Depression - different types

Different types of depression often have slightly different symptoms and may require different treatments. Several mental health disorders have depression as a key feature, including major depressive disorder, bipolar disorder, dysthymic disorder, cyclothymic disorders and seasonal affective disorder.

While the exact cause of depression isn’t known, multiple factors can be associated with its development, including life events, personal factors such as family history and personality, serious medical illness, and drug and alcohol use. Generally, depression does not result from a single event, but from a mix of recent events and other longer-term or personal factors.

Depression is not just feeling sad

While we all feel sad, moody or ‘low’ from time to time, some people experience these feelings intensely for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious illness that has an impact on both physical and mental health. On average, one in six people – one in five women and one in eight men – will experience depression at some stage of their lives.

Symptoms of depression

You may be depressed if, for more than two weeks, you have felt sad, down or miserable most of the time, or have lost interest or pleasure in most of your usual activities, and if you have also experienced several of the signs and symptoms across at least three of the groupings below.

It’s important to note that everyone experiences some of these symptoms from time to time – it may not necessarily mean you are depressed. Equally, not every person who is experiencing depression will have all of these symptoms.

Behaviour

A person with depression may:

• Have stopped going out
• Not be getting things done at work or school
• Be withdrawing from close family and friends
• Be relying on alcohol and sedatives
• Have stopped their usual enjoyable activities
• Be unable to concentrate.

Thoughts

A person with depression may have thoughts such as:

• ‘I’m a failure’
• ‘It’s my fault’
• ‘Nothing good ever happens to me’
• ‘I’m worthless’
• ‘Life’s not worth living’
• ‘People would be better off without me.’

Feelings

A person with depression may feel:

• Overwhelmed
• Guilty
• Irritable
• Frustrated
• Unconfident
• Unhappy
• Indecisive
• Disappointed
• Miserable
• Sad.

Physical symptoms

A person with depression may experience:

• Fatigue
• Feeling sick and ‘run down’
• Headaches and muscle pains
• Churning gut
• Sleep problems
• Loss or change of appetite
• Significant weight loss or gain.

Risk factors for depression

While the exact cause of depression isn’t known, many things can be associated with its development, including life events, family history, personality, illness, drug or alcohol misuse, or brain changes.

Everyone is different and often a combination of factors can contribute to developing depression. It’s important to note that you can’t always identify the cause of depression or change difficult circumstances. The most important thing is to recognise the signs and symptoms and seek help.

Life events

Research suggests that continuing difficulties – such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, or prolonged exposure to stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can trigger depression in people who are already at risk because of past bad experiences or personal factors.

Family history

Depression can run in families, so some people are at increased genetic risk. However, this doesn’t mean that a person will automatically experience depression if a parent or close relative has had the illness. Life circumstances and other personal factors are still likely to have an important influence.

Personality

Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.

Serious medical illness

Having a medical illness can trigger depression in two ways. Serious illnesses can bring about depression directly or can contribute to depression through the associated stress and worry, especially if it involves long-term management of the illness or chronic pain.

Drug and alcohol use

Drug and alcohol use can both lead to and result from depression. Many people with depression also have drug and alcohol problems.

Changes in the brain

What happens in the brain to cause depression is not fully understood. Depression may be related to changes in the levels or activity of certain chemicals that carry messages within the brain – particularly serotonin, norepinephrine and dopamine, the three main chemicals related to mood and motivation. Changes to stress hormone levels have also been found in people with depression.

Research suggests that behaviour can affect brain chemistry – for example, long-term stress may cause changes in the brain that can lead to depression. Changes in brain chemistry have been more commonly associated with severe depression rather than mild or moderate depression.

Different types of depression

Different types of depression often have slightly different symptoms and may require different treatments. The five main types of depression are:

• Major depressive disorder
• Bipolar disorder (which used to be called manic depressive illness)
• Cyclothymic disorder
• Dysthymia
• Seasonal affective disorder (SAD).

Major depression

Sometimes this is called major depressive disorder, clinical depression, unipolar depression or simply depression. It involves low moods, and loss of interest and pleasure in usual activities, as well as other more common symptoms.

The symptoms of major depression are experienced most days, nearly every day and last for at least two weeks. The symptoms interfere with all areas of a person’s life, including work and social relationships. Depression can be described as mild, moderate or severe, melancholic or psychotic.

Melancholia

Melancholia is a term used to describe a severe form of depression in which many of the physical symptoms of depression are present. For example, one of the major changes is that the person moves more slowly. The person is also more likely to have depressed mood characterised by complete loss of pleasure in everything or almost everything.

Psychotic depression

Sometimes people with a depressive disorder can lose touch with reality. Experiencing psychosis can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others). People with this type of severe depression may believe they are bad or evil, being watched or followed, or feel as though everyone is against them (paranoia), or that they are the cause of illness or bad events occurring around them.

Antenatal and postnatal depression

Women are at increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period). The causes of depression at this time can be complex.

In the days immediately following birth, many women experience the ‘baby blues’ – a common condition related to hormonal changes affecting up to 80 per cent of women. The ‘baby blues’, or general stress adjusting to pregnancy or a new baby, are common experiences, but are different from depression.

Depression is longer-lasting and can affect not only the mother, but her relationship with her baby, the child’s development, the mother’s relationship with her partner and other members of the family. Almost 10 per cent of women will experience depression during pregnancy and 16 per cent in the first three months after having a baby.

Bipolar disorder

Bipolar disorder used to be known as ‘manic depression’ because the person experiences periods of depression as well as periods of mania. In between, there are periods of normal mood. Mania is like the opposite of depression and can vary in intensity – symptoms include feeling great, having plenty of energy, racing thoughts and little need for sleep, talking fast, having difficulty focusing on tasks, and feeling frustrated and irritable. This is not just a fleeting experience.

Sometimes the person loses touch with reality and has episodes of psychosis. Experiencing psychosis involves hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others). Bipolar disorder seems to be most closely linked to family history. Stress and conflict can trigger episodes for people with this condition.

Cyclothymic disorder

Cyclothymic disorder is often described as a milder form of bipolar disorder. The person experiences chronic fluctuating moods over at least two years, involving periods of hypomania (a mild to moderate level of mania) and periods of depressive symptoms – with very short periods (no more than two months) of normality between. The duration of the symptoms are shorter, less severe, and not as regular as those of bipolar disorder or major depression.

Dysthymia

The symptoms of dysthymia (or dysthmic disorder) are similar to those of major depression, but are less severe. However symptoms of dysthymia last longer than those of major depression. A person has to have this milder form of depression for more than two years to be diagnosed with dysthymia.

Seasonal affective disorder (SAD)

SAD is a mood disorder that has a seasonal pattern. The cause of the disorder is unclear, but it is thought to be related to the variation in light exposure in different seasons. SAD is characterised by mood disturbances (either periods of depression or mania) that begin and end in a particular season. Depression which starts in winter and subsides when the season ends is the most common.

SAD is usually diagnosed after the person has had the same symptoms during winter for two or more years. People with SAD are more likely to experience lack of energy, sleep too much, overeat, gain weight and crave carbohydrates. SAD is rare in Australia, and more likely to be found in regions with short winter days such as Greenland, Scandinavia and other high-latitude parts of the Northern Hemisphere..

Treatment for depression

Depression is often not recognised and can go on for months or even years if left untreated. It’s important to seek help early as the sooner a person gets treatment, the greater the chance of a faster recovery. A range of treatments, health professionals and services is available to help with depression, and there are many things that people with depression can do to help themselves.

Different types of depression require different types of treatment. Mild symptoms may be relieved with lifestyle changes (such as regular physical exercise) and self-help (for example, online e-therapies) alone. For moderate to more severe depression, psychological or medical treatments are likely to be required. Often, a combination of treatments is most useful for tackling the symptoms of moderate to severe depression.

Psychological treatments for depression

Psychological treatments (also known as talking therapies) help people with depression to change negative patterns of thinking and sort out relationship difficulties. They improve coping skills so people feel more able to deal with life’s stresses and conflicts, and help to prevent relapse once the person is well again.

Different types of psychological treatments include cognitive behaviour therapy, interpersonal therapy and family therapy.

Antidepressant medication

Antidepressants are often prescribed alongside psychological treatments when a person experiences a moderate to severe episode of depression. There are many different types of antidepressant medication and your doctor will need to find the medication and dose which is most effective for you.

Keep in mind that antidepressants take time before they start to help. Stopping medication should only be done gradually, on a doctor’s recommendation and under supervision.

Where to get help

• Your doctor
• Your local community health centre
• A psychiatrist
• A psychologist
• beyondblue Info Line Tel. 1300 22 4636
• Lifeline Tel. 13 11 14
• Mensline Australia Tel. 1300 78 99 78
• SuicideLine Tel. 1300 651 251
• Suicide Callback Service Tel. 1300 659 467

Things to remember

• Depression is an illness, not a weakness, and people shouldn’t feel ashamed to seek help.
• Depression is treatable and effective treatments are available. The earlier a person seeks help and gets the right treatment, the sooner they can recover.
• By talking about depression and anxiety, we can help raise awareness and reduce the stigma.
• If you think you or someone you know needs help, talk to a doctor or another health professional about getting appropriate treatment.

You might also be interested in:

• Anxiety disorders.
  
• Bipolar disorder.
  
• Depression.
  
• Depression - coping and recovering.
  
• Depression - how to get treatment.
  
• Depression - seasonal affective disorder.
  
• Depression - teenagers.
  
• Depression and ageing.
  
• Depression and exercise.
  
• Depression in men.
  
• Postnatal depression.
  
• Schizoaffective disorder.
  
• Stress can become a serious illness.
  

Want to know more?

Go to More information for support groups, related links and references.

This page has been produced in consultation with and approved by:

(Logo links to further information)

beyondblue

Last reviewed: February 2013

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

If you would like to link to this fact sheet on your website, simply copy the code below and add it to your page:

<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Depression_different_types?open">Depression - different types - Better Health Channel</a><br/>
Different types of depression exist, with symptoms ranging from relatively minor (but disabling) to very severe. Risk factors for depression include stressful life events, personal factors such as family history and personality, serious medical illness, and drug and alcohol use. Early detection of depression is important, as untreated depression can lead to suicide. Treatment is widely available and effective.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

Copyight © 1999/2013  State of Victoria. Reproduced from the Better Health Channel (www.betterhealth.vic.gov.au) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission.