Several types of depression exist. Depressed (or irritable) mood or a loss of interest in pleasurable activities is characteristic of all types, and all types have to cause impairment in functioning. There are some differences in symptom presentation, however, and treatment approaches may vary somewhat. The different types of depression are
- Major depressive disorder
- Dysthymic disorder
- Seasonal affective disorder
- Bipolar depression
- Depressive disorder not otherwise specified
In major depression qualifiers can be added to the diagnosis, such as “atypical,” “melancholic,” or “postpartum onset.” Such qualifiers describe a specific pattern of symptom presentation. For example, increased appetite, rejection sensitivity, and a sensation of heaviness of the limbs characterize an atypical major depressive episode. Melancholic depression is most associated with sleep and appetite loss and psychomotor retardation. It also is characterized by a phenomenon known as a diurnal variation of mood—feeling much worse in the morning with some improvement in mood by evening.
Major depression and dysthymic disorder are the most common forms of depression. Dysthymic disorder is more chronic with persistent sadness nearly daily for at least 2 years. In seasonal affective disorder the depressive symptoms are the same as in major depression but occur exclusively within one season (usually the winter). Bipolar depression is the depressed phase of a condition called bipolar disorder (see Question 19). In many cases the symptom presentation of depression does not fit the criteria as described in the DSM-IV-TR . Symptoms, however, may be causing impairment in functioning. The diagnosis of depressive disorder not otherwise specified can be used in those cases. Although the type of depression impacts the prognosis and treatment modality, in general, all types respond to a combination of medication therapy and talk therapy.