What are the different types of depression?

There are a number of different types of depression and symptoms of major depression or clinical depression often vary depending on the patient. In order to clarify the type of depression the patient has, the doctor may add a specifier or two.

Specifiers mean that the depression has specific features or symptoms, these may include:

Anxious distress 

This means that the depression is marked by worry, distress or unusual restlessness about losing control over one’s life or about a possible event that may or may not take place.

Mixed features 

This denotes mania and depression that occur simultaneously. Symptoms include having self-esteem that is elevated, having increased energy and talking more than usual. Symptoms of mania mean the patient is unusually happy or excited for a period, therefore they have bouts of unexplained euphoria and then experience depression at other times.

Melancholic features 

Melancholic features are associated with cases of severe depression that are marked by a lack of excitement, enthusiasm or interest.  Waking up early and negative moods in the mornings (i.e. symptoms of this specifier are often worse in the mornings), acting negatively or not at all to something that was once met with emotions of happiness in the past, losing one’s appetite, or having major changes in appetite or expressing feelings of sluggishness, guilt or agitation are symptoms of depression marked by melancholic features.

This type of depression used to be seen as a distinct disorder, however, it is now no longer recognised as a separate mental condition, but rather a specifier, or subtype of MDD (major depressive disorder). It is defined by intense and persistent emotions of hopelessness and sadness, affecting multiple areas of one’s life. People with melancholic depression may have the below symptoms:

• Extreme and persistent feelings of sadness over a prolonged period
• Loss of enthusiasm and interest in things that were once met with excitement
• Acting anxious and irritable
• Changes in appetite (eating too little or too much)
• Changes and twitches in body movement such as shaking one’s leg (something that was not done before)
• Suicidal thoughts or thoughts of death
• Loss of pleasure in daily activities
• Not wanting to wake up in the morning at all

Atypical features 

Atypical depression is referred to as a subtype of depression and can be a specifier for both major depression and dysthymic disorder (aka persistent depressive disorder).

As the name implies, it does not follow typical depression symptoms in that the person suffering from it may be temporarily cheered up by the occurrence of positive events (which is not generally the case with other forms of depression).

 This type of depression consists of the following symptoms:

• Suffering from hypersomnia, this means sleeping too much and possibly not wanting to wake up
• Having an increased appetite which leads to weight gain
• Experiencing feelings of being paralysed or constantly weighed down
• Having an increased sensitivity to criticism or rejection, this often results in issues at work and in personal relationships.

The cause of this specifier of depression is believed to be due to issues with the functionality of brain circuits that are responsible for regulating one’s mood and allowing one area of the brain to communicate with another through the use of neurotransmitters, which are chemicals in the brain that allow for the brain to transmit signals and tell the body how to function properly.

Nerve cells in these communication circuits use neurotransmitters (chemicals which include serotonin, norepinephrine and dopamine) as the communicators and when issues arise with regard to the functioning of these systems, changes emerge in the brain that may lead to depression.

Psychotic features

This is also known as psychotic depression, and it is marked by psychotic features such as delusions, paranoia or hallucinations experienced by the patient. Delusions are false perceptions of, or false beliefs regarding reality wherein the deluded person cannot distinguish between what is real and imagined. Hallucinations, on the other hand, are a sensory experience wherein the patient may hear, see or feel something that does not exist. Hallucinations are generated by one's mind, as opposed to external stimuli. 

For example, someone may believe that their partner is trying to murder them, this is a delusion, a hallucination is seeing something that is not there, such as seeing wolves attacking them when in actual fact, there are no wolves. This can be a very stressful situation for someone to go through and terrifying for both themselves and those around them.

Catatonia 

Catatonia, which is also known as catatonic depression, is defined as a state of stupor, stupor meaning a state of near-unconscious or being dazed.

This type of depression results from motor (muscle movement) activity and involves either purposeless or uncontrollable movements, being in an inflexible posture or a rigid position being held for a long period of time. The patient may feel leaden, this is a state of paralysis where the body will feel heavy in the arms and legs, feeling as though they are unable to move.

Peripartum onset 

Also known as postpartum depression, this specifier of depression usually occurs within the first four months after giving birth but can present itself at any time within the first year after birth (thus being termed postpartum or postnatal depression.) It may also occur during a pregnancy in some cases.

It is defined by symptoms of a loss of appetite, feelings of shame, finding it difficult to bond with one’s baby, feeling guilty or inadequate as a parent. Roughly 10 to 13 percent of women who have recently had a baby will suffer from this type of depression after their baby has been delivered, however, as mentioned, the symptoms can begin before the baby is delivered This condition is not restricted to women only and can affect both the mother and father, being particularly prevalent in first time parents.

Many women who have had a natural birth do not have as high of a risk of developing this type of depression as their body will naturally release oxytocin, which is a ‘happy’ hormone that is released during the birthing process.

It is also important to note that suffering from “baby blues”, a normal, short-term period (lasting up to two weeks) which is thought to affect up to 80 percent of new mothers, making them feel sad and weepy or irritable and moody, due to changing hormone levels after giving birth, is not the same thing as peripartum onset depression whose symptoms are persistent and longer lasting.

Seasonal pattern 

This type of depression is related to the changes in the seasons as well as being exposed to sunlight, or more specifically, the lack thereof. This is also known as seasonal affective disorder, abbreviated as SAD. It can often result in patients becoming depressed in the colder, darker months. However, it is important to note that there is no hard evidence to suggest that this type of depression is real, although it is a specifier of depression.