Depression

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The word “depression” is used in many different ways. People often say they are depressed when they are feeling sad or blue when bad things happen. In most cases, this sort of depressed mood will pass within a few hours or a few days. However, in some people the depressed mood does not go away and they develop other symptoms besides sadness. Because of these symptoms, they have difficulty doing their work or study and have problems in interacting with family and friends. In the worst cases, the person will feel that they are better off dead and may make plans to end their life. When depressed mood becomes long-lasting, is accompanied by other symptoms, and interferes with the person’s ability to fulfil their goals in life, the person has a depressive disorder. These disorders are sometimes also called mood disorders or affective disorders.

Symptoms of a depressive disorder

If a person has a depressive disorder they would have, for at least two weeks, nearly every day, many of the following symptoms:

An unusually sad mood
Loss of enjoyment and interest in activities that used to be enjoyable
Lack of energy and tiredness
Feeling worthless or feeling guilty when they are not really at fault
Thinking about death a lot or wishing to be dead
Difficulty concentrating or making decisions
Moving more slowly or sometimes becoming agitated and unable to settle
Having sleeping difficulties or sometimes sleeping too much
Loss of interest in food or sometimes eating too much. Changes in eating habits may lead to either loss of weight or putting on weight.

Not every person who is depressed has all these symptoms. People differ in the number of symptoms they have and also how severe the symptoms are. A person who has mild depression would have 5 or 6 of the above symptoms. They would be affected in their ability to function at work or in their family roles, or they might be able to function with unusual effort. A person who has severe depression would have most of the symptoms and would be clearly unable to function. A person with moderate depression would be in between mild and severe. The Patient Health Questionnaire can be used to find out whether a person has a depressive disorder.

Different types of depressive disorders

Mental health professionals recognise different types of depressive disorders. ¹ The main ones are:

Major depressive disorder

Major depressive disorder is sometimes called “major depression”, “clinical depression”, “unipolar depression” or simply “depression”. It involves low mood and/or loss of interest and pleasure in usual activities. In addition, the person will have other symptoms such as those described earlier. The symptoms are experienced most days, nearly every day and last for at least two weeks. The symptoms interfere with the person’s work and social relationships.

Dysthymia

Dysthymia is milder than major depressive disorder, but lasts longer. A person has to have this milder depression more than two years to be diagnosed with dysthymia.

Bipolar disorder

Bipolar disorder used to be known as “manic depression”, because the person has periods of depression, but at other times periods of mania. In between they have periods of normal mood. Mania is like the opposite of depression and can vary in intensity. The person may feel great, have plenty of energy, talk fast, have racing thoughts and little need for sleep. The person may have difficulty focusing on tasks and may become frustrated and irritable. Sometimes the person loses contact with reality. For example, they could become convinced that they have special powers or are some important person (such as Jesus or a famous movie star). When in a state of mania a person can do foolish things such as get into debt or take serious risks.

Other types of depression are sometimes distinguished:

Psychotic depression

Sometimes a person with a depressive disorder can lose contact with reality (becomes “psychotic”). For example, they may falsely believe that other people are persecuting them or that they are being punished for bad actions in the past.

Melancholia

This is a more biological form of depression. The person is more likely to have depressed mood that feels different from normal sadness, early wakening, being slowed down, weight loss and excessive guilt. One of the major changes is that the person can be observed to move more slowly.

Seasonal affective disorder (SAD)

This form of depression comes and goes with the seasons. The most common pattern is for the person to become depressed in the winter or autumn. This is sometimes called “winter depression”. Lack of sunlight is the cause. People with seasonal affective disorder are more likely to experience lack of energy, sleeping too much, overeating, weight gain and a craving for carbohydrates.

Post-partum or post-natal depression

Women are at increased risk of depression following childbirth. Causes include hormonal and physical changes and the responsibilities of caring for the baby. For many women, this may only be mild “baby blues”. For other women it is longer lasting and interferes with their mothering in a significant way. The symptoms do not differ from depression at other times. However, depression at this time has an impact not only on the mother, but also on the mother-infant relationship and on the child’s development.