Types of Depression

It's difficult to classify depression into highly distinct categories because the lines can be blurred at times. The level of severity differs from person to person as well. But in general, there are three main types:

Major depression: Severely interferes with the ability to work, enjoy daily activities, sleep, eat, etc. Episodes commonly occur several times throughout a person's life.

Dysthymia: Less severe than major depression, but is chronic and long-term and keeps one from feeling good and functioning well. People who suffer from dysthymia often experience episodes of major depression as well.

Bipolar disorder (manic depression): Severe highs (mania) and extreme lows. Affects judgment and behavior in ways that can cause serious problems and embarrassment. People with untreated manic depression may become psychotic (out of touch with reality).

Symptoms of Depression

Symptoms of depression without mania include:

• Feelings of sadness or emptiness
• Lack of interest in activities that used to be pleasurable, including sexual activity
• Decreased energy
• Difficulty sleeping or oversleeping
• Change in appetite and weight
• Irritability
• Thoughts of suicide

Symptoms with mania may include many of the symptoms above, plus the following symptoms during a high:

• Highly increased energy
• Racing thoughts
• Increased sexual desire
• Extreme, excessive happiness
• Inappropriate social behavior
• Decreased need for sleep
• Poor judgment

It's common for men and women to experience depression a little differently. Men may mask their depression by acting irritable and angry, while women tend more to experience feelings of hopelessness or helplessness. Men also tend to avoid seeking treatment more than women. These are just generalities, however. Depression strikes across all age and gender, and it's difficult to predict how it will be expressed from person to person.

There are many theories for the causes of depression. Studies of identical twins indicate that there may be a genetic element. Other studies suggest that continued trauma and stress can lead to depression. And sometimes, specific types of events can trigger a depressive episode.

Types of Treatment Options

Before receiving a diagnosis of depression, you need a physical examination first to rule out any other possible conditions that may be causing your symptoms. If depression is diagnosed, your doctor will design a treatment based on the type of depression you have, the causes and the severity. For mild depression, psychotherapy, or talking therapy, may be the best choice. But most people do best with a combination of medication and psychotherapy.

Medication
Depression can be caused by chemical imbalances in the brain. These chemicals, called neurotransmitters, are responsible for much of the communication that takes place between the brain and the body. Medications can correct the chemical imbalances. They reduce the symptoms of current episodes and can often prevent episodes from recurring.

Medications for depression include:

• Selective serotonin re-uptake inhibitors (SSRIs). These are the newest calls of drugs and they tend to have fewer side effects.
• Trycyclics
• Monoamine oxidase inhibitors (MAOIS)

Your doctor may prescribe one drug or a combination of drugs for you. There may be some improvement in the first week or two, but most people have to take the drug for three, four, sometimes as many as eight weeks before experience the full effect. In some cases, it may even be necessary to try two or three drugs before finding the one that works for you. It takes patience in the beginning, which can be quite difficult for people who are feeling especially down.

Some people need to take medication for the rest of their lives. This is especially true in cases of manic depression. Other medications can be stopped, but must be done so gradually. Others may cause serious side effects, so regular visits with your doctor are important.

When you're taking medication for depression, it's important to be honest with your doctor about any possible drug or alcohol use, whether you take the medication as often as you should, whether you think you want to stop taking the medication or any other doubts or questions you have.

Psychotherapy
Many people today believe that taking a pill can be the answer to all their problems. Sometimes, a pill is enough. But for some people, psychotherapy, or talking therapy, is an important part of the equation.

Key Redfield Jamison, a professor of psychiatry at Johns Hopkins School of Medicine and author of An Unquiet Mind, a chronicle of her own struggle with manic depression, writes:

No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of psychotherapy alone can prevent my manias and depressions. I need both.

There are different kinds of talking therapies, but perhaps the key to having success with psychotherapy is to find a therapist you respect and feel comfortable with.

Alternative therapies
St. John's wort is a well known herb that has been popular in Europe, and to a lesser degree in the U.S., for treating depression. The National Institutes of Health is currently conducting a three-year study to determine the effectiveness of this herb. St. John's wort can interfere with the effectiveness of medications used for heart disease, depression, seizures, some cancers and rejections of transplanted organs. It's extremely important to discuss with your doctor the safety of taking this herb.

ECT Therapy
In cases where the depression is severe and medications do not seem to have any effect, electroconvulsive therapy may be considered. It can be highly effective in severe cases.

Getting treatment for depression can improve your important, close relationships. It can help you to function at your best at work or at school. It can improve your general outlook in number of ways. Most importantly, untreated depression can, in some cases lead to suicide, a highly preventable outcome.

Source:
K. Jamison. An Unquiet Mind. Vintage Books, New York, New York, 1995. National Institute of Mental Health; National Mental Health Association; A. Solomon.