I feel very passionate about this subject.  Depression is an enormously common disorder that destroys many lives and diminishes even more.  Many people who have it don’t even recognize the problem. Among those who do realize they are suffering, many do not seek treatment or realize that treatment for depression is widely available and highly effective.  Helping people to be more aware of depression, to recognize it when they feel it in themselves or observe it in loved ones can facilitate more people getting the help they need and that change their lives dramatically.

TYPES OF DEPRESSION

There are actually several recognizable and fairly different types of depression.  In the past it was thought that were primarily two types of depression, endogenous, meaning a condition that arises from within having to do with the inherent nature of a person and exogenous, arising from external circumstances such as loss, grief, trauma or pain.  Years ago psychiatrists and psychologists thought that only one type, endogenous, could be treated with medication and that exogenous depression would only benefit from psychotherapy.  Research now shows that a combination of psychotherapy and medication is the strongest and most effective treatment for most types of depression.  The following types of depression are currently defined.

1) Major Depression  can be a chronic condition, called Recurrent or a Single Episode if it is the first time it has occurred.  A large percentage of people with depression will report suffering episodes off and on throughout their lives.  Major Depression is now being diagnosed even in very young children.  A Single Episode Depression often is initiated by a major loss or trauma in life and can occur even in someone who has never before suffered from depression.  Major Depression can range from mild to severe.  Severe depression becomes more dangerous as suicide is a risk.

2) Postpartum Depression is a Major Depression that occurs after childbirth and is thought to be related to hormonal changes.  About 17% of women experience Postpartum Depression after delivering a baby.  Prenatal depression also occurs to about one in 10 women so it is less common but can be debilitating.

3) Dysthymia is a milder version of Major Depression that must have been occurring at least two years to be diagnosed.  This condition is diagnosed when there are only two of six common symptoms present. The six symptoms of dysthymia are: changes in appetite, changes in sleep, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions and feelings of hopelessness. Diagnosis is often missed for this condition as the individual and people around them may think they are just an irritable or pessimistic person.

4) Bipolar Disorders are complex and often more severe conditions although they can range from mild to incapacitating. A diagnosis of Bipolar I Disorder  requires episodes of mania, an extreme condition, as well as episodes of depression or mixed episodes of depression and mania. Bipolar II Disorder seems to be a more common condition and much more difficult to diagnose as it looks primarily like Major Depression.  The episodes of Major Depression are punctuated by brief periods of hypomania, a mild form of mania which the person often considers to be a return to high functioning.  Since the hypomania is not perceived as abnormal it is often not reported to treating doctors or therapists and must be discovered by an alert and persistent clinician.  It should usually be suspected in people who are being treated for depression and who are not making steady improvement, despite various methods being tried.

SIGNS OF DEPRESSION

Depression seems like it would be easy to spot and obvious but as the list above reveals, depression has several definitions and types and the signs can be different.  Skill and experience can be necessary to truly evaluate the signs of depression and make an accurate diagnosis and treatment plan.  The stigma of seeking help prevents many from seeking care even when there are obvious signs.  More depression is reported to family doctors and internists than to mental health clinicians.  Physicians are being educated to recognize the signs of depression but often do not have the luxury of time to allow their patients to really discuss how they are feeling.  If you recognize signs of depression, if you understand that you have a treatable condition, your chances of improving your life are greatly increased.