This mood disorder can take different forms, depending on your symptoms and other variables.
Depression is one of the most prevalent mental disorders worldwide . Specifically, and according to the WHO, it is the leading cause of disability and sick leave in the world.
Depression is characterized by causing deep sadness, as well as an inability to enjoy things that used to produce pleasure (a symptom called anhedonia), and many other symptoms, such as guilt or apathy.
Depression can manifest itself in many ways in terms of symptoms and course. In this article we will learn about the different types of depression according to five criteria : the number of episodes, the type of episodes, the symptoms, the onset/course and the new specifications of the disorder proposed by the DSM-5.
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What is depressive disorder?
Before seeing what types of depression exist according to the parameters mentioned, we are going to see briefly what depression (or depressive disorder) consists of.
Depression is a mood disorder, classified as such in the DSM-IV-TR . In the DSM-5 , in addition, the category of depressive disorders is created (as an independent category), which encompasses a series of disorders with depressive symptoms.
The prototypical disorder is depression, with the presence of mood symptoms (sadness, unhappiness…), motivational and behavioral (inhibition, apathy…), cognitive (altered performance and deficits in attention and memory, among others), physical (sleep problems, fatigue…) and interpersonal (deterioration in personal relationships, rejection…).
In the DSM-5, classically known depression is conceptualized as “major depressive disorder”. That is why in this article we will speak interchangeably of “depression” and “depressive disorder”, being here interchangeable terms.
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types of depression
We are going to analyze the different types of depression, according to four different parameters or criteria.
1. According to the number of episodes
Depending on the number of depressive episodes, we will talk about different types of depression . It is worth mentioning that a depressive episode implies the appearance of depressive symptoms (according to the DSM-5, five or more symptoms) for a minimum of two weeks; the symptoms, in addition, must appear almost every day, and cause significant discomfort to the patient.
1.1. Single episode major depressive disorder
The first of the types of depression according to its number of episodes is single episode, and is characterized in that the person has only presented (or currently presents) one depressive episode, with no previous history of depressive episodes.
1.2. Recurrent major depressive disorder
In the event that two or more depressive episodes have appeared over time, we would diagnose a recurrent major depressive disorder, which implies that the depression is recurrent.
2. According to the type of episodes
Perhaps this is the best known classification in terms of types of depression. In this case, the criterion is based on the type of episode(s) that the patient has (or has had). We found two: bipolar depression and unipolar depression.
2.1. bipolar depression
Bipolar depression is characterized in that the patient has had (or is having) a manic or hypomanic episode in addition to the depressive episode. The two types of episodes are presented with a certain temporal space. This type of depression is so named because the person has been in both poles (bi-polar); the depressive and the manic.
This type of disorder occurs with equal frequency between men and women, in a ratio of 1/1. The average age of onset is 20 years. On the other hand, the percentage represented by bipolar depressions, in relation to the total number of mood disorders, is 10%.
2.2. unipolar depression
Continuing with the types of depression according to the episodes that the patient presents, we find the second: unipolar depression. This is characterized by presenting only depressive episodes (never manic or hypomanic); that is, the patient has only been in “one pole”.
Unlike the previous one, it occurs more frequently in women than in men, in a ratio of 2/1. In addition, its onset is later (the average age of onset is 35 years). Finally, in the case of unipolar depression, the percentage that it represents in relation to the total number of mood disorders is 90%; that is, the vast majority of cases.
3. According to symptoms
Depending on the type of symptoms that appear, in addition to “classic” major depressive disorder, there are two other types of depression: atypical depression and melancholic depression .
In addition, these two types of depression constitute specifications of the disorder typical of the DSM-IV-TR (that is, when diagnosing depression, it can be specified whether it is melancholic or atypical, if it corresponds to one of these two types).
3.1. atypical depression
Atypical depression is characterized by a series of specific symptoms, such as a reactive mood in positive situations , together with at least two of the following symptoms: weight gain or appetite, despondency (limbs feel heavy or inert), hypersomnia (high need for sleep), and a prolonged pattern of sensitivity to interpersonal rejection (causing significant social impairment).
In addition, atypical depression has the characteristic that it responds very well to pharmacological treatment with MAOI antidepressants (Monoamine Oxidase Inhibitors).
3.2. melancholic depression
Continuing with the types of depression according to its symptomatology, we find melancholic depression, which is characterized by a peculiar pattern of symptoms: a greater vegetative component especially appears, together with symptoms such as anhedonia. Unlike atypical depression, melancholic depression responds very well to treatment with tricyclic antidepressants and ECT (Electroconvulsive Therapy).
Thus, broadly speaking, a person with melancholic depression will usually feel worse in the mornings, present early awakenings (before the “usual” time at which the person used to wake up), psychomotor retardation or agitation, anorexia or weight loss and excessive or inappropriate guilt.
Together with all (or some) of these symptoms, there is also a depressive mood, qualitatively different from that which typically appears in depression.
4. Depending on the start/course
Following a third criterion to classify the different types of depression, we find different depressions according to their onset and/or course.
4.1. postpartum onset depression
This type of depression appears in the first four weeks postpartum, according to DSM-IV-TR, and in the peripartum period (which includes pregnancy), according to DSM-5. Specifically, it is a specification of depression in the DSM-IV-TR.
It affects a large number of women, and its etiology has been related mainly to biological and hormonal factors.
4.2. Seasonal pattern depression
Seasonal pattern depression entails a sustained temporal relationship between the onset of depressive episodes and a time of year; this means that the episodes usually appear in a specific season (or time) of the year.
On the other hand, and according to the diagnostic criteria (since this type of depression is also a specification of the depressive disorder in the DSM-IV-TR), the remissions of the disorder (or the change of pole, in the case of bipolar disorder ) , also occur at a certain time of year.
In order to establish this specification together with the diagnosis of depressive disorder, it is required that in the last two years there have been two seasonal episodes (at least) and none non-seasonal. In addition, these episodes are required to be the majority in the patient’s life.
5. According to DSM-5 specifications
Until now we have been commenting on different types of depression, according to different criteria, and according to some specifications of depression that appear in the DSM-IV-TR. However, the DSM-5 introduces two new specifications for depressive disorder , and with them, we find two new types of depression.
5.1. Depression with anxious discomfort
According to the DSM-5, this type of depression is characterized by presenting the classic symptoms of depression, together with at least two anxiety-type symptoms, such as: a feeling of nervousness or tension, difficulty concentrating (due to worry) , fear that something terrible will happen, feeling that you could lose control at any moment, and feeling unusually tired.
In addition, this type of depression requires specifying the severity of the disorder: mild (if 2 of the aforementioned anxiety symptoms appear), moderate (if 3 appear), moderate/severe (if 4 or 5 appear) and severe (if 4 or 5 appear). together with a state of agitation).
5.2. Depression with mixed symptoms
Depression with mixed symptoms, according to the DSM-5, is characterized by meeting criteria for a depressive episode, and by meeting at least 3 diagnostic criteria for another episode, the latter being a manic, hypomanic, or mixed episode.
Bibliographic references
- American Psychiatric Association (APA). (2000). DSM-IV-TR. Barcelona: Mason.
- American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
- Belloch, A.; Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.