Unipolar Depression is a severe form of depression characterized by sadness and/or irritability that affects sleep, energy level, and either weight gain or loss. It is one of the most common mental health problems, affecting roughly 8% of adults in the US each year.1 Evidence-based treatments for this disorder include psychotherapy, medication, and lifestyle changes.
What Is Unipolar Depression?
Unipolar depression is a type of depression experienced, not a specific disorder. It can sometimes take the form of Major Depressive Disorder (MDD) or clinical depression. The low mood that occurs with MDD will last most of the day and is present more days than not for at least two continuous weeks. If a person does not experience a low mood with unipolar depression, they might report a marked loss of interest or pleasure in any of their normal daily activities instead. The negative emotions and low energy usually impair daily functioning at work and home.
In contrast to Bipolar depression, a person with unipolar depression does not experience any periods of mania. Such mood swings toward highs (mania) and lows (depression), along with periods of hypomania, are signs of a Bipolar Depression. The focus of the experience for those with unipolar depression is the low mood with negative thoughts and feelings. For example, feelings of worthlessness or inappropriate guilt might be a daily occurrence with unipolar depression.
How Does MDD Differ From Other Types of Unipolar Depression?
Unipolar depression is a broad category. Major Depressive Disorder (MDD) is a distinct clinical condition with specific symptoms and history but there are other types of unipolar depression, too. Other forms of depression are defined as unipolar in that they lack manic episodes, but they are different from MDD.2,3 Each unipolar type of depression is characterized by its specific circumstances, considering the history, intensity, or duration of symptoms experienced by the person.
- Postpartum Depression is unipolar and occurs after the birth of a baby.
- Seasonal Affective Disorder is unipolar that typically occurs during the winter months.
- Persistent Depressive Disorder (PDD) is a less severe, long-term form of unipolar depression.
Unipolar Depression Symptoms
Unipolar depression is a type of depression experienced, not a specific disorder. Numerous symptoms are common in the various forms of unipolar depression. Depression symptoms might include negative feelings, changes in energy level, and changes in self-talk. The following is a list of the possible range of depression symptoms that is not for the purpose of identifying any particular depressive disorder.
Symptoms of a unipolar depression might include:3
- Feelings of persistent sadness, low mood, or increased irritability
- Loss of interest in hobbies or activities that someone previously enjoyed
- Change in appetite, with either a gain or loss in weight
- Feelings of fatigue or low energy
- Changes in sleep, with insomnia or hypersomnia
- Difficulty concentrating or making decisions
- Slowing down of movement or speech
- Feeling restless or agitated
- Negative self-talk, related to feelings of worthlessness or inappropriate guilt
- Feelings of hopelessness about the future
- Thoughts of self-harm, death, or suicidal ideation
Causes of Unipolar Depression
Depression can be caused by both genetic and environmental factors. Brain chemistry, medication use, hormones, and difficult life stressors like losing a job or relationship difficulties can all be risk factors for depression.
Biological
Biological causes of depression are varied and include genetics, hormonal changes, neurotransmitter levels, certain physical illnesses, and medications. When asking, “is depression genetic,” it is essential to look at all the different factors and not at genes alone.
Biological causes of depression include:
- Lower levels of brain chemicals: such as the neurotransmitters serotonin, norepinephrine, and dopamine, which affect mood.2
- Physical differences in the structure of the brain: such as a smaller hippocampus, resulting in fewer serotonin receptors.4
- Hormonal changes: such as those that occur with thyroid disorders, pregnancy, and menopause.
- Certain medications: including those used to treat acne, some antiviral drugs, corticosteroids, barbiturates, and benzodiazepines.4
- Health conditions: including chronic pain and some forms of cancer.
Genetic
Genetic factors account for about 40% of the causes of depression.5 Genetic causes of depression identified through research have indicated that there is not a specific gene that causes depression but numerous pieces of genetic code.6 Even when a person has a genetic predisposition toward clinical depression, they would not necessarily become depressed based on their genetics alone. Their other biological factors and environmental triggers would influence whether or not their genetics would lead to unipolar depression.
Environmental
Environmental causes of depression are now better thought of as triggers for a genetic response. If a person has a genetic risk for depression, specific environmental stressors might trigger an episode of unipolar depression. Alternatively, even without genetic risk, an episode of depression can still be caused by increased environmental stressors.
Environmental causes of unipolar depression can include:5
- Physical, emotional or sexual abuse (past or present)
- Violent or traumatic events, including serious accidents
- Death of a loved one
- Separation or divorce
- Financial hardship
- Loss of a job
- Social Isolation
- Relationship conflict at home or at work
- Major life transitions, such as moving to a new home
- Lifestyle habits such as abuse of alcohol or other drugs
When to Seek Professional Help for Unipolar Depression
Occasional periods of low mood are relatively standard experiences for most people. However, there are some signs that one’s low mood is beyond the norm and may require professional help to resolve. It is essential to ask yourself if your day-to-day functioning is affected by any of the following:
- If the feelings of sadness or irritability are intense, or if they do not go away within a couple of weeks.7
- Low mood or irritability has made it challenging to complete daily obligations at work, home, or school.
- If you begin to have no interest in what you usually enjoy doing.
- If there are thoughts of self-harm or suicide, which is a vital sign to seek professional help immediately.
Psychotherapy is an effective way to treat depression for both short-term results and long-term prevention. Therapy can be effective alone but, in some circumstances, may need to be paired with medication to relieve severe symptoms. In the short term, therapy helps by reducing the intensity and frequency of symptoms currently experienced. By working with their therapist, the person learns to recognize both patterns of thought and behavior that have led them toward a worsening depressed mood.
Once a therapist can identify these patterns or triggers, the individual can manage them in new ways to prevent a worsening downward spiral. Psychotherapy also helps prevent future clinical depression by creating new habits of thought and behavior that the person can maintain over their lifetime.
Now more than ever, online help is available when wondering how to find a therapist. An online therapist directory is one way to get started with the process!
Unipolar Depression Treatments
While the frontline treatment for unipolar depression is psychotherapy, other effective treatment pairings include medication, brain stimulation, and lifestyle changes. Each person’s treatment plan for unipolar depression will be unique, based upon their specific cluster of symptoms and personal health concerns. Mental health professionals work with the individual to design the best treatment plan for them. Although there are a variety of depression treatments, the most commonly used treatments are therapy and medication.
Therapy for Unipolar Depression
Various psychotherapies are presently seen as best practices to treat depression, allowing patients to find the right fit for them. Each method begins with the therapist and client meeting to discuss the current problems or symptoms and develop a plan to address them. Each type of psychotherapy for depression will differ in the length of time for treatment, focus on the past vs. present, and how much structure they offer.
Cognitive behavioral therapy for depression involves acknowledging and changing someone’s thoughts, behaviors, and actions to remedy mental health concerns. It is the most evidence-based practice, with hundreds of outcome studies supporting its effectiveness for anxiety and depression symptoms. A review of outcome studies published by the NIH indicates that CBT is particularly effective in treating acute episodes of unipolar depression.8
EMDR Therapy involves working with the body’s existing healing networks to help the nervous system find, resolve, and become unstuck from its emergency responses. It has less extensive research to date, however, one study indicated a significant reduction in symptoms of unipolar depression after 6 to 8 sessions of EMDR.9
Regardless of the therapy used, it is always best to begin therapy as early as possible once you have decided to get help. If the identified symptoms of unipolar depression continue without any treatment, it can become even more likely for further episodes of depression to occur in the future.
Medication
Antidepressant medication targets one of the biological causes of depression: low levels of specific neurotransmitters that affect mood, energy, and motivation. The proper medication can improve the relief of symptoms in instances where therapy alone has not been effective enough. However, outcome studies have shown that medication alone does not provide the same lasting benefits therapy treatment for unipolar depression offers. Individuals should only start medication after discussing their potential risks and side effects with a medical professional familiar with their treatment history.
There are various types of medication for depression and several possibilities for administration within each type to target individuals or combinations of neurotransmitters. The most commonly prescribed type of antidepressant is the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), which the FDA approves for the treatment of Unipolar Depression.
Other types of antidepressants approved by the FDA for the same purpose include:10
- Norepinephrine and Dopamine reuptake inhibitors (NDRIs)
- Serotonin antagonist and reuptake inhibitors (SARIs)
- Serotonin and Norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic and Tetracyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Outliers such as Remeron do not fit in the above medication classes.
All of these medications require a prescription and should only be taken with the oversight of the person prescribing. Medical guidance is also needed for any changes in dosage and for the process of discontinuing medication to prevent potential withdrawal reactions.
Final Thoughts
While it is difficult to cope with unipolar depression, there are various ways to manage it effectively so that life can return to normal. Although there are different forms of unipolar depression, they all share similar symptoms. In most cases, therapy is the recommended treatment and may be supplemented with antidepressant medication for some people. It is never too soon to ask for help if you are struggling with symptoms of unipolar depression.
For Further Reading
- Anxiety and Depression Association of America
- Depression and Bipolar Support Alliance
- National Alliance on Mental Illness
- National Suicide Prevention Lifeline, 1-800-273-TALK
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
Unipolar Depression Infographics
