Not all depressions are alike. The nature of one’s depression depends on the cause and on each person’s individual adaptation to this disorder. Here are several generally recognized forms of depression.
A major depression is different from a state of normal sadness. People who experience depression describe it as agonizing pain that cannot be shaken and seems to have no end in sight. They feel trapped and often talk about having a dark empty pit in their chest or stomach that cannot be filled. Some depressed people contemplate suicide. Virtually all people with depression complain about reduced energy, reduced concentration, and the inability to complete projects. About eighty percent of depressed people say they have trouble sleeping, with frequent nighttime awakening during which they worry about their problems. Many people with depression oversleep during the daytime. Many people with this disorder report that they have had either an increase or a decrease in their appetite, sometimes accompanied by weight gain or loss. About fifty percent of people with depression say that their symptoms are worse in the morning and that they feel a bit better by evening. Half of all people with depression report only one severe episode within their lifetimes, but the remainder may have this happen twice, or repeatedly, during their lives.
Here are some symptoms of major depression:
• Diminished ability to enjoy oneself
• Loss of energy and interest
• Difficulty concentrating; slowed or fuzzy thinking; indecision
• Magnified feelings of hopelessness, sadness, or anxiety
• Decreased or increased sleep and/or appetite
• Feelings of worthlessness or inappropriate guilt
• Recurring thoughts of death
Another common form of depressive disorder is called dysthymia. This involves having chronic, long-lasting symptoms of depression, which are not disabling, but prevent a person from functioning at top capacity or from feeling good. Women experience dysthymia about twice as often as men, and it is also found in those who lack a relationship and in those who are young or with few resources (such as a low income or few social contacts). The primary symptoms of dysthymia (which means “bad humored”) include a depressed mood, a feeling of being down in the dumps, and a lack of interest in usual activities for at least two years. People with dysthymia can experience any of the symptoms of major depression, but usually not to the degree that may be found in a full-blown depression. Dysthymic people, though, are vulnerable to moving into a major depression during times of stress or crisis. Dysthymia often leads to a life without much pleasure, and many people with this condition feel that it is simply a part of their personality so that they never seek treatment.
Symptoms of dysthymia include:
• Poor appetite or overeating
• Insomnia (lack of sleep) or hypersomnia (oversleeping)
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness
• Fatigue or low energy
A third type of depressive disorder is bipolar disorder or manic-depressive illness. This disorder, which is much less common than major depression, is characterized by a pattern of cycling between periods of depression and elation. These cycles, or “mood swings,” can be rapid, but most often occur gradually over time. When in the depressed part of the cycle, the person can experience any of the symptoms of depression. When the person moves into the manic or elated phase, however, he or she can experience irritability, severe insomnia, inappropriate social behavior (like going on spending sprees), talking rapidly with disconnected thoughts, increased energy, poor judgment, and increased sexual desire.
There is strong evidence that bipolar disorder is largely an inherited condition, and many people with this disorder respond well to medication.
Some symptoms of bipolar disorder are:
• High energy with a decreased need for sleep
• Extreme irritability
• Rapid and unpredictable mood changes
• An exaggerated belief in one’s abilities
• Impulsive actions with damaging consequences (e.g., charging up credit cards, sudden love affairs, etc.).
Two other forms of depression:
Post-Partum Depression is linked to hormonal changes following the birth of a child. This can be a serious form of depression, sometimes with psychotic features, but most sufferers respond well to treatment.
Seasonal Affective Disorder or SAD is found among those who are sensitive to the shorter days of winter, especially those who live at northern latitudes. Many people with SAD respond to daily exposure to full-spectrum lighting.
Dr. Baya Mebarek, Psy.D., LMFT
San Diego Couples and Family Therapy serves the surrounding areas of Sorrento Valley Road as La Jolla, UTC San Diego, Del Mar, Rancho Santa Fe, Rancho Bernardo, Rancho Penasquitos, Poway, University City and Escondido.