Depression refers to a deeply felt sense of sadness or despair that tends to overwhelm a person. It may have started out as a dark feeling but has progressed to an illness that affects every aspect of the person’s life.
Clinical depression is different from having “the blues” in that it is all consuming and requires treatment. Depressive illness or clinical depression impacts on everything: sleeping, eating, and energy level, ability to work effectively, mood, cognitions (thoughts), judgment, and more. It can be viewed as both a psychological and physical condition.
There are several types of depression. In this article I describe 4 of the most well known types. Distinctions between the different forms of depression are important to understand because they help us to choose the best possible treatment.
Major depression is also known as major depressive disorder (MDD). A person who has this illness has been feeling deeply sad persistently for about 2 or more weeks. He is unable to enjoy himself even when doing things that previously gave him pleasure. He has lost interest in most everything and seems listless and flat. When interviewed, people with MDD will likely report feeling hopeless and unable to get motivated. They often feel as if they are sinking deeper and deeper and are unable to control the descent into oblivion.
People of any age can become victims of MDD. However, it will often strike those between the ages of 25-45. In addition MDD can frequently run its course in 6-9 months. This type of depression can be a one time event but once it strikes there is a good possibility that it will happen again, perhaps several times in a person’s life.
Another form of depression is known as dysthymia. This type of depression often begins early in a person’s life, frequently in childhood, and continues throughout adulthood. It is a milder form of depression and is diagnosed when someone has been feeling sad, unhappy, irritable, generally withdrawn and disinterested in life for 2 or more years.
People with this type of depression often have a hard time remembering if they have ever felt “happy”. They are frequently critical of themselves and seem never to have any fun. Since this condition is chronic the person’s low mood can go unnoticed, appearing “normal” for him.
It is usually when the individual becomes more severely dysthymic that he seeks treatment. Sometimes his mood is so disturbing to a spouse, friend or family member, they insist he get help. Other times he may get so disgusted with a fruitless, unhappy life that he becomes self motivated to seek it out.
Dysthymia seems to affect twice as many women as men. Depression in general has more female than male victims.
This type of depression is also known as manic-depressive disorder. It is characterized by significant mood swings that that interfere with a person’s ability to function. Shifts in mood are often so severe that the person’s entire life is affected by them.
Bipolar Disorder is different from other depressions in that the person has experienced at least one or more manic episodes. When a person is having a manic episode he can seem to go on non stop. He needs little or no sleep, his speech may be rapid and his ideas change very quickly, he can become grandiose or belligerent and might even cause himself or others physical harm. Since these symptoms are episodic and may appear years apart, the person may go untreated for a long time.
This condition will often appear early in one’s life and is likely to be chronic. Manic episodes are frequently followed by a drop into the black hole of a major depression. These cycles can occur many times causing enormous disruption and wreaking havoc on the individual and his family.
This is a type of major What is the connection between sleep and mood that can strike a woman after childbirth. It is thought that the dramatic hormonal changes that take place both before and immediately after a baby is born may trigger a depression. Postpartum depression affects about 10% of new mothers, but is more common in mothers who have had some prior depression.
This depression is made more tragic because a new mother’s emotional world is turned upside down and her dreams of enjoying the joys and wonders of motherhood completely destroyed. As a result of the many changes that take place in a woman’s life once a baby is born, there are many factors that can contribute to this kind of depression.
New mothers routinely experience lack of sleep, feelings of being overwhelmed, high degrees of stress, loss of identity and feeling less attractive or desirable. A mother may resent her new child, feel irrationally angry towards it and, at the same time, feel horribly guilty for having these feelings in the first place. If these feelings persist they can weaken her defenses and create more potential for postpartum depression to occur.
Treatment early and effectively can prevent it from becoming more severe and lasting longer. The type of depression a person is suffering with will determine the best choice for treatment.
Major Depression and Dysthymia can be treated with both psychotherapy and medication. Most people respond well to these in combination. Psychotherapy should focus on learning coping strategies, problem solving skills, challenging negative mindsets and changing critical as well as pessimistic thought patterns. Improvement comes when a person begins to feel empowered and more in control of his life (and emotions).
Supportive therapy should also be used to help address painful feelings of hopelessness and despair. However this type of therapy should be a part of the treatment and not the only method.
Medication is an option with major depression. Antidepressant medication can often help to relieve the painful impact of symptoms such as the inability to concentrate or sleep, inability to work, control emotions or make decisions necessary to effectively conduct everyday life.
Antidepressants work by increasing the availability and level of certain neurotransmitters in the brain. Neurotransmitters carry information to the different parts of the brain. These chemicals and their levels of availability affect the range of moods we experience.
In severe cases of depression where other forms of treatment have not helped, electroconvulsive therapy (ECT) may be recommended. In this type of therapy electric current is passed through the brain of the patient while under anesthesia causing convulsive seizures to occur for about 15 seconds each. ECT has been shown to be effective, especially as a treatment of last resort, but its side effects can include some memory loss and disorientation.
The treatment of Bipolar Disorder will most likely include medication. As explained in the previous article, this is a very serious and disabling mental illness. It is chronic and manic episodes followed by depressive episodes are likely to recur if treatment is not ongoing.
Lithium and anti-convulsive medications such as Depakote, Lamictil and Neurontin are often used in combination to achieve mood stabilization. Getting the patient on the best combination of medication is both science and art and can be trying for the patient and his family.
People with bipolar disorder are sometimes discouraged by the difficult task of keeping their moods in check over long periods of time. The patient sometimes complains that the edge or “high” he used to enjoy feeling has been replaced by a different mood, one he may interpret as being flat and boring.
When this occurs he may stop taking the medication and go back to “cycling” through his moods again. That is why long-term counseling that includes the monitoring of the patient’s medication, moods, sleep patterns and general health is often critical in maintaining control over bipolar disorder.
Postpartum Depression has similar symptoms to major depression. If left untreated the consequences of postpartum depression can be sever. The attachment bond that is so important for a child’s healthy development will likely not occur if mother is not getting the help she needs.
Treatment here should be multifaceted and involve the entire immediate family. Counseling should educate the family members and enlist them to help more around the home. Individual therapy is necessary to help the mother learn and implement the coping skills that are so important for her new role.
The option for medication needs to be weighed against the severity of the depression. If a mother is breast feeding for example, taking medication can be dangerous to the health of the baby. The same problem exists when hormone replacement therapy is recommended.