Explained: 10 Types of Clinical Depression
Depression goes beyond just feeling sad. Everyone feels low, upset, or unmotivated from time to time. Depression is much more complicated than simply being “down in the dumps”.
Depressive disorder is a mood disorder. It affects how a person thinks, feels, and behaves. Signs and symptoms of depression can range dramatically, from hopelessness and fatigue to a loss of interest in life, physical pain, and suicidal thoughts.
The DSM-5 definition of depression states that should a person present with these symptoms for a period of two weeks, the individual is experiencing a depressive episode.
There are many different types of clinical depression. Sometimes, the cause relates to a chemical change in the brain or a change in your life.
While some of the symptoms associated with various depressive disorders overlap, each type has distinct characteristics.
At this point, you might wonder to yourself, “What kind of depression do I have?”
Let's take a deep dive into the different types of clinical depression. Remember, it is vital that you seek help from a doctor to get an accurate diagnosis and receive the treatment and support you need to get better.
Table of Contents
#1. Major Depression (Clinical Depression)
#2. Dysthymia (Persistent Depressive Disorder)
#3. Manic Depression (Bipolar Disorder)
#4. Postpartum Depression (Peripartum Depression)
#5. Seasonal Affective Disorder (SAD)
#7. Premenstrual Dysphoric Disorder (PMDD)
#9. Situational Depression (Reactive Depression/Adjustment Disorder)
#10. Disruptive Mood Dysregulation Disorder (DMDD)
#1. Major Depression (Clinical Depression)
Major depressive disorder is also known as unipolar or clinical depression. Its main characteristics are the persistent feeling of sadness or a lack of interest in outside stimuli.
You might have this type of depression if you have five or more of the following symptoms on most days for longer than 2 weeks. At least one of the symptoms must be a depressed mood or loss of interest in activities.
Loss of interest or pleasure in your activities
Feelings of worthlessness or guilt
Negative thinking with the inability to see positive solutions
Feeling restless or agitated
Inability to focus
Lashing out at loved ones
Irritability
Withdrawing from loved ones
Increase in sleeping
Exhaustion and lethargy
Morbid, suicidal thoughts
Weight loss or gain
Major depression comes with major depressive episodes. These episodes are a period of two weeks or more where someone experiences the symptoms of major depression. You will feel things like hopelessness, loss of pleasure, fatigue, and suicidal thoughts. The main symptom of a major depressive episode is low mood and/or loss of interest in activities.
Technically, major depression is not curable. Doctors say this because major depression is a condition that comes and goes in someone’s lifetime. But hope is not lost! With the right treatment, the symptoms of depression are manageable over time.
So how do you treat major depression?
A variety of treatment options are available for major depressive disorder. This includes psychotherapy, anti-depressant medications, cognitive behavioral therapy (CBT), electroconvulsive therapy (ECT), and natural treatments.
The treatment plan will differ for each person depending on individual needs. The “best” treatment for major depressive disorder is often thought to be a combination of medication and therapy.
#2. Dysthymia (Persistent Depressive Disorder)
Dysthymia is also known as persistent depressive disorder. It is a long-term form of depression that lasts for years and can interfere with daily life, work, and relationships.
People with dysthymia often find it difficult to be happy even on typically joyous occasions. People around them might perceive them as gloomy, pessimistic, or as a complainer However, in reality, they are dealing with a chronic mental illness.
Symptoms of dysthymia can come and go over time, and the intensity of the symptoms can change, but symptoms generally don’t disappear for more than two months at a time.
So how is dysthymia different from major depression?
The depressed mood experienced with dysthymia is not as severe as major depressive disorder. That said, it still evokes feelings of sadness, hopelessness, and loss of pleasure. A diagnosis of dysthymia requires one to experience a combination of depressive symptoms for two years or more. This is in stark contrast to the two weeks required for clinical depression.
Dysthymia is often referred to as “high-functioning” depression. This is due to the chronic nature of this type of depression. Many individuals living with dysthymia continue to go through the motions of life in a robotic way, seemingly fine and healthy to those around them.
If you have come across the term “dysthymia” then you have likely also heard of “double depression”. Double depression is a complication of dysthymia. Over time, some people with dysthymia experience worsening symptoms. This leads to the onset of full major depression on top of their dysthymic disorder. This results in something called double depression.
#3. Manic Depression (Bipolar Disorder)
Bipolar disorder, sometimes referred to as manic depression, is another type of clinical depression. It is a mental health condition that causes extreme fluctuations in mood. It also causes fluctuations in energy, thinking, behavior, and sleep.
With manic depression, it's not as simple as feeling “down in the dumps”. An episode of a depressive state may lead to suicidal thoughts. This can then change over to feelings of euphoria and endless energy.
Such extreme mood swings can occur more frequently, such as every week, or show up sporadically, like twice a year.
Mood stabilizers can help control the mood swings that come with bipolar disorder. Lithium is one such stabilizer. That said, individuals often get prescribed a variety of different medications including antidepressants and antipsychotics.
A common question concerning bipolar disorder is if it's genetic. While scientists have not pinpointed a single root cause, however, it appears genetics does play a role. Genetics are likely to account for around 60-80% of the risk of developing bipolar disorder. This indicates the key role heredity plays in the condition. Your risk of developing bipolar disorder is also increased significantly if you have a first-degree relative suffering from the disorder.
Unfortunately, there is no known cure for bipolar disorder. A patient can manage it successfully with a treatment plan involving both medication and psychotherapy.
In the clinical setting, bipolar comes in several forms, including bipolar 1 and bipolar 2. All types of bipolar disorder involve extreme highs and lows. The main difference between bipolar 1 and bipolar 2 is the severity of the manic symptoms. With bipolar 1 the mania is typically more severe. With bipolar 2, the individual experiences hypomania, a less severe form of mania that results in behaviors that are atypical for the individual but not abnormal to society at large.
#4. Postpartum Depression (Peripartum Depression)
In the world of newborns and new mothers, there is a phenomenon known as the “baby blues.” Sad feelings and crying bouts that follow childbirth are common and tend to decrease within a week or two.
Doctors believe this type of sadness happens sometimes because of the dramatic hormonal changes a woman experiences following childbirth. Around one in seven women will experience more severe versions of the typical baby blues.
Women that struggle with sadness, anxiety, or worry for several weeks or more following childbirth have something called postpartum depression, or PPD.
Signs and symptoms of PPD include….
Feeling down or depressed for most of the day for several weeks or more
Feeling distant and withdrawn from family and friends
A loss of interest in activities (including sex)
Changes in eating and sleeping habits
Feeling tired most of the day
Feeling angry or irritable
Having feelings of anxiety, worry, panic attacks, or racing thoughts
It's important to realize that postpartum depression does not necessarily begin immediately after childbirth. Symptoms may start in the first few weeks following childbirth. Other times, symptoms of PPD do not begin until months after birth and can emerge at any time during the baby’s first year.
We don’t know why PPD happens. Doctors think it is the result of a variety of factors, including…
The physical changes resulting from pregnancy
Anxiety about parenthood
Hormonal changes
Previous mental health problems
Lack of support
A complicated pregnancy or delivery
Changes to the sleep cycle
Doctors also say that women who have previously suffered from postpartum depression are always at risk for future mood episodes thereafter. PPD can be a woman’s first experience of depression allowing future episodes of depression to occur. Doctors also say depression can come back since the stress of motherhood does not go away and can even worsen depending on ongoing psychological stressors.
#5. Seasonal Affective Disorder (SAD)
Seasonal affective disorder, often abbreviated as SAD, is a type of depression. It's related to the change of seasons.
People suffering from SAD often have symptoms beginning and ending at about the same time each year. For many, symptoms start in the fall and continue into the winter months. That said, it is possible for SAD to occur in the spring or summer.
In either case, people experience symptoms of depression, such as hopelessness, fatigue, and loss of interest or pleasure in activities. These symptoms start out mild and progress to be more severe as the weeks go on.
Those who experience SAD in the winter have also noted the following unique symptoms:
Heaviness in arms and legs
Frequent oversleeping
Cravings for carbohydrates/weight gain
Relationship problems
Treatment plans for SAD may include medication, psychotherapy, light therapy, or a combination of these options. The goal of this type of treatment is to manage the depression symptoms. Talk therapy can be a useful and effective option for those with SAD. A psychotherapist can help you identify patterns in negative thinking and behavior that impact depression, learn positive ways of coping with symptoms, and institute relaxation techniques that can help you restore lost energy.
I mentioned above that seasonal affective disorder often happens in the winter months, but can occur in the summer months too. Experiencing SAD in the summer months is more common than you might think. Around 10% of individuals with SAD begin noticing the signs of depression in the summer months.
At this point, you might be thinking to yourself, “Why does seasonal affective disorder occur?” The exact cause of SAD is still unclear. That said, experts made a variety of hypotheses related to the cause of the disorder and why some experience more severe symptoms than others. Some doctors suggest that the effects of light, a disrupted body clock, low serotonin levels, high melatonin levels, traumatic life events, and even physical illness have a connection to the onset of SAD.
#6. Psychotic Depression
According to the National Alliance on Mental Illness, around 20% of people with depression have episodes so severe that they develop psychotic symptoms.
A doctor might give a diagnosis of major depressive disorder with psychotic features to individuals suffering from a combination of the symptoms of depression and psychosis. Psychosis is a mental state characterized by disorganized thinking or behavior; false beliefs (known as delusions), or false sights or sounds (known as hallucinations).
Many people want to deal with psychotic depression before it gets out of hand, leading to a patient harming themselves or others. Doctors use the term “early psychosis” when referring to a period when a person first starts to appear as though they are losing contact with reality. The early signs of psychosis include…
Suspicion of others,
Withdrawing socially,
Intense and inappropriate emotions,
Trouble thinking clearly,
A decline in personal hygiene
A drop in performance at work or school
To receive a diagnosis of major depressive disorder with psychotic features, the patient must have a depressive episode that lasts two weeks or longer. They also need to experience delusions and hallucinations.
There are two different types of major depressive disorder with psychotic features. Both types feature delusions and hallucinations. The two types are…
Major depressive disorder with mood-congruent psychotic features
the content of the hallucinations and delusions is consistent with depressive themes
Mood-incongruent psychotic features
the content of the hallucinations and delusions does not involve depressive themes
Some people upon hearing about psychotic depression may become concerned that it can turn into schizophrenia. Depression is a mood disorder and schizophrenia is a psychotic illness. Both psychotic depression and schizophrenia share psychosis as a symptom. However, there is no reason to think that psychotic depression would morph into schizophrenia. On the other hand, individuals with schizophrenia can become depressed when they realize the stigma surrounding their illness, the poor prognosis, and the loss of function.
#7. Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder, or PMDD, is a cyclic, hormone-based mood disorder. It is commonly considered a severe and disabling form of premenstrual syndrome (PMS).
While up to 85% of women experience PMS, only around 5% of women receive a diagnosis of PMDD.
The core symptoms of PMDD relate to depressed mood and anxiety. That said, behavioral and physical symptoms also occur.
To receive a diagnosis of PMDD, a woman must experience symptoms during most of the menstrual cycles in the past year and these symptoms must have an adverse effect on work or social functioning.
Many people don’t know the difference between PMS and PMDD. Allow me to explain. Premenstrual dysphoric disorder (PMDD) is a more serious condition than premenstrual syndrome (PMS). The symptoms of PMS do not generally interfere with everyday function and are less severe in their intensity. While it is normal for women to experience fluctuation in mood in the days leading up to menstruation, the psychological symptoms of severe depression, anxiety, and suicidal thoughts do not occur with PMS.
The symptoms o PMDD typically reoccur each month prior to and during menstruation. Symptoms usually begin 7-10 days prior to menstruation and decrease in intensity within a few days of the period beginning. Symptoms disappear completely until the next premenstrual phase.
Since PMDD is closely related to menstruation, medication to help alleviate symptoms is an option. A doctor can prescribe a group of antidepressants named “selective serotonin reuptake inhibitors” (SSRIs). The FDA approved medications like sertraline, fluoxetine, and paroxetine hydrochloride as medications to alleviate symptoms when prescribed.
#8. Atypical Depression
Atypical depression is different from the persistent sadness or hopelessness that characterizes major depression. Doctors consider Atypical depression to be a “specifier” or subtype of major depression. It describes a pattern of depression symptoms, including…
Oversleeping
Overeating
Irritability
Heaviness in the arms and legs
Sensitivity to rejection
Relationship problems
One of the main hallmarks of atypical depression is the ability of the patient to have an improvement in their depression symptoms following a positive event.
Just like any type of depression, atypical depression is a serious mental health condition. Patients with this type of depression have an increased risk of suicide and anxiety disorders. Atypical depression often starts in the teenage years, earlier than other types of depression, and can have a more long-term (chronic) course.
There is no one-size-fits-all treatment to “cure” atypical depression. That said, it can be successfully managed with a combination of medication and psychotherapy. Remission is the goal for atypical depression. It is important to remember that depression has a high risk of reoccurrence so it is important to be conscious of any reemerging symptoms.
Speaking of managing depression, treatment is a good option. Atypical depression responds well to treatment comprised of both medications and psychotherapy. Monoamine oxidase inhibitors (MAOIs) and other antidepressants are the most common medications prescribed to treat atypical depression.
#9. Situational Depression (Reactive Depression/Adjustment Disorder)
Situational depression is otherwise known as reactive depression or adjustment disorder. It is a short-term, stress-related type of depression.
Situational depression can develop after a person experiences a traumatic event or a series of changes to their everyday life. Examples of events or changes that may trigger situational depression include but are not limited to:
Divorce
Retirement
Loss of a friend
Illness
Relationship problems
Situational depression is therefore a type of adjustment disorder. It stems from a person's struggle to come to terms with the changes that occurred.
Most people who experience situational depression begin to have symptoms within about 90 days following the triggering event.
If you have situational depression, you will experience many of the same symptoms as someone with major depressive disorder. There is one key difference: situational depression is a short-term response triggered by an event in someone’s life and the symptoms will resolve when the stressor no longer exists. Otherwise, the symptoms will resolve themselves when the individual is able to adapt to the situation.
In order to receive a diagnosis of situational depression, a person must experience psychological and behavioral symptoms within 3 months of an identifiable stressor. These symptoms are beyond an ordinary response and improve within 6 months after the stressor changes or go away.
#10. Disruptive Mood Dysregulation Disorder (DMDD)
DMDD is a fairly recent diagnosis. It appeared for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.
The DSM-5 classifies DMDD as a type of depressive disorder, as children diagnosed with DMDD struggle to regulate their moods and emotions in an age-appropriate way. As a result, children with DMDD exhibit frequent temper outbursts in response to frustration, either verbally or behaviorally. In between outbursts, they experience chronic, persistent irritability.
At this point, DMDD may sound a bit like bipolar disorder. However, they are not the same thing. The key feature of DMDD is irritability. The hallmark of bipolar disorder is the presence of manic or hypomanic episodes. Although DMDD and bipolar disorder can both cause irritability, manic episodes tend to occur sporadically. With DMDD, irritable mood is chronic and severe.
Children are unlikely to simply grow out of DMDD. They need to learn how to effectively regulate their moods and emotions. If you think your child may have DMDD, seek advice from a mental health professional for diagnosis and an effective treatment plan.
Speaking of treatment, what does it look like?
A combination of psychotherapy and parent management techniques is the first step towards teaching children coping skills for regulating their moods and emotions and teaching parents how to manage outbursts. However, a doctor may prescribe medication if these methods alone are not effective.
Conclusion
Living with depression is difficult. It can feel like an uphill battle. No matter how hard life becomes due to this mental illness, you don’t have to face it alone.
There are a whole variety of medical factors or chronic conditions that cause depression. These factors can affect the body’s systems, including the brain.
There are some things you can do proactively to help with your depression. The best thing to do to help your doctors diagnose your condition is to document your symptoms in a visual way.
Chartam provides a mental health tool to help patients document their symptoms in a visual manner to help them better communicate with their doctors about their conditions.
If you would like to use a mental health planner when talking with your doctors, click here.
