There can be up to 4 types of depression depending on different factors such as duration, severity or symptoms. It is a disease that can affect anyone, from children or young people to older adults.
So much so that the WHO estimates that 350 million people across the world suffer from some of the types of depression that exist, with women being the most likely to suffer it. In the fourth century, BC Hippocrates already referred to states of mind characterized by depression and sadness and called it melancholy. It was based on the idea that mood disorders were due to an imbalance in the humors of the body (black bile, yellow bile, blood, and phlegm).
This conception was maintained until the nineteenth century and is considered the antecedent of current theories that explain mood disorders, among which is depression. Depression is one of the disorders that most psychological discomfort produces at present being probably the most patients generated in clinical practice.
The word depression is used frequently to define a mood but, contrary to what is usually thought, the feeling of sadness is not enough to diagnose depression.
Classification of the main types of depression
1- Major depressive disorder
This disorder is suffered by people who have suffered or suffer a major depressive episode. Two subtypes are distinguished:
- Major depressive disorder, single episode : if only one episode appears.
- Major depressive disorder, recurrent episode : if there has been at least one major depressive episode in life.
In order to diagnose a major depressive episode, five or more of the following symptoms appear during a period of two weeks. And at least one of these symptoms has to be depressed mood or loss of interest or capacity for pleasure:
- Depressive mood most of the day and almost every day.
- An acute decrease in interest or capacity for pleasure in all or almost all activities, most of the day.
- Major weight loss without regimen, or weight gain, or loss or increase of appetite almost every day.
- Insomnia or hypersomnia every day.
- Agitation or slowing psych0m0tor almost every day.
- Fatigue or loss of energy almost every day.
- Feelings of excessive or inappropriate uselessness or guilt.
- Decreased ability to think or concentrate.
- Recurrent thoughts of death.
In addition these symptoms cause clinically significant discomfort or social, occupational or other important areas of the individual’s activity.
In turn, within the major depressive episode we can find different subtypes. This division has been made with the objective of proposing an intervention and more specific treatments depending on each case.
This form of depression is very rare, but when it appears its main characteristics are the motor alterations that accompany it.
These alterations may consist of immobility during a period of time or in strange and abrupt movements. When this subtype appears, it is usually accompanied by episodes of mania, that is, in bipolar disorder.
The main symptom, in this case, is the loss of generalized pleasure and an absence of response to stimuli that have usually been considered pleasurable. This symptom is known as anhedonia.
In addition, patients who suffer from it usually notice a worsening of mood in the mornings, wake up early and due to motor disorders such as slowing or agitation of the body or part of it.
Unlike the previous one, it is characterized by a high number of responses to stimuli. It is accompanied by a very high level of anxiety.
Some of the most characteristic symptoms are increased appetite, weight and the need to sleep for many hours.
This episode may appear in the woman after giving birth. The symptoms manifest themselves in the days after childbirth or even a year later.
In addition to the usual characteristics of the depressive state, other peculiarities appear, such as the feeling of fear of being alone with the baby and/or the inability to take care of herself or the newborn. Hormonal alterations have a fundamental role in the appearance of this subtype
The main characteristic is that both the beginning and the end of the episode coincide with a certain time of the year. They usually begin in autumn or winter and remit in the spring, although they may occur at other times.
2- Dysthymic disorder
The main difference of this disorder with the previous one is that the symptomatology is less severe but more sustained in time, at least two years.
The main symptom that appears is a sad mood practically every day and that lasts for at least the two mentioned years. In addition there are two or more of the following symptoms:
- Loss or increase of weight.
- Insomnia or hypersomnia
- Lack of energy or fatigue.
- Low self – esteem.
- Difficulty concentrating or making decisions.
- Feeling of hopelessness
In the two years that this state of mind is maintained, there can not be a period of more than two months in which the symptoms have not appeared. If so, dysthymic disorder could not be diagnosed.
In addition, these symptoms cause significant discomfort in the person who suffers them or social, labor or other important deterioration of the individual’s activity.
3- Major depressive disorder not specified
This category includes depressive disorders that do not meet the criteria for inclusion in the other categories. Within this type of disorder the most frequent are:
Premenstrual dysphoric disorder
It refers to depressive symptoms such as markedly depressed mood, significant anxiety, marked affective liability, loss of interest in activities, etc. They usually appear the last week of the menstrual cycle and disappear in the first days of menstruation.
In order to diagnose it, these symptoms must have appeared in most of the menstrual cycles of the last year.
They also have to be serious enough to interfere noticeably in work, studies or any other important area for the person.
Postpsychotic depressive disorder in schizophrenia
It refers to the appearance of a major depressive episode exclusively in the person suffering from schizophrenia. More specifically, this episode usually appears in the residual phase of schizophrenia.
Minor depressive disorder
It refers to cases that meet the duration criteria (that is, the symptoms appear for two weeks) but do not reach to add the five symptoms to diagnose a major depressive disorder.
Recurrent brief depressive disorder
These are depressive episodes with very short duration (between two days and two weeks) that appear during a year with a frequency of at least once a month.
It is important to distinguish if these episodes are associated with menstrual cycles, in which case premenstrual dysphoric disorder would be diagnosed.
4- Depression due to a duel
After the loss of a loved one symptoms appears very similar to those of the major depressive episode: anxiety, emotional numbness, and denial.
Some people, after the loss, need immediate psychological treatment, because their symptoms cause them a discomfort so severe that they can not continue with their lives.
However, usually the natural process of mourning is resolved in the first months. Although some people continue afflicted for a year or even more.
After the first year, the chances of recovering from a duel without specialized treatment are considerably reduced. In these cases, a normal grieving process becomes a disorder.
The most frequent symptoms in this pathological grief are intrusive memories and painfully strong longings for the loved one, as well as the avoidance of people or places that remember the loved one.
People suffering from depression have a series of symptoms that can be included in five main categories:
Often the basic symptom of depression is deep sadness. But in some cases the sadness can be replaced by irritability.
In the most severe depressions the state of mind is characterized by an inability to feel, an affective anesthesia is experienced. Other symptoms that frequently appear are depression, grief, unhappiness, nervousness, anguish or anxiety.
Motivational and behavioral symptoms
Often people with depression experience the so-called “triple-A depressive”: apathy, apathy, and anhedonia.
These symptoms are related to a general state of behavioral inhibition that in the most severe cases can be manifested with the general slowing of speech, motor responses, gesture, etc. In extreme cases, there may even be a state of motor paralysis.
In this category, two main groups can be distinguished: There is a decrease in the cognitive capacities of the person, such as memory, attention, concentration, mental speed, etc.
On the other hand, cognitive distortions appear, that is, errors in the interpretation of reality, about their environment, the past, the future, and their own person.
Symptoms such as delusions of ruin or catastrophe, as well as auditory, defamatory or accusatory hallucinations, may come to light.
The most common physical symptoms are: sleep disturbances (usually insomnia but hypersomnia can also occur), changes in appetite and weight (by default or excess), fatigue, decreased activity, discomfort and pain bodily ( headaches , abdominal pain, nausea, vomiting, diarrhea, dizziness, cardiorespiratory problems, etc.) and decreased sexual desire .
Often social relationships are completely neglected. According to some research, 70% of people who suffer from depression say they have lost interest in the people around them.
They are usually isolated because in addition to the loss of interest on their part, the discomfort they suffer and transmit often causes rejection by others.
Treatment for depressive disorders
Depression, along with anxiety, are the disorders that are most often treated in the psychologist’s office.
For this reason, there are numerous studies and advances in its treatment. Today we know many and varied techniques to cope and in most cases a satisfactory result is achieved.
Currently, within the psychological treatment, there are three types of therapy that have proven to be more effective: behavioral treatment, cognitive treatment, and interpersonal therapy.
The duration of the treatment will be greater or less depending on the type of therapy, the severity of the symptoms and the advances that the patient makes outside the consultation.
In any case it is important to keep in mind that depression is a disorder that generates a deep discomfort in the person who suffers it.
In addition, they are not always understood by the people around them, as they often downplay the causes that have led to depression. In these cases, it is very important to consult with a mental health professional.
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- American Psychiatric Association (2002). DSM-IV-TR. Diagnostic and Statistical Manual of Mental Disorders.