Under the big tent of depression, there are many shades of gray. Depression can be mild or severe. 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 doctors determine treatment. And for people who are diagnosed with depression, having information about their specific disorder can be helpful. “Folks seem comforted in knowing what’s going on for them,” says 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 what you should know about the different types of depression. If you suspect you or a loved one has one of these, get evaluated by a mental health professional. They can help you figure out a diagnosis–and the best course of treatment.
Major depressive disorder
In a given year, more than 16 million Americans (a majority of them women) experience this very common type of depression, also known as major depression or clinical depression. 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; changes in sleep habits; and thoughts of death and suicide. Most cases are highly treatable.
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 explains. Those in the latter category have trouble sleeping and tend to ruminate over guilt-ridden thoughts, she says. Young adults tend to present with atypical depression, and the melancholic type is seen more often in seniors.
Treatment-resistant depression
Sometimes people with major depressive disorder don’t readily respond to treatment. Even after trying one antidepressant and then another–and maybe a third or fourth–their depression stubbornly hangs on. “Maybe it’s genetic, maybe it’s environmental,” Dr. Noble says. “Their depression is just tenacious.”
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, doctors 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.
Persistent depressive disorder
People with persistent depressive disorder (PDD) have a low, dark, or sad mood on most days and at least two additional symptoms of depression lasting two years or more. In children and teens, PDD (also called dysthymia) 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 explains.
To be diagnosed with this type of depression, people must also have two of the following: sleep problems (too much or too little); low energy or fatigue; low self-esteem; poor appetite or overeating; poor concentration or difficulty making decisions; and feelings of hopelessness.
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