Broadly speaking, there are two types of depression, and this distinction is important to make because the treatments are different.
Situational Depression (also known as adjustment disorder) is a response to a specific difficult or traumatic life event.
Major depression is generally longer term and may have no cause. This may lead to frustration or guilt for the depressed person or their loved ones who have trouble empathising with the depression when there is no obvious reason for it. Trying to rationalise the cause of the depression may lead to blaming people or situations that have nothing to do with it, for example a wife thinking, "He won't tell me why he is depressed, therefore it must be my fault." As someone who doesn't suffer with major depression it can be very hard to accept the fact that there is no one and nothing to blame and that doing so can make the situation worse.
The following symptoms may be caused by depression. They do not have to be present all day, or every day, for the diagnosis to be made.
- Not being able to enjoy most things, including things that used to be pleasurable.
- Difficulty thinking or concentrating.
- Feelings of guilt, as though you have let yourself or your family down.
- Hoplessness or despair, or a feeling thing won't ever get any better.
- Difficulty in recognising your own achievements or your own self-worth.
- Lack of inspiration or pragmatc thinking; ie problem solving becomes very difficult.
- Intrusive thoughts of negative self-image and worth.
- Poor appetite or overeating.
- Insomnia, frequent waking, or oversleeping.
- Little motivation to do anything.
- Exhaustion at the thought of socialising with people.
- Excessive fatigue.
- Thoughts that you would be better off dead.
In extreme cases, major depression can cause psychosis. This means perceiving and believing things that are not physically there, or couldn't feasibly be true (hallucinations and delusions). Please see the section on psychosis for more information.
Persistent Depressive Disorder
PDD used to be known as "dysthymia". This is sort of like a "less severe" form of major depression. To diagnose it someone has to have experienced some of the symptoms of depression, consistently for more days than not, for over two years.
Bipolar is characterised by two distinct "mood states". This is very different from mood swings, or having different personality types but is often referred to colloquially as this. It used to be called manic depression, but this is a bit misleading.
First it is important to discuss what mania and depression are.
"Mania" usually lasts for a period of a few weeks. When someone is manic, they may feel "high" and full of energy, ideas, and inspiration. They may feel like they are indestructible and partake in risky behaviours. They think (and often talk) very quickly and erratically, and their thoughts may become quite disorganised and difficult to follow for other people. Whilst manic, people often find it very difficult to sleep and will function on only a couple of hours sleep per night until they exhaust themselves. As a result, they can be very irritable and may say or do things which they wouldn't normally, leading to problems with loved ones.
In extreme cases, whilst manic people may partake in very risky or wreckless behaviour. They may gamble excessively (or make very dangerous business decisions) and lose important assets such as their home, car, or business. They may have unsafe sex or do drugs. They may behave dangerously, putting their own safety or the safety of others at risk. Sometimes they even have psychosis - including hallucinations, which is the perception of something that isn't there, or delusions, which in mania are usually grandiose beliefs. These can range from anything to having superpowers, or being immortal and invulnerable, or having grand ideas such as changing the world's poverty or curing global warming.
The depressive episodes tend to last much longer. They can be months, or years in duration. They fit the diagnostic guidelines for major depression, which can be found further up in this section.
There are two types of Bipolar Disorder; Type 1s have had one or more manic phases, with or without a separate depressive phase. The manic phase might also have displayed symptoms of depression which is known as a "mixed state".
Type 2s do not meet diagnostic criteria for "mania" but have a less severe state called "hypomania". They also have depressive episodes as above.
In general, depressive episodes last much longer than the manic phase. In between the two, there can be long periods where the individual feels completely normal. They do not strictly alternate, and a person may have multiple depressive episodes before they have a manic episode.
The treatment is mood stabilising medication, and therapy to help recognise entry into the episodes. Lithium is a traditional mood stabiliser and is the first choice medication in most countries. It has been shown to be very effective as a treatment for bipolar disorder.
Also, sodium valproate (Epilim), an anti-convulsant medication, can be used. Another common drug is quetiapine (Seroquel) which is an antipsychotic.