Depression is one of the most common mental health disorders in the United States. It affects millions of people each year, and it can have far-reaching mental and physical health effects. Depression is associated with a larger category of mental health issues called mood disorders. These disorders include major depressive disorder, seasonal affective disorder, and bipolar disorder, among many others.
Several of these disorders cause low mood and many other depressive symptoms. Depression is sometimes a progressive disorder, which means it can worsen over time if it isn’t treated effectively. But are there stages of depression like there are stages of grief? Does depression follow a predictable pattern?
Understanding the type of depression you have is the first step in learning to deal with it and finding effective treatment options. Learn more about the types of depression and the different methods that can be used to treat them.
What Are the Types of Depression?
Depressive disorders and mood disorders cover a range of mental health issues that cause a low mood affecting your quality of life or functioning. Depression can cause mental and emotional symptoms, but it may also cause physical symptoms like fatigue. Several types of depressive disorders have unique symptoms or experiences. The type of depressive disorder that you have can make a difference in treatment options. This is why it is important to get an accurate diagnosis.
Major Depressive Disorder
Major depressive disorder (MDD) is one of the most common types of depression in the United States. It involves at least two weeks of depressive symptoms that include either low mood or loss of interest in most activities, or both. A major depressive episode is identified by nine symptoms. To qualify as a major depressive episode, you have to experience five or more of these symptoms. If your depression doesn’t qualify as a major depressive disorder, you may still have another mood disorder.
Major depressive episodes may come and go, but single episodes usually don’t last longer than a few weeks. However, your symptoms may be intense during the episode, and it may feel like your symptoms will never end. Major depressive episodes can interfere with your daily life. In severe episodes, you could experience suicidal thoughts or actions.
Bipolar Disorder
Bipolar disorder, once called manic depression, is a mood disorder involving periods of low and high moods. Low mood can involve major depressive episodes, while high moods involve something called mania or manic episodes. During depressive episodes, you may experience symptoms very similar to major depressive disorder, and bipolar disorder is sometimes misdiagnosed for that reason. However, low moods are often preceded or followed by high moods.
Bipolar disorder is separated into two categories. Bipolar II involves manic episodes, which are identified by three or more of the seven common symptoms that last for at least one week. Bipolar II involves major depressive symptoms with hypomanic symptoms. If you experience high and low moods that don’t qualify as mania or major depression, you may have cyclothymia, a disorder very similar to bipolar disorder, although not as severe.
Persistent Depressive Disorder
Persistent depressive disorder (PDD) is also called dysthymia. It’s a form of depression that lasts for a long time but has milder symptoms than major depression. Persistent depression lasts for two years or more, but you may not experience symptoms that qualify as major depressive disorder. Common symptoms include fatigue, sleep problems, general apathy toward most activities, low-self esteem, and poor concentration.
Persistent depressive symptoms can cause symptoms similar to a major depressive episode, though you may have fewer or less intense symptoms. While major depressive disorders typically last only for a few weeks, you may experience persistent depressive symptoms indefinitely.
Perinatal Depression
Perinatal depression is a term that includes depression that occurs during or after pregnancy. Postpartum depression is better known and perhaps more common, but it’s also possible to experience depression during pregnancy. It’s common to experience what is often called the “baby blues,” the sadness or stress brought on by hormone changes or life changes that come with a new baby. However, perinatal depression is more serious and can lead to significant impairment in your life. Perinatal depression can cause irritation, irritability, unwarranted guilt, sadness, and other common depression symptoms. In severe cases, you may experience intrusive thoughts of harming yourself or your baby.
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) is a mood disorder related to menstruation. A woman’s menstrual cycle can come with unpleasant physical and emotional symptoms. It’s normal to experience irritability, sadness, or increased stress around menstruation. However, PMDD is more intense than menstruation’s typical emotional symptoms. PMDD typically affects women in the days or weeks leading up to their period, but it usually dissipates after menstruation is over. Common symptoms include mood swings, sadness, anger, anxiety, hopelessness, and panic attacks. Symptoms are severe enough to cause clinically significant impairment of social or occupational functioning.
Seasonal Affective Disorder
Seasonal affective disorder (SAD) is a mood disorder that occurs when the seasons change. It’s most often associated with the winter season and may have to do with lower levels of sunlight and daylight hours. SAD is more common in regions that experience dark or cold winters. In rarer cases, SAD is associated with other seasons, even spring and summer. For the most part. SAD begins in late fall or early winter and lasts until spring. To be diagnosed with SAD, you have to experience depressive symptoms around the same time of year for two years in a row. SAD may have to do with changes in your body’s internal clock, lower Vitamin D intake, and other factors.
Different Types of Major Depression
Depression is complex and can come with several variations. If you are diagnosed with major depressive disorder, you may experience symptoms very different from someone else with a similar diagnosis. Here are some of the different types of major depression you might experience and what sets them apart:
Melancholia
Melancholia, or melancholic depression, is a term used to describe a particularly severe form of depression. The term was once used as a more modern medical term to describe one of four basic temperaments. While that use is now archaic, the word is still used to describe depression with features of deep sadness. In modern medicine, melancholic depression was once seen as a separate diagnosis, but it’s currently used as a subcategory for major depressive disorder.
Melancholic depression may involve the following symptoms:
- Persistent extreme sadness
- Irritability or anxiety
- Extreme, unintentional weight changes
- Changes in sleep patterns
- Frequently thinking about death
- Suicidal thoughts or actions
You may experience many of these symptoms with many different types of depression. However, if you have melancholic depression, your symptoms may be more severe.
Psychotic Depression
Psychotic depression is another subcategory of depression that comes with severe symptoms. Psychosis is a common feature of mental health issues like schizophrenia, but it can also occur in mood disorders like bipolar disorder. Psychotic symptoms include delusions and hallucinations, although delusions are the most common among mood disorders. While delusions are often seen in people experiencing manic episodes, they can also occur alongside severe depression. Depressive delusions are false beliefs not based on reality that have to do with guilt, paranoia, fear of disease, impoverishment, and persecution.
Are There Stages of Depression?
You may be aware of the stages of grief, a cycle of emotions that occur after you experience a major loss or disappointment. But does this cycle also apply to depression? It’s important to realize that depression and grief are not the same things. Grief is a natural, healthy human response to a negative situation, but depression is a mental health problem that significantly disorders your life.
It is possible for grief to trigger depression, which leads to complex questions like, “how long can you experience grief before it becomes a mental health disorder?” Exploring these questions led psychologists to include a controversial diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders called prolonged grief disorder.
However, it’s clear that depressive disorders don’t usually follow a predictable pattern like the stages of grief. Someone with major depressive disorder may experience deep sadness one week and feel fine the next week. Depressive symptoms may also return with no clear cause. Bipolar disorder is known for coming and going with no clear pattern.
In many cases, depression is a chronic and progressive disorder, which means it can get worse over time. A paper published in 2015 reported that recurrent depression can cause the disorder to progress to the point where it is resistant to treatment. Treating this kind of depression as progressive can help prioritize treatment options that focus on preventing or reversing depressive symptoms that resist treatment.
When Should You Seek Treatment?
If depression can get worse over time, when should you seek treatment for depressive symptoms? When you’re dealing with any mental health issue, a good rule of thumb is you should seek help if your symptoms get in the way of you living your life. Everyone experiences periods of sadness, disappointment, apathy, and fatigue.
But if you experience those symptoms to the point that it strains your relationships, makes it difficult to perform in school or at work, or lowers your enjoyment of your life, you may need to look for treatment options. Here are other signs that you should ask a doctor or psychologist about depression:
- Hopelessness or worthlessness. If you have recurrent thoughts that your life is worthless and that there is no hope for your future, you may have a depressive disorder.
- Deep sadness. Feeling down is normal, especially if you’re facing challenges in your life. But if you could describe your sadness as deep despair, it may be depression.
- Lasting or recurring symptoms. Mood disorders typically cause symptoms that last for more than a few days. Major depression lasts for two weeks at a time and may return. Seasonal affective disorder lasts for a few months and returns the following year. Persistent depressive disorder lasts for multiple years at a time. If you experience a low mood that you can’t seem to shake, you may need help.
- Feeling overwhelmed. A hallmark of mental health disorders is that symptoms go beyond your current ability to cope with them in a healthy way. Treatment may involve therapy that helps you develop healthy coping responses to stress and challenges.
- Struggling at work or school. Depression can destroy your concentration.
Depression with Co-Occurring Disorders
Depression affects millions of people each year. In fact, generalized anxiety disorder (GAD) alone occurs in around 6.8 million adults in the United States. There is a significant overlap between depressive disorders and other mental and physical health problems. When depression combines with other challenges, it can complicate treatment and cause you to feel overwhelmed. Here are common mental and physical problems that may occur alongside depression.
Anxiety
Anxiety and depression may seem like opposing forces, but they are often related. Anxiety involves excessive worry, fear, or panic. Anxiety disorders are the most common mental health issues in the United States. They can make you feel overwhelmed and make many aspects of your life more difficult. Chronic anxiety issues can lead to depression as the disorder lowers your quality of life. However, many treatments for anxiety are also effective in treating depression and other mood disorders, including SSRI medications.
Substance Use Disorders
Mental health and substance use disorders often go hand-in-hand. Some estimates say that as much as 50% of people that experience substance use problems also experience mental health issues. Mental health problems can worsen substance use disorders and vice versa. There are many reasons why these two disorders might be linked, including overlapping risk factors and self-medication. Using drugs to self-medicate for mental health issues is one of the most direct links between these two disorders. While drugs or alcohol may offer temporary relief from depression, substance use problems are more likely to make depression worse.
Medical Problems
Medical problems are often associated with depression and other mood disorders. Getting an unfavorable diagnosis or living with a challenging or painful disease can lead to depression. Diseases commonly associated with depression include diabetes, hyperthyroidism, heart disease, arthritis, kidney disease, HIV, lupus, and multiple sclerosis.
The loss of bodily function, such as losing senses or the use of a limb, can also cause depressive symptoms. Cases of depression that medical problems cause often require psychotherapy to help cope with medical issues. Occupational and physical therapy can also help regain a sense of hope and functionality.
Neurodevelopmental Disorders
Neurodevelopmental disorders include attention-deficit/hyperactive disorder (ADHD), autism, learning disabilities, and cerebral palsy. It’s common for these disorders to come with co-occurring anxiety or depression. In many cases, challenges that come with neurodevelopmental disorders cause children to struggle with school or in social situations, especially if they are undiagnosed or untreated. This can cause children to fall behind their peers, leading to stress and mental health problems.
Eating Disorders
Eating disorders are behavioral health problems that affect your eating. Examples include bulimia, anorexia, and binge eating disorder. Eating disorders are often related to other mental health issues, including body dysmorphic disorder, anxiety disorders, or depression. As eating disorders lead to health problems, you may feel overwhelmed, and this can lead to worsening mental health.
Body Dysmorphic Disorder
Body dysmorphic disorder is a mental health problem that causes you to be unhappy with your body’s appearance. It may cause you to focus on bodily imperfections that are noticeable to other people. Some have an inaccurate view of their weight, size, or shape, which they believe is unattractive, even if it is a normal, healthy part of their body. It’s often associated with eating disorders, crash diets, or extreme workout routines. Anxiety and depression are common with body dysmorphic disorder.
Sleep Disorders
Sleep disorders are closely related to other mental health problems. A lack of sleep can increase your stress levels, eventually contributing to anxiety or depression. In some cases, depression can cause sleep problems. Depression can cause insomnia, preventing you from getting enough sleep at night. It could also cause hypersomnia, which is when you sleep for long hours and have trouble getting out of bed. A poor sleep schedule can lead to a host of mental and physical problems, including obesity, poor concentration, and hypertension. Chronic sleep problems can increase your risk of heart attack or stroke.
How Different Types of Depression Are Treated
Since there are many different types of depression, there are multiple treatment options that depend on your needs and your specific diagnosis. Both medications and therapies can be effective in treating the disorder. SSRIs are the first-line drug used to treat depression. SSRIs, or selective serotonin reuptake inhibitors, work to increase levels of serotonin in the brain, which can improve your mood. They are commonly called antidepressants, and they are generally safe and well-tolerated. SNRIs, or serotonin and norepinephrine reuptake inhibitors, are similar medications that also increase norepinephrine levels, which can affect your blood flow and heart rate.
Mood disorders that also involve high moods may require mood stabilizers like lithium, which are taken during manic or hypomanic episodes. Someone with bipolar disorder may use both antidepressants and mood stabilizers depending on their current mood and symptoms. Depression or bipolar disorder with psychotic symptoms may require antipsychotics, which can relieve delusions and hallucinations.
Therapy is also frequently used to treat many types of depression. The best treatment plan will be tailored to your needs, and it will depend on the type of depression you have and any other complications. General talk therapy can help work through your thoughts and feelings. Behavioral therapies, especially cognitive behavioral therapy (CBT), can help you develop effective coping responses to stressors and triggers you encounter.
