Depression is often thought of as just one condition, but it is actually a collection of disorders that affect mood, energy, and motivation. Although the assorted diagnoses produce varied symptoms, they all have the power to drastically impact a person’s overall well-being. Depression disorders are treatable, though, and understanding the types of depressive disorders can streamline the process.
Major Depressive Disorder
Major depressive disorder (MDD) is the condition many picture when they think of depression, and with more than 20 million Americans having the condition, it is a common form.1 MDD will affect a person’s mood and happiness, but it also has the power to disrupt a person’s energy, sleep, and diet. MDD can negatively influence the attention levels, concentration, decision-making, and self-esteem of anyone with the condition.2
One person may have only a single episode of major depression with a few mild symptoms. Another person could have recurrent MDD with severe symptoms that trigger feelings of worthlessness, guilt, and suicidal thoughts, illustrating the invaluable point that one person’s depression can vary greatly from another’s. Professionals are always investigating the symptoms of depression to diagnose the condition.
If someone has five or more of the following for at least two weeks, MDD could be to blame:2
- Feeling sad, low mood, or increased irritability
- Low motivation to engage in pleasurable activities
- Low energy or feelings of fatigue
- Unintentional Weight loss or weight gain
- Significant sleep changes – sleeping too much or too little
- Problems with concentration or decision-making skills
- Feeling very slowed down or sped up in thinking or actions
- Feeling worthless or excessively guilty for no reason
- Frequent thoughts about death or suicide
Major depressive disorder is a very common variant of depression. During a year, about 7% of the U.S. population will have major depressive disorder.
Persistent Depressive Disorder (Dysthymia)
People with persistent depressive disorder will feel periods of depression lasting for two years or longer, rather than the only two weeks needed for a major depressive episode. Since symptoms of persistent depressive disorder are so long in duration, a person can struggle to remember a time when they were not depressed. It is possible for a person’s experience with depression to begin with MDD before the condition gives way to the extended duration of persistent depressive disorder.
Like with MDD, symptoms of persistent depressive disorder center around:2
- Poor appetite or overeating
- Sleeping too much or sleeping too little
- Low energy
- Poor self-esteem
- Trouble concentrating and making positive decisions
- Feeling hopeless
While other depressive disorders have a way of remitting and returning, the trademark of persistent depressive disorder is the disorder’s consistency. This consistency can frustrate the individual, their family, and even mental health professionals tasked with treating the condition. Symptoms may show little improvement, even with expert treatment. If signs of persistent depressive disorder do alleviate, they may only do so for less than two months before returning. The disorder, formerly called dysthymia, affects about 0.5% of people in the U.S. each year.
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder should not be confused for common reactions to menstruation. The hormonal changes linked to menstruation create an expected shift in mood and energy, but premenstrual dysphoric disorder marks an extreme departure in irritability and anxiety brought on by the menstrual cycle.
The symptoms typically build during the days leading up to menstruation and will then alleviate a few days after menstruation begins. Premenstrual dysphoric disorder will create a negative effect on the person’s school, work, or social life due to the intensity of symptoms.
Premenstrual dysphoric disorder affects as many as 5.8% of menstruating women each year. To accurately identify premenstrual dysphoric disorder, experts look for multiple symptoms from several clusters.2
At least one symptom from the following:
- Increased mood swings, increased sensitivity, or suddenly feeling sad
- Increased irritability and anger, which may impact relationships
- Feeling depressed, hopeless, and negative about self
- Increased anxiety, tension, and feelings of being on edge
At least one symptom from the following:
- Lower interest in usual activities
- Poor concentration
- Lack of energy and feeling lethargic
- Significant appetite change
- Sleep changes
- Pain, tenderness, or swelling
Symptoms from both categories must equal five or more to achieve the standard for diagnosis. As with other mental health disorders, these symptoms must cause stress and impairment of normal functioning to qualify.
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder (DMDD) is a condition marked by high levels of irritability. People with DMDD will have frequent outbursts and tantrums that occur at home, work, school, or in the community. In between the outbursts, they will display a chronically irritable mood.
DMDD marks a major deviation from how most people think about depression. Here, the person is not presenting with sadness, low energy, and hypersomnia. With DMDD, the person will seem angry, aggressive towards people and property, and frustrated with self and others.2
Someone with DMDD will display symptoms including:2
- Severe and repeated temper outbursts that are too extreme for the situation
- The outbursts are inappropriate for the person’s age and developmental levels
- The tantrums occur at least three times each week
- Mood is steadily irritable in between outbursts
An essential aspect of DMDD is the timing of the symptoms as mental health professionals cannot give the diagnosis to anyone under six and older than 18. Experts believe that between 2% and 5% of people under 18 will have DMDD each year.
Kids with DMDD may grow up to have no mental health disorders, while others may experience depressive or anxiety disorders as adults. The good news is children with DMDD do not usually become adults with bipolar disorder.1
Other Common Depressive Disorders
The above conditions will be the most frequently encountered depressive disorders, but there are others.
Some other depressive disorders include:2
- Substance/medication-induced depressive disorder: Occurs when the use of drugs, alcohol, or medications cause depressive symptoms to emerge. This diagnosis may be given to a person experiencing depressive symptoms for the first time in the weeks and months that follow recovery from opioid dependence.
- Depressive disorder due to another medical condition: A group of depressive symptoms triggered by a medical condition, physical health change, or an event like a stroke. People may experience new or worsening depression following a heart attack, and this diagnosis could be the most appropriate fit.
- Smiling Depression: When an individual appears happy but it actually depressed.
- Other specified depressive disorder & unspecified depressive disorder: When depressive symptoms appear but do not fit into other categories, one of these diagnoses could be appropriate. For example, someone may have four intense symptoms of a major depressive episode, but since the condition requires five, they would not qualify.
Other Specifiers for Depression
While the disorders listed above are some of the most common, depression can take on many forms with symptoms that serve to further complicate the individual’s experience. People will endure other types of depressive disorders and depression specifiers that add another layer of complications.
With depressive disorders, the American Psychiatric Association (APA) lists eight specifiers. The presence of one or more of these can drastically modify the timing, intensity, and types of symptoms expressed by depression.
The specifiers for depressive disorders, according to the APA, include:1
- Peripartum onset (peripartum depression)
- Seasonal pattern (seasonal affective disorder)
- Catatonia
- Psychotic features
- Anxious distress
- Mixed features
- Melancholic features
- Atypical features
These specifiers are not separate types of depressive disorders. Instead, they are additional labels experts insert onto the diagnosis. If someone had major depressive symptoms that occur during or soon after a pregnancy, the diagnosis would be major depressive disorder with peripartum onset. If someone experiences increased periods of depression only during the fall and winter months, their diagnosis would be major depressive disorder with seasonal pattern.1
Peripartum Depression
Postpartum depression is a term used often in the media and popular culture to describe depression that emerges or worsens in the days and weeks after a woman gives birth. Despite its popularity and familiarity as a mental health diagnosis, the accepted term is depression with peripartum onset.1
The distinction between postpartum and peripartum is important because as many as 50% of women experience the increase in depression before the baby is born. Using the appropriate name can help bring more attention and normalcy to the condition that affects between 3 and 6% of women.1
Some periods of sadness and anxiety are common in the weeks that follow birth, but just as premenstrual dysphoric disorder is significantly different than typical menstruation, depression with peripartum onset is significantly different from “baby blues.”
Women can experience a range of intense and potentially dangerous symptoms including:1,3
- Severe anxiety
- Panic attacks
- Hallucinations
- Delusional or paranoid thoughts
- A desire to harm self or the baby
Diagnosing depression with peripartum onset is valuable because a woman with the condition has about a 50% chance of similar symptoms repeating during or after the following pregnancies. Learning about and treating the condition can help mothers make informed decisions in the future.1
Seasonal Affective Disorder
Seasonal affective disorder (SAD) is not an officially-recognized disorder, but it is one that many people are familiar with through its use in media and culture. The preferred term among mental health professionals is depression with seasonal onset or bipolar disorder with seasonal onset.1
Feeling down, lethargic, or poor motivation during the fall and winter is a perfectly natural response to changing weather patterns, but some people note symptoms that exist beyond the average person. These people could be experiencing depression with seasonal onset.
When a person has symptoms of seasonal onset, they will experience the standard symptoms of depression linked to major depressive disorder only during a certain season or part of the year. To have seasonal onset, there must be no depressive episodes during the other parts of the year.
Though some may have SAD symptoms during the summer and spring, most will experience symptoms in the fall and winter as the shorter daylight hours impact hormones, neurotransmitters, and circadian rhythms of the body.4 Fortunately, there are many effective treatment options for SAD.
Catatonic Depression
Depression commonly reduces a person’s energy and motivation, but when a person has major depressive disorder with catatonia, drastic changes to speech, movement, and response to stimuli occur. Catatonic depression is an extreme form of depression that can cause tremendous concern to loved ones.
Catatonia has two main subtypes that differ in the symptoms produced:5
- Stuporous catatonia is marked by slowed movements and responses. A person with this form could lack speech and spontaneous movement. They may become completely obedient and respond to any request.
- Excited catatonia is marked by sped up, bold, and erratic movements. Speech will become pressured, scattered, and disorganized.
Symptoms of depression with catatonia can confuse even seasoned mental health experts, but fortunately, these serious symptoms will only present during periods of depression. By managing depression, a person can successfully manage catatonia.
Psychotic Depression
Another form of depression that deviates from the common perception of the condition is psychotic depression. Officially labeled as depression with psychotic features, this form of depression can be quite severe and result in the individual experiencing various hallucinations or delusions.1
During periods of psychosis linked to depression a person may experience depressive symptoms as well as seeing, hearing, smelling, and feeling things that are not really present. The delusions may involve extreme paranoia, feelings that they are in danger, concerns that others are reading their minds, or the notion that they have powerful romantic connections with those they have never met.1
People experiencing depression with psychotic features will not have schizophrenia or another psychotic disorder because these symptoms only emerge when depressive symptoms are intense. Still, they could pose a great danger to self or others, and should receive emergency treatment when needed.
Other Forms of Depression Without a Diagnosis
Because depression varies so much from person to person, the symptoms and experiences of some people will not have a diagnosis that seems to be the appropriate fit. A professional may offer a MDD or unspecified depressive disorder diagnosis, but these cannot capture the individual’s status, so some “unofficial” terms can prove helpful.
High-Functioning Depression
Sometimes, a person’s depression is obvious as their nonverbal and verbal cues seem to convey their state. With high-functioning depression, the opposite is true as their presentation may mask the reality of their symptoms.
People with high-functioning depression can experience low mood, sadness, low energy, low motivation, and poor self-worth, but they conceal their symptoms. On the outside, they appear to be a fully-functional part of society who works, raises kids, and even participates in community activities, all while battling the unwanted effects of depression behind the scenes.6
Reactive Depression
Reactive depression is the name given to a type of depression with symptoms that seem to stem from the outside, rather than the inside (which used to be called exogenous depression). Many people may feel the impact of depression caused by negative views of their self-worth or physical appearance, but those with reactive depression experience numerous symptoms triggered by the outside world.7
When world events turn ugly, the national political landscape shifts negatively, or issues in the home escalate, a person with reactive depression will be impacted in a particularly powerful way. Reactive depression can become a significant distraction as the individual will focus more effort and energy on the outside, rather than addressing and tending to their needs.
When & How to Get Help for Depression
People looking for depression treatments may worry that it is too early to contact a mental health professional as they hope the symptoms will remit with time. This view could be flawed, though, because there is no such thing as getting help for depression too early. If symptoms of depression, or any other mental health concern, are beginning to come to the surface, seek professional guidance. Waiting is unnecessary.
Treatment may include a combination of medication for depression, psychotherapy and lifestyle changes. Just as it’s never too early to speak with a therapist about symptoms, medication takes time to alleviate symptoms, so it’s important to also discuss options with your prescribing doctor.
How to find help for depression is a more challenging proposition, since there are so many available methods to gain professional services. A person can choose:
- Mental health services coordinated from their work or school
- Counseling at their primary care office
- In-person, traditional therapy services
- Online, telephone, text, or app-based counseling
You may not find the best therapist the first time, so take time to experiment with providers and forms of communication. No one option is the best for everyone, but there is a great option for each person who is willing to search.
Final Thoughts on Types of Depression
No one should tolerate depression. Whatever type of depression you may be dealing with, you are not alone, no matter how you feel. Talk to trusted supports in your life and consider reaching out to a therapist sooner rather than later. It is a small decision that could have a huge impact on your life and well-being.
For Further Reading
Types of Depression Infographics
