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Feeling sad, hopeless, or not interested in the usual fun stuff for 2 weeks or more? You could have depression. And getting the right treatment could come down to what kind of depression you have.
Let’s break down what distinguishes one type of depression from another.
Harvard University’s Beverly Merz called major depression “a state where a dark mood is all-consuming and one loses interest in activities, even ones that are usually pleasurable.”
Research showed that in 2017, 17.3 million adults in the U.S. (7.1 percent) had at least one major depressive episode.
Symptoms of major depressive disorder include trouble sleeping, changes in appetite or weight, loss of energy, feelings of worthlessness, and thoughts of death or suicide.
Major depression, also known as clinical depression, is diagnosed based on symptoms (depressed mood and lack of interest in activities) lasting most of the day, every day, for more than 2 weeks.
There’s no clear single cause for depression, but several factors are believed to contribute to it, including differences in genetics, neurobiology, brain chemistry, and hormones.
Major depression is treated with psychotherapy and medication. For some people with severe depression that isn’t alleviated with psychotherapy or antidepressants, electroconvulsive therapy or transcranial magnetic stimulation may be effective.
Persistent depressive disorder (also called dysthymia) is the long-term relationship you can’t seem to get out of. While it may not be as intense as major depression, it drags on for 2 years or longer.
Persistent depression doesn’t keep you from functioning, but it does make everything kind of suck. Watch out for appetite and sleep changes, low energy, low self-esteem, or hopelessness.
Like major depression, the cause of persistent depression is not fully understood, but is probably impacted by genetics and brain chemistry. It can be diagnosed by a doctor based on a combination of physical exams (to rule out other illnesses) and psychological evaluation.
According to the National Institute of Mental Health, 1.3 percent of U.S. adults experience persistent depressive disorder at some point in their lives.
People with severe depression may also experience delusions or hallucinations, a combo known as depressive psychosis.
Delusions are thoughts that are unlikely to be true, and hallucinations are seeing, hearing, feeling, smelling, or tasting things that aren’t real. Psychosis can trigger thoughts of suicide.
It isn’t clear why some people with depression develop psychosis, but it may be associated with stressful life events or trauma. Antipsychotic and antidepressant medications may be prescribed to treat depressive psychosis.
Other treatments include cognitive behavioral therapy and electroconvulsive therapy.
To be diagnosed with bipolar I disorder, a manic episode is all that’s required. For people with bipolar disorder II disorder, depression alternates with periods of high energy and risky behavior known as mania.
Mania and depression are like opposite sides of a coin, and treatment focuses on stabilizing moods. Episodes may also be “mixed,” with elements of both mania and depression.
Differences in brain structure and family history are believed to be associated with increased risk of bipolar disorder. Treatment usually requires a combination of medication (antidepressants, mood stabilizers, or atypical antipsychotics) and psychotherapy. Sometimes people are treated with electroconvulsive therapy.
Unipolar depression is like bipolar disorder without mania. The term may be used to refer to major depressive disorder or clinical depression.
What’s so out of the ordinary about atypical depression? The symptoms are pretty much the same as those of other types of depression, like feeling sad, increased appetite, and sleeping too much.
You may also feel rejected or criticized, or feel a heaviness in your arms and legs. The main difference between atypical depression and other types is that people with atypical depression may feel better for short periods in response to positive events.
Atypical depression can start earlier in life than other forms of depression and may last for longer periods of time. Risk factors are alcohol and drug use, childhood trauma, environmental stressors, and a family history of depression, bipolar disorder, or alcoholism.
Like other kinds of depression, it’s treated with both medication and therapy.
Premenstrual dysphoric disorder (PMDD) is an extreme form of premenstrual syndrome that causes severe irritability, depression, or anxiety.
Symptoms usually occur between ovulation and your period. That means up to 5 percent of menstruating women are in misery for 1 to 2 weeks every month.
Fluctuations in hormones and serotonin may be responsible. PMDD is treated with several types of medication, including antidepressants, birth control pills, and over-the-counter pain relievers. Stress management, a balanced diet, and regular exercise may also help.
PMDD symptoms to watch for include:
- irritability and anger
- sadness or thoughts of suicide
- anxiety or panic
- mood swings or crying
- lack of interest in activities and relationships
- trouble thinking or focusing
- food cravings or binge eating
- trouble sleeping
- feeling out of control
- cramps, bloating, and pain
Some people are more sensitive to the lack of natural light in fall and winter, and may become depressed. Seasonal affective disorder (SAD) is thought to be caused by changes in circadian rhythms, serotonin, and melatonin in response to reduced light exposure.
While SAD can be treated with medication and psychotherapy, light therapy is the go-to treatment.
Though SAD most often occurs in fall and winter, some people are affected in spring and summer. People with bipolar disorder may also experience seasonal mood changes.
Stress happens. You get depressed. In some cases, symptoms of depression start with a stressful life event like a death, move, or family change.
When you don’t recover from stress in the expected way, you may have situational depression, also known as adjustment disorder. Symptoms are the same as other depression types, but start within 3 months of a stressful event and tend to resolve within 6 months.
Depression can occur anytime during pregnancy (perinatal depression) or within 12 months after delivery (postpartum depression). Pregnancy and childbirth coincide with dramatic hormonal and physical changes. Add sleep deprivation to the mix, and you have a recipe for postpartum depression.
In addition to other depressive symptoms, a new mother may have trouble bonding with the baby, doubt whether she can care for the baby, or have thoughts of harming herself or the baby.
If you have a history of depression, experience abnormal stress during or after pregnancy, have medical complications, or substance use problems, you may be at greater risk for postpartum depression.
Talk to your doctor about the possibility of depression if you experience:
- sadness that seems out of the ordinary for you
- a depressed mood that lasts longer than you expect or results from a stressful event or major life change
- changes in energy or interest in activities and relationships you used to enjoy
- appetite or sleeping changes
- physical pain with no apparent physical cause
- chronic illness along with feeling down emotionally
- thoughts of death or suicide
To find the best diagnosis and treatment, tell your healthcare provider about stressful events that coincide with your symptoms, whether you have a personal or familial history of depression, and when your symptoms began or changed.
If you think you need help for depression but can’t afford therapy, consider these budget-conscious options:
Mental health therapy apps: Apps to the rescue! There are new-ish companies that will pair you with a licensed therapist you can consult from the comfort of your own home for a fraction of the price of a traditional therapy appointment. Betterhelp and Talkspace are two of the most recognizable.
Sliding scale therapists: These are therapists who are willing to adjust their rates based on what a patient is able to pay. You can do a web search for one in your area or visit a site like Open Path Collective to find an option near you and in your price range.
Crisis hotlines: There are people ready to listen to you and help at various hotlines. Visit stopitnow.org to find the right hotline for you.
Support groups: No matter where you are there are others going through similar struggles, and there’s likely a support group you can join. Sharing your feelings and hearing what others are going through is a powerful reminder that we’re all in this together. The Mental Health America website is one place to find the right group for you.
Most of these types of depression share symptoms and treatment options, so what difference does it make what kind you have? It’s important to understand that not all depression looks or feels the same.
If you think that your particular brand of sadness doesn’t qualify as depression or can’t be treated, you may be wrong. If you have any of the symptoms listed above or see yourself in these descriptions, it’s worth a chat with your doctor or therapist to find out more.