Subtypes of depression
What are the subtypes of depression?
Though common, there are different types of depression, which can take different courses. Signs and symptoms vary in number, timing, severity, and persistence, but on the whole they are quite similar. As different subtypes of depression may require different treatments, your doctor will want to identify which type is affecting you. There are also differences in how individuals experience depression and express symptoms in accordance with age, gender, and culture.
Depression is a mood or affective disorder that in most patients occurs in phases. This means that periods of normal mood alternate with depressive episodes. Sometimes, in addition to depressive episodes, manic episodes occur characterized by euphoria (very high mood), hyperactivity, irritability and agitation. In this case not a unipolar depression but a bipolar depression (depressive episode in the context of a bipolar affective disorder) is diagnosed.
1. Depressive episode
The most common and typical form of depression is the depressive episode. An episode can start rapidly within few days or slowly over several weeks and typically has a duration of several weeks and months. A number of depressive symptoms have to be present permanently for at least 2 weeks in order to be able to speak of a depressive episode. The majority of people experiencing a depressive episode will have further episodes in their life (recurrent depressive disorder). This risk of recurrence can be reduced by an appropriate treatment.
2. Recurrent depressive disorder
When the depressive episode recurs, we speak about recurrent depressive disorder.
Dysthymia is characterised by milder severity of depressive symptomatology compared to depressive episodes or recurrent depressive disorder. However, the disorder starts mostly during adolescence and is persistent with symptoms lasting at least 2 years, sometimes decades. People suffering from this type of depression sometimes suffer additionally from depressive episodes. In this case with dysthymia and depressive episodes the diagnosis is double depression.
4. Bipolar depression
Bipolar Affective Disorders (manic-depressive disorder) are severe disorders. They are less frequent than unipolar disorders.
Two subforms are distinguished: bipolar I and bipolar II.
Bipolar I patients suffer from both depressive and manic episodes. The manic episodes can suddenly occur after several depressive episodes and the original diagnosis of unipolar depression has to be changed to bipolar affective disorder. This change in mood state can occur very rapidly (switch over night) after a depressive episode or after months and years of an healthy mood state. Manic phases are characterized by excessive high mood, connected with hyperactivity, restlessness, irritability, talkativeness and reduced need for sleep.
Mania affects thinking, judgment, and social behaviour causing serious problems and difficulties. Indiscriminate or unsafe sexual practices or unwise business or financial decisions may be made when an individual is in a manic phase.The best way to describe this alternating "turmoil of emotions" is "going from being on top of the world to the depths of despair".
Bipolar II: If the manic symptoms are less pronounced and do not lead to major psychosocial problems, not a manic but hypomanic episode is diagnosed. If a patient suffers from both depressive and hypomanic episodes a bipolar II disorder is diagnosed. Sometimes the hypomanic episode occurs immediately after the end of a depressive episode.
5. Psychotic depression
A special form of depressive episode is psychotic or delusional depression. Psychotic depression is characterized by false ideas and convictions (delusions) and sometimes also by hallucinations. The delusions have typically centered around grossly exaggerated feelings of guilt (e.g. “I am only a burden for my family” or “I have made a terrible mistake”), around the fear of complete financial ruin (delusion of poverty) or around exaggerated fear of incurable severe disease (hypochondriac delusion). Delusions typically exist even if there is evidence of the contrary (e.g. enough money available). Patients with psychotic depression almost always need psychiatric inpatient treatment because of the severity of this disorder and the very high suicide risk. Psychotic depression can occur in both unipolar and bipolar depression.
6. Atypical depression
Patients with this type of depression have the same depressive symptoms as those with typical depression with two exceptions: whereas in typical depression patients have a lack of appetite (often with loss of weight) and difficulties to fall asleep, patients with atypical depression show overeating and oversleeping. This type of depression can occur in unipolar and bipolar depression.
7. Seasonal affective disorder (SAD)
Patients with SAD show the atypical symptoms described in atypical depression and in addition suffer from this kind of depression only during a certain season of the year, in most cases during autumn and winter. Usually, when the depression season ends, people get well and regain normal functioning again.