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Looking for the signs and symptoms of depression? Types of depression discussed on this page include:

• Major Depression
• Bipolar Depression
• Postpartum Depression
• Dysthmyia
• Melancholia
• SAD (Seasonal Affective Disorder)
• Summer SAD

Major Depression

Major depression is also known as depressive disorder or clinical depression.  Major depression  occurs in approximately 16% of the population. It is an illness that should be taken seriously, as it decreases the individual's ability to be productive, negatively affects the quality of life and increases the chance that the patient will die. According to an article published by Lancet in October, 1999, "depression will be one of the most important causes of ill health overall."   Major depression is characterized by the presence of severe depressive symptoms such as suicidal thoughts, feelings of worthlessness and hopelessness.  It takes more than an act of will to overcome major depression and those individuals who are suffering from severe symptoms should seek treatment from a qualified source.  Anyone who is experiencing some or all of the symptoms of major depression should seek help from their primary care doctor or mental health professional.

The symptoms of major depression may include:

• Recurrent thoughts of suicide
• Feelings of sadness
• Inability to experience pleasure
• Decreased or increased appetite
• Inability to concentrate
• Indecisiveness
• Feelings of worthlessness and/or blaming yourself for all of your problems
• Excessive guilt
• Decreased energy
• Motor disturbances
• Early morning awakenings
• Multiple awakenings through the night
• Substance abuse
• Social withdrawal

Bipolar Disorder

While bipolar disorder (also known as manic depression) only affects between 1% and 2% of the population, it is this form of depression that receives the most attention from the entertainment industry.  This is because the symptoms of bipolar depression may cause behavior that is quite extreme. 

While bipolar disorder is a mental illness, it is also described as a neurobiological brain disorder that causes extreme mood swings.  According to "Diagnostic and Statistical Manual of Mental Disorders" as published by the American Psychiatric Association in 1994, the symptoms and criteria for diagnosing two of the most common forms of bipolar disorder are Bipolar I and Bipolar II. It is possible for someone who has bipolar disorder to be in a mood state where they are experiencing some of the symptoms of depression and some of the symptoms of mania or hypomania. 

The symptoms of bipolar disorder can be divided into three types: depressive, manic, and hypomanic. It has not been established what causes a person to develop bipolar disorder.  While many people with bipolar disorder have a family history of the illness, at least half of the suffers do not.

There is no known cure for bipolar disorder.  It is a chronic medical condition that for most individuals can be managed to some degree. Treatment for bipolar disorder requires the use of psychotropic medications (such as lithium, antidepressants, neuropetics, ECT, and others) and anyone who thinks they may have bipolar disorder should seek the best medical advice they can find. 

Because people with bipolar disorder may react negatively to some types of medications, it is critical that if you have a family history of bipolar disorder or if you suspect that you may have bipolar disorder that you discuss the possibility with your doctor.  She will need this information to properly treat you.  It is also very important that the patient practice good healthy lifestyle habits such as exercise, regulated sleep, eating regular meals, avoiding stress, caffeine, alcohol, and illicit drugs.

Bipolar I  

Bipolar I is characterized by  widely space, long-lasting bouts of mania that are followed by long-lasting bouts of depression.  Then the bouts of depression are followed by episodes of mania and so on and so on...  This swinging back and forth between extreme highs and lows is often known as "mixed states."

Bipolar II  

Bipolar II involves at least one hypomanic episode and one major depressive episode, but the patient never experiences a full-blown manic episode.  Shifts from one mood to the other are usually gradual.  If the patient has a "rapid-cycling" form of this disorder, the shifts can be quite sudden and the patient experiences four or more mood cycles within a period of one year.  Some people experience these rapid cycles in a matter or days or hours.

The Manic symptoms of Bipolar Disorder may include:

• A period of time (at least one week) of abnormally elevated, expansive, or irritable moods. 
• During the period of mood disturbance, three or more of the following symptoms have been experienced:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual (feelings of "having" to talk)
  • Racing thoughts 
  • Distractibility
  • Increase in goal-directed activity
  • Extreme agitation
  • Excessive involvement in pleasurable activities that can cause painful consequences
• Other factors to consider are:

  • The symptoms experienced should be significant enough to cause problems with relationships, employment, or other areas of functioning.  
  • The symptoms are not related to substance abuse or a general medical condition.

The Hypomanic symptoms of Bipolar Disorder may include:

• A period of time (at least four days) where the mood is elevated, expansive, or irritable to the point of being clearly different from a nondepressed mood.
• During the period of mood disturbance, three or more of the following symptoms have been experienced:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual (feelings of "having" to talk)
  • Racing thoughts 
  • Distractibility
  • Increase in goal-directed activity
  • Extreme agitation
  • Excessive involvement in pleasurable activities that can cause painful consequences

  Other factors to consider are:

  • The symptoms experienced are significant enough that there is a change in functioning, but not severe enough to cause problems with relationships or employment.  The symptoms do not require hospitalization and there are no psychotic features. 
  • The symptoms are not related to substance abuse or a general medical condition.
  • The symptoms cannot be caused by other factors such as bereavement experienced after the loss of a loved one, etc.
  • The symptoms are severe enough to be noticed by others.
   

The Depressive symptoms of Bipolar Disorder may include:

• Oversleeping or undersleeping
• Feeling depressed most of the time 
• Diminished interest in nearly all activities
• Significant weight loss or gain
• Feeling fatigued or experiencing a loss of energy
• Agitation or lethargy that can be observed by others
• Feelings of worthlessness
• Inappropriate guilt
• Diminished ability to think or concentrate
• Indecisiveness
• Suicidal thoughts

Other factors to consider are:

• The symptoms experienced should be significant enough to cause problems with relationships, employment, or other areas of functioning.  
• The symptoms are not related to substance abuse or a general medical condition.
• The symptoms cannot be caused by other factors such as bereavement experienced after the loss of a loved one, etc.
• The symptoms must persist for a period longer than two months or are severe enough that the patient is impaired by thoughts of worthlessness, thoughts of suicide, psychotic symptoms, or inability to function.

Postpartum Depression

Baby blues

Most people have heard of the "baby blues."  The symptoms are familiar to most of us who have had a baby.  We cry.  We sleep.  We feel confused.  We don't understand why we're not as excited and happy as we thought we would be.  These symptoms are very common and can affect up to 70% of all women who bear children.  Typically, the symptoms appear anywhere between 3 days to 1 month following the delivery and usually last about 10 days.

Postpartum depression

True postpartum depression is not as common as the baby blues.  An article written by C. Niell Epperson (American Family Physician (April 15, 1999) states that Postpartum major depression affects approximately 10% of new mothers. Postpartum depression can be very traumatic for the new mother.  According to Dr. Epperson, it can affect both the mother's confidence in her ability to mother her infant and the infant's "social, emotional, and cognitive development." The symptoms may appear anytime during the first several months after the baby is born and may include:

• No energy
• Such difficulty in concentrating that the woman loses her train of thought
• Extreme difficulty making decisions
• Feelings of "going crazy" and worry that if these feelings are shared, someone will take the baby away.
• May be suicidal, but is not psychotic

 Sometimes, the symptoms appear abruptly and are severe enough that the woman recognizes right away that she needs to seek treatment.  Other times, the symptoms appear so gradually that the woman doesn't seek treatment immediately, if at all.  If treatment isn't sought, the symptoms can disappear on their own within several months.  However, untreated postpartum depression can last into the second year after delivery.  Once a woman suffers from an episode of Postpartum depression, she is at risk for with each subsequent delivery.

Postpartum psychosis

Another type of postpartum depression is postpartum psychosis.  This is very rare and occurs only once for every 500 deliveries.  The symptoms of postpartum psychosis are severe and must be taken very seriously.  Postpartum psychosis requires hospitalization, as its occurrence is a medical emergency. The symptoms of postpartum psychosis may include:

• Hallucinations
• Delusions
• Extreme agitation
• Inability to care for self or infant
• Lack of interest in the infant
• Inability to sleep

Dysthymia

Dysthymia (or chronic depression) was identified in 1980 as a disorder and the name was added to the Diagnostic and Statistical Manual of Mental Disorders. According to a March 1999 article, published by Harvard Heath Letter, it was previously assumed that low-level depression was simply a character trait associated with certain types of people.  It was felt that these individuals wouldn't respond to treatment and so their symptoms were ignored. However, this theory has been proven to be false and it is now known that people don't have to continue suffering in this manner.  Low-level depression - or mild depression - can make life feel like a constant struggle.  Even more alarming, it can make an individual more prone to developing major depression.  It has been discovered that several therapies, including medications and cognitive-behavior therapy can be helpful in treating the patient who is suffering from this type of depression.  

The symptoms of dysthymia may include:

• A depressed mood on most days for at least two years
• Not going more than two months without experiencing two or more of the following symptoms:

  • Poor appetite or overeating
  • Difficulty falling or staying asleep
  • Sleeping too much
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration
  • Difficulty making decisions

The symptoms should not have been caused by drug or alcohol abuse, or by a medical condition and must be serious enough to have caused difficulties dealing with everyday life.  Dysthymia is most often seen in young and middle-aged adults, but is not considered as a possibility often enough in the elderly, as it is often assumed (incorrectly) that the symptoms are caused by aging.

Sometimes major depression can be superimposed upon dysthmia, resulting in "double depression."  The outcome of this double depression is that the individual doesn't fully recover from the major depressive episode.

Melancholia

Melancholia is a subtype of depression whose symptoms include:

• Loss of pleasure in all activities
• Failure to react positively to things that would normally cause pleasure
• Distinct depressed mood that is worst in the morning
• Early morning wakening
• Slowing of movement
• Agitation
• Significant loss of appetite causing weight loss
• Excessive or inappropriate guilt

Most of us long for the summer during the dark days of January and February.   It feels hard to go to work in the dark, come home in the dark, and we look forward to the lengthy daylight hours which accompany the warmer seasons.  However, for people suffering from SAD (Seasonal Affective Disorder), January and February are the peak months of the most difficult time of the year.  As the days grow shorter, individuals suffering from SAD, find themselves becoming more and more affected by their symptoms.

SAD

SAD became officially recognized as a psychiatric diagnosis during the early 1980s and it is estimated that up to 25 million Americans suffer from this form of depression.  It seems to affect people in the northern regions of the country at a higher rate and it occurs in women four times more often than in men.  The symptoms include:

• Feeling depressed
• Excessive eating, sleeping, and weight gain when the days grow shorter
• Cravings for sugary and/or starchy food
• Loss of energy
• Anxiety
• Irritability
• Loss of interest in physical relations
• Difficulty concentrating and processing information
• Symptoms that have repeated during the last two years, with no signs of depression during the spring and summer months.

Antidepressants and psychotherapy are options for treatment, but SAD doesn't seem to respond to traditional treatments as well as other forms of depression.  Bright-light therapy, in which a patient uses a therapeutic light box, often between the hours of 6 a.m. and 8.a.m., is a popular choice of treatment.  There are manufacturers who specialize in building these types of lights.  An effective light box should be at least 10,000 lux intensity.  According to Dr. Katherine Thomas, director of the Seasonal Affective Disorder Clinic at the Oregon Health Sciences University School of Medicine (as quoted in an USA Today article of December 4, 2000), "Cool white light is adequate.  It is not necessary or desirable to use full-spectrum light."

Summer SAD

I'll bet you've heard of SAD before.  It's that type of depression that makes a lot of sense to nearly everyone.  After all, the long, dark winter months can wear on a person, even if you don't actually have Seasonal Affective Disorder.  But have you heard of another form of SAD before?  The kind that makes people miserable during what is (for most people) the best time of the year?

Summer SAD is more common than you may think.  According to an article in the May, 2001 issue of Prevention, SAD expert Norman E. Rosenthal, MD, it occurs more in the South than in the North and is probably increasing due, "to global warming."  "We don't know what causes summer SAD; it could be the increased light or the heat," Dr. Rosenthal said to Prevention's reporter.  

The symptoms of summer SAD include:

• Depressive symptoms similar to winter SAD
• Agitation
• Sleep disturbances
• Disinterest in food

What you do if you think you have summer SAD?

• See your doctor.  Antidepressants can help.  
• Lower the shades.
• Turn up the air-conditioning and keep yourself cool.
• Get your thyroid levels checked.  Prevention reports that there might be a correlation between low thyroid function and summer SAD.

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