Depression’s Many Shades of Blue

Understanding the different types of depression is essential to ensuring those with symptoms get the treatment they need, many experts argue.

When it comes to depression there is no single, one-size-fits-all entity. It comes in many different shades of severity, of symptoms and of causes.

As a result many psychiatrists now argue that it is helpful to understand major depression not as a single condition, but as different sub-types. Not only do these subtypes and disorders vary in terms of the symptoms, but also in how they respond to different treatments.

Non-melancholic depression

Non-melancholic depression refers to depression that is primarily psychological, rather than biological.

It is sometimes called ‘reactive’ depression because it develops in response to a stressful life event, such as the death of a loved one, divorce or job loss, or ongoing stressors that have a negative effect on someone’s self-esteem. It can also come about as a result of an individual’s personality type.

Of those people who go to their doctor with depression, 90 per cent of cases fit into this category.

While non-melancholic depression is common, it can also be difficult to diagnose because it doesn’t generally have the same distinguishing features that characterise other forms of depression, such as extreme lethargy or delusions.

The main features of non-melancholic depression are:

  • a depressed mood for more than two weeks,
  • social impairment; for example, difficulty functioning normally at work or in relationships.

On the positive side, people with non-melancholic depression often get better by themselves over time. This type of depression also tends to respond well to treatment, particularly psychological treatments such as psychotherapy or counselling, that can help individuals deal with the stressors that may have triggered the depression in the first place.

Melancholic depression

Melancholic depression is less common and affects between 2 and 10 per cent of people who have been diagnosed with depression; but it tends to be more severe than non-melancholic depression, affecting not only mood but also physical function.

People with melancholic depression often have:

  • extremely depressed mood
  • difficulty being cheered up
  • an inability to find pleasure in anything
  • extreme lethargy – tend to move more slowly
  • low energy
  • poor concentration
  • more agitated movements (sometimes).

Melancholic depression rarely gets better by itself and doesn’t tend to respond well to psychological therapies as a first step. Melancholic depression is best treated with drugs, such as antidepressants, which can help to correct the underlying imbalance of neurotransmitters – the brain’s chemical messengers – such as serotonin, dopamine and noradrenaline.

When the depression starts to abate, psychological interventions can play an important role in getting a person back to full functioning.

Psychotic depression

Psychotic depression is the rarest of the depression sub-types.

People with psychotic depression tend to have a more severe depressed mood than melancholic and non-melancholic depression, and more severe psychomotor disturbances, such as lethargy, poor concentration and slowed or agitated movements.

On top of that, psychotic depression’s most defining characteristics are psychotic symptoms such as hallucinations (seeing things or feeling sensations that aren’t real), delusions (false beliefs) and paranoia (believing that people are conspiring against them or that they themselves are the cause of bad things happening around them).

Psychotic depression will not get better by itself and only responds to treatment with medicines such as antipsychotics and antidepressants.

Antenatal/postnatal depression

Having a new baby can be extremely stressful, particularly in the first year as the usual day-to-day challenges of life are compounded by lack of sleep, the general chaos associated with a new baby, and hormonal changes.

However, for some women, the so-called ‘baby blues’ persist for much longer or are more severe, affecting not only the mother but also her relationship and interactions with her baby, partner and family. This then becomes known as postnatal depression. If the depression affects a mother during, rather than after pregnancy, it is called ‘antenatal depression’.

Around 10 per cent of women will experience antenatal depression, but even more – around 16 per cent – will experience depression in the first year after their child’s birth. (For more see our post-natal depression fact file.)

Bipolar Disorder

Once known as ‘manic depression’, bipolar disorder features both depression and periods of mania interspersed with periods of normal functioning. It’s thought to affect around 2 per cent of the population.

The mania or hypomania of bipolar disorder can take a variety of forms. Individuals may actually feel really good during periods of mania, with lots of energy, racing thoughts, little need for sleep and fast talking. However, they may also be easily frustrated and irritable and having difficulty focusing on tasks.

Sometimes people with mania experience features of psychosis, such as hallucinations and delusions, e.g. believing they have superpowers.

Bipolar disorder I is the more severe disorder in terms of symptoms, and those with the condition are more likely to experience mania, have longer ‘highs’, be more likely to have psychotic experiences and be more likely to be hospitalised.

Bipolar disorder II is diagnosed when a person experiences the symptoms of a high but with no psychotic experiences. These hypomanic episodes can last a few hours or a few days, but research suggest the effects can be as severe as in bipolar I disorder.

While bipolar disorder does appear to run in families, it is often triggered by a stressful event or conflict.

It can be hard to diagnose unless the doctor is aware of the mania or hypomania and because of that, bipolar disorder is often misdiagnosed as depression or schizophrenia, or is blamed on other factors such as drugs or alcohol abuse.

Seasonal Affective Disorder

Seasonal Affective Disorder, or SAD, is a mood disorder tied to changes in season. Thankfully in sunny Australia, SAD is relatively rare compared to gloomier northern hemisphere climates.

SAD generally follows a pattern of depression – including symptoms of lack of energy, excessive sleeping and eating, weight gain and a craving for carbohydrates – starting at the beginning of winter and lifting at the end of the season.

The pattern is repeated for several years.

Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder lasting for at least two years.

Individuals have periods of hypomania, although not as severe as in bipolar disorder, and periods of depression with only short breaks of normal functioning in between.

Dysthymic Disorder

Dysthymic disorder is essentially a mild but very persistent depression, lasting for more than two years.

Atypical depression

This is a form of depression that has the opposite characteristics to major depression.

People with this type of depression still show depressed mood, but they are able to be cheered by happy events; rather than loss of appetite they show increased appetite and weight gain; they tend to sleep excessively, but also experience a heaviness in their limbs.

Individuals with atypical depression tend to be extremely sensitive to rejection and expect that others will dislike or disapprove of them.

by Bianca Nogrady