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Different types of depression often have slightly different symptoms and may require different treatments. A number of disorders have depression as a key feature. These include major depressive disorder, bipolar disorder (manic depressive illness), dysthymic disorder, cyclothymic disorders, postnatal depression and seasonal affective disorder.
Depression is a complicated illness that can involve a number of contributing factors – genes, environment, diet, lifestyle, brain chemicals, psychology and personality.
Depression is not just feeling sad
Everyone feels sad from time to time, but people with depression experience severe and prolonged feelings of sadness, dejection and hopelessness that are a change from their usual self. One in four women and one in six men will suffer from depression at some point in their lives.
It’s normal to be ‘depressed’ or feel sad when you experience some major disaster or have suffered a severe loss. However, you should see your doctor if you are depressed for more than two weeks.
Symptoms
Generally, the symptoms of depression include:
- Feeling sad, hopeless and despairing
- A loss of interest and pleasure in normal activities
- Loss of appetite or weight
- Loss of sex drive
- Sleeping problems, such as an inability to get to sleep or early waking
- Feeling physically tired all the time
- Concentration difficulties
- Feeling guilty and worthless
- Feeling that life isn’t worth living.
Risk factors
Depression is thought to be caused by a combination of physical, emotional, biochemical, psychological, genetic and social factors. It is often impossible to track down and identify each contributing element. Some of the risk factors may include:
- A life-changing event, such as the loss of a loved one or the arrival of a new baby
- Chronic illness
- Certain medications, including some drugs for treating high blood pressure
- Alcohol misuse
- A history of child abuse
- Sustained problems at home or at work
- Physical trauma
- Other family members with a prior history of depression
- Chronic stress or anxiety.
Different types
Some of the different types of illnesses that have depression as a key feature include:
- Major depressive disorder
- Bipolar disorder, which used to be called manic depressive illness
- Dysthymic disorder
- Cyclothymic disorder
- Postnatal depression (PND)
- Seasonal affective disorder (SAD).
Major depressive disorder
A person suffering from major depressive disorder experiences a change in their mood that involves persistent low moods or sadness, or loss of interest or pleasure in most activities over at least two weeks. Not everyone with major depressive disorder experiences the same symptoms – the more severe the depression, the more symptoms are experienced. Major depressive disorder has a severe impact on daily life and can interfere with work, school or social activities.
People with major depressive disorder may feel despair and hopelessness, their energy levels may be extremely low and they might find it hard to motivate themselves to do even the simplest of daily tasks. They may also commonly experience low self-esteem and thoughts of death and suicide. It is important to get immediate help to stay safe when having thoughts about suicide.
Bipolar disorder
Bipolar disorder used to be called manic depression. A person with bipolar disorder has one or more episodes of mood disturbances that include distinct periods of extreme highs, where they feel invincible, or paralysing lows where they feel complete despair.
This psychiatric illness can be mild, moderate or severe. During the manic phase, the person is optimistic and buoyed by exaggerated feelings of wellbeing. Their mind is overactive and they need very little sleep but, while they have plenty of energy, they lack concentration. Work and study may suffer.
People with this disorder also have major depressive episodes at other times. During the depressive phase, the person feels despairing and may contemplate suicide.
Dysthymic disorder
Dysthymic disorder is a long-term or chronic disorder where low mood is experienced for most of the day, on more days than not, over a period of at least two years. Someone with dysthymia may experience fatigue, sleeping and eating problems. They may be plagued by low self-esteem, guilt and negative thinking. They may also experience cognitive (thought-related) difficulties such as concentration and memory problems. The overall disturbance is less severe than major depressive disorder.
Cyclothymic disorder
Cyclothymic disorder is when a person has mild and alternating mood swings of elation and depression occurring over a long time period. Because the mood swings are mild and the elation is often enjoyable, frequently people with cyclothymic disorder do not seek medical help.
The periods of elation and depression can last for lengthy periods, such as a few months. Often, a person with cyclothymic disorder has a relative with bipolar disorder or they may develop bipolar disorder themselves.
Postnatal depression (PND)
Around one in eight new mothers experience depression following the birth of a child and this is known as postnatal depression (PND). Usually, the depression begins during the first year of parenthood and ranges from mild to severe.
Contributing factors may include:
- The hormonal upheaval of pregnancy, birth and lactation
- Prolonged or complicated labour
- Physical exhaustion from broken sleep
- Lack of support, both emotional and practical
- Loss of independence
- Financial pressures
- Altered relationships with partner, family and friends
- A personal or family history of depression
- A history of premenstrual dysphoric disorder (this is another name for seriously debilitating premenstrual syndrome)
- Perfectionist or anxious personality.
Seasonal affective disorder (SAD)
Depression is more common in the winter months and in the Northern Hemisphere, which suggests to some researchers that brain chemistry is affected by sunlight exposure. This is often called seasonal affective disorder (SAD). Some studies have shown that light hitting the back of the eye (retina) stimulates the brain to make chemicals that lift a person’s mood.
People with SAD may eat more and gain weight, sleep excessively and withdraw from others. Usually, a person with SAD comes out of their ‘hibernation’ in the spring.
Diagnosis
Depression can be difficult to diagnose because many of its symptoms, such as fatigue, mimic those of physical illness. To exclude such physical illnesses and to explore the depressive symptoms, diagnostic methods may include:
- Physical examination – to check for any underlying physical illnesses.
- Medical history – for example, asking about prior use of various drugs (such as high blood pressure medications, steroids and alcohol), which can cause depression as a side effect.
- Detailed questioning – for example, asking questions about the severity and duration of the depression, any triggering life events and so on.
- Psychological tests – to further help identify the type of depression and its contributing factors.
- Laboratory investigations – for example, to examine your blood counts, electrolytes and thyroid activity.
Treatment
Treatment for depression depends on the type, cause and severity. It is important that you discuss treatment options with your doctor and follow their advice, particularly about combining different treatments.
Treatment may include:
- Psychological treatments such as cognitive behavioural therapy (CBT) or interpersonal therapy
- Antidepressant medications – there are a range of different types
- Medications for treating bipolar disorder, including mood-stabilising drugs such as lithium carbonate, sodium valproate or carbamazepine
- Regular exercise and a healthy, balanced diet
- Stress management techniques
- Natural therapies such as St John’s Wort for milder depression – always consult a doctor, as some natural therapies can be harmful and should not be taken with certain medications
- Addressing any contributing problems, such as relationship difficulties
- Counselling, including psychotherapy
- In the case of SAD, bright light therapy (BLT) – this may be used to stimulate the brain to make mood-enhancing chemicals, but is seldom necessary in a well-lit country like Australia
- Electroconvulsive therapy (ECT) – in cases of severe, life-threatening depression that don’t respond to other forms of treatment
- Hospital admission, in the case of very severe depression, threatened suicide or suicide attempt.
Where to get help
- Your doctor
- Your local community health centre
- Find a GP near you who specialises in mental health issues through the beyondblue website Info Line Tel. 1300 22 4636
- SANE Mental Health Information Line Tel. 1800 187 263, Monday to Friday, 9am to 5pm
- Lifeline Tel. 131 114
- Kids Helpline Tel. 1800 551 800
- Suicide Helpline Victoria Tel. 1300 651 251
- Mental Health Foundation Tel. (03) 9427 0407, Monday to Friday, 9am to 5pm
Things to remember
- Depression is a complicated illness that involves a number of factors such as genes, environment, diet, lifestyle, brain chemicals, psychology and personality.
- Many different disorders have depression as a key feature. These include major depressive disorder, bipolar disorder, dysthymic disorder, cyclothymic disorder, postnatal depression and seasonal affective disorder.
- Always seek help if you feel depressed.
You might also be interested in:
Anxiety disorders.
Bipolar disorder.
Depression - an overview.
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.
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