Types of Depression


“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.
Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.” Stephen Fry, actor, comedian, writer, TV celebrity

“Friends have suggested that I am the least qualified person to talk about happiness, because I am often down, and sometimes profoundly depressed. But I think that’s where my qualification comes from. Because to know happiness, it helps to know unhappiness.” Alastair Campbell, journalist, political adviser, writer.

What is depression?

As a starter when thinking about depression, here’s a question for you. How often do you say, “I feel a bit depressed today”, or “a bit low”, “I’m feeling fed up”, or find a similar way of expressing that you are having a ‘down’ day? I’d argue that, at times, we all have moments of feeling low. Sometimes we may be able to identify why – we are tired or a bit run-down, we’ve had an argument with someone close, we’ve had a difficult day at work – but sometimes we just don’t know. What we do know, though, is that we’re just having a low day and that, from experience, tomorrow it will have passed and our mood will have picked up. This is ‘normal’ and usually nothing to be concerned about.

Clinical depression, however, is an illness that can be persistent and difficult to deal with. It is defined by features such as hopelessness, profound sadness, self-hatred, feelings of worthlessness; loss of motivation and sometimes suicidal thoughts, plans and acts.

One problem with depression is that on the outside we may appear to be fine. It isn’t a physical illness so we can’t see any signs such as a rash, spots, or a broken limb to shoe that something is wrong. We may get told, “Just pull yourself together”. We may hide the symptoms because, without anything physically wrong, we don’t realise that we need help.

However, as the quotes above indicate, there is a growing social awareness that may encourage us to seek the help we need – talking therapies, medication, stress reduction, the improvement of physical wellbeing.

Symptoms and signs
 Feelings of helplessness and hopelessness.
 Loss of interest in hobbies, work, social activities, sex.
 Loss of ability to feel joy and pleasure.
 Significant appetite or weight changes.
 Insomnia, especially waking in the early hours of the morning, or oversleeping.
 Anger, agitation, irritability.
 Feelings of fatigue, sluggishness, heavy body.
 Self-loathing, feelings of worthlessness or guilt, self criticism.
 Reckless or escapist behaviour, substance abuse.
 Trouble concentrating, making decisions, or remembering things.
 Increased physical complaints – back pain, aching muscles, headaches, stomach pain.

Some examples of causes

 Loneliness
 Lack of social support
 Recent stressful life experiences
 Family history of depression
 Marital or relationship problems
 Financial strain
 Early childhood trauma or abuse
 Alcohol or drug abuse
 Unemployment or underemployment
 Health problems or chronic pain

Risk of suicide

Depression is a major risk factor in suicide – the person feels that it is the only way to escape the pain. If you know someone with depression, take suicidal talk or behaviour seriously.

Warning signs to watch out for include:

 Preoccupied with death
 Letters or calls to friends and others saying goodbye
 Sudden changes in mood
 Talking about killing or harming oneself
 Expressing strong feelings of hopelessness
 Feeling trapped
 Acting recklessly or dangerously
 Putting their affairs in order
 Statements such as “Everyone would be better off without me”

Types of depression

Major depression – also called major depressive disorder, clinical depression, unipolar depression or just depression. Symptoms include very low mood, loss of interest and pleasure in usual activities and other symptoms, which are experienced most days and last for at least two weeks. These symptoms interfere with all aspects of someone’s life, including work and social relationships. Depression may be further defined as mild, moderate or severe.

Melancholia – a severe form of depression with many of the physical symptoms of depression. A person will be seen to be moving slowly and to have totally lost loss of pleasure or joy in most things, and maybe everything.

Psychotic depression – sometimes people lose touch with reality and experience hallucinations (seeing, hearing, smelling, tasting, feeling things that are not there) or delusions (false beliefs that are not shared by others) – e.g., believing they are bad or evil, or that they are being watched or followed. This can include paranoia – feeling that everyone is against them or that they have caused the bad events occurring to them or around them.

Antenatal and postnatal depression – Women can experience increased risk of depression during pregnancy and in the year following childbirth.

Bipolar disorder – also known as manic depression. This will be dealt with in more detail in a later blog. The person experiences periods of depression and periods of mania, with periods of normal mood in between. Current ideas around this condition vary and include a range of different presentations of the illness.
Treatment for depression

Treatments include anti-depressants (effectiveness varies according to research); talking therapies (counselling, psychotherapy, CBT); mindfulness; EMDR (Eye Movement Desensitisation and Reprocessing Therapy) for trauma-related condtions.

Seasonal Affective Disorder (SAD) – a mood disorder with a seasonal pattern. It is thought to be related to the variation in exposure to light in different seasons. Depression starting in winter and fading when the season ends is most common. Symptoms: lack of energy, sleeping too much, overeating. It appears to be more common in countries with shorter days and longer periods of darkness, e..g., the Northern Hemisphere.

Useful sites:
MIND – www.mind.org.uk
The Mental Health Foundation – www.mentalhealth.org.uk
Bridge Mental Health – www.bridgementalhealth.org
Sane – www.sane.org.uk
Time To Change – www.time-to-change.org.uk
Young Minds = www.youngminds.org.uk
Rethink – www.rethink.org.uk

Next blog: Stress and Anxiety

Malcolm Couldridge

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