The Four Types of Depression

There are several different diagnoses for depression, mostly determined by the intensity, duration, and specific causes of the symptoms. Types of depression include Major Depression, Bipolar Depression, Dysthymic Disorder, and Adjustment Disorder with Depressed Mood.

Major Depression

This is the most severe category of depression. In major depression, more of the symptoms are present, and are usually more intense or severe. It can result from a single traumatic life event or may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop the symptoms of major depression without any obvious life crisis causing it. Others have had less severe symptoms of depression for a long time and a life crisis results in increased symptom intensity.

Major Depression is marked by a combination of symptoms that occur together and last for at least two weeks without significant improvement. Symptoms from at least five of the following categories must be present for major depression.

Persistent depressed, sad, anxious, or empty mood
Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
Hopelessness about the future, excessive pessimistic feelings
Loss of interest and pleasure in usual activities
Decreased energy and chronic fatigue
Loss of memory, difficulty making decisions or concentrating
Irritability, restlessness, or agitation
Sleep disturbances, either difficulty sleeping, or sleeping too much
Loss of appetite and interest in food, or overeating with weight gain
Recurring thoughts of death, or suicidal thoughts or actions

Bipolar Disorder

The distinguishing characteristic of Bipolar Disorder is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition—the vast majority of individuals who have one manic episode will have more in the future, with an average of four episodes in ten years if left untreated. Every individual with bipolar disorder has a unique pattern of mood cycles, depression and manic episodes, specific to that individual.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment. Without treatment, marital breakups, job loss, alcohol and drug abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance. Most individuals with bipolar disorder do not perceive their manic episodes as problematic and they resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode and don't want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Risk taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some develop secondary substance abuse problems.

Dysthymia

Dysthymic Disorder is characterized by chronic depression, but with less severity than a major depression. The essential symptom for dysthymic disorder is an almost daily depressed mood for at least two years, but without the necessary criteria for major depression. Low energy, sleep or appetite disturbances, and low self-esteem are usually part of the clinical picture.

People who have dysthymic disorder often report that they don't recall ever not feeling depressed. However, they may be relatively functional in managing their life, although the symptoms are severe enough to cause distress and interfere with important life role responsibilities.

Adjustment Disorder with Depressed Mood

This is also called "reactive depression." The diagnosis of an adjustment disorder implies mild to moderate depression following a specific stressful event. The depressive symptoms related to adjustment disorder should be treated and dissipate within six months following the end of the stress that produced the reaction. If stressors continue over a long period of time, for example, if a person is continuing to deal with a chronic illness or difficult home life, the adjustment disorder diagnosis could still be used.

The symptom picture is similar to other depressive disorders and the recommended treatment emphasizes resolving the problem that created the stress. This may involve making concrete changes in the way the person manages his/her life and may require specific actions and decision making. For example, if a newly diagnosed illness is resulting in depression, the person may need to learn how to adjust to the losses and changes in their life that are a result of their illness. Often people become depressed in reaction to psychosocial stressors when they don't believe a solution exists to their problem. In such cases, helping the person develop a reasonable solution is a key part of the treatment process.

Our Depression Counseling Specialists

Nancy Baker-Brown,
MS, LPC, BCETS

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Jeremy Sprott,
M.Ed, LPC-I