Different Types of Depression

October 07, 2008

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Different Types of Depression

by Robert Needlman, M.D., F.A.A.P.
reviewed by Robert Needlman, M.D., F.A.A.P.

In diagnosing depression, most doctors refer to a book called the DSM-IV. (The full name, which no one uses, is The Diagnostic and Statistical Manual of Mental Disorders, fourth edition.) The DSM-IV gives the official criteria for mental disorders according to the American Psychiatric Association. For laypersons, the terminology can be confusing. The purpose of this article is to help clear up the confusion.

It's important that you don't try to use this article as a guide for a do-it-yourself diagnosis. For one thing, a short article can't contain all the relevant information. Also, diagnosing depression takes more than just knowing the criteria. You have to know how to interpret them and how to rule out other psychiatric and medical conditions. The goal of this article is to help you communicate more effectively with your doctors, not to replace them.

Major depressive episode
The main features of a major depressive episode are that it lasts at least two weeks (usually much longer) and includes depressed mood or a marked loss of interest or pleasure in all activities. The mood is sad or tearful or empty, or it may be very irritable (more common in children and adolescents). During almost every day of the episode, these moods last most of the day.

Other symptoms include significant weight loss or gain, or appetite change; sleeping much more or less than usual; agitation (an excess of nervous energy) or its opposite, difficulty moving at a normal rate; low energy; severe feelings of guilt or worthlessness; difficulty thinking or making decisions; and thoughts of death or suicide.

In a major depressive episode, a person has at least four of these symptoms, in addition to either depressed mood or loss of interest. The symptoms have to be severe enough to interfere with a person's ability to function at home, in school, or on the job. They can't be caused by other medical problems (such as hypothyroidism) or by medications, or by other psychiatric diagnoses.

Manic episode
Depressive episodes sometimes come along with episodes of the opposite mood, mania. The main feature of a manic episode is a week or more of "high" mood (overly energetic, happy, expansive), or irritability, along with at least three or four of the following:

Inflated self-esteem (really believing you're the greatest person in the world, for example)

Decreased need for sleep

Being overly talkative, much more so than usual

Racing thoughts

Distractibility (attention swings from one thing to another)

Increased and uncharacteristic goal-directed activity (getting a huge amount of work done, for example), or just being unusually agitated about your work or other activities

Reckless pleasure seeking (for example, going on spending sprees or engaging in highly risky sexual activity).

As with regular depression, the symptoms have to be severe enough to interfere with daily functioning, and they can't be the result of medication or a medical illness.

Other definitions

A mixed episode is one that meets the criteria for both major depressive episode and manic episode.

A hypomanic episode is much like a manic episode, only less severe.

Once other psychiatric disorders are ruled out, psychiatrists diagnose major depressive disorder if a person has had at least one major depressive episode.

If a person has had both a major depressive episode and a manic or hypomanic episode, the diagnosis is bipolar disorder, also called manic-depressive disorder.

Dysthymic disorder is similar to major depressive disorder, but less severe. Symptoms have to be present for at least two years.
Cyclothymic disorder is the diagnosis when a person has milder symptoms of depression, mixed with hypomanic episodes.

Knowing these terms doesn't automatically make the problems go away, of course. But it can help to realize that there are names for many of these disorders; it's possible to talk about them, and handle them.


RELATED INFORMATION

			Depression

Created February 18, 2001
Reviewed August 15, 2004

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