reproduce. 

If a patient has a full hysterectomy, they will experience abrupt menopause. This can affect the patient’s mood and well-being. Patients can experience symptoms such as:

●      Depression

●      Fatigue

●      Hot flashes

●      Night sweats

●      Vaginal dryness

Stress Response Syndrome (Situational Depression)

Situational depression is where people get depressed trying to cope with a stressful situation in their life, like the death of a close friend/family member, a divorce, or losing their job. The technical term for this type of depression is, “stress response syndrome.”

Talk therapy can often be useful in helping people get through a period of depression that’s related to a stressful event. 

Atypical Depression

Atypical depression differs from typical depression because a positive event can temporarily improve the patient’s mood. 

Other symptoms of atypical depression can include:

●      Increased appetite

●      Sleeping more than usual

●      Oversensitive to criticism

●      Feeling of heaviness in your arms and legs

Talk therapy and/or antidepressants can help patients with atypical depression. Some patients may be recommended a selective serotonin reuptake inhibitor (SSRI) as the first-line of treatment. An older class of antidepressant called a monoamine oxidase inhibitor (MAOI) is also sometimes recommended because it has been well-studied in treating atypical depression.

If you have depression and you want additional resources or if you’re concerned that you might have undiagnosed depression, please contact Mangrove Women’s Health at (530) 345-0064, Ext 281 to set up an appointment. 

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