Webster’s Dictionary defines depression as “a mood disorder that is marked by varying degrees of sadness, despair, and loneliness and that is typically accompanied by inactivity, guilt, loss of concentration, social withdrawal, sleep disturbances, and sometimes suicidal tendencies.’

While it’s perfectly normal to feel sad during certain life situations, or to grieve for a certain length of time, depression is a more seriousness matter than just sadness over things like death, divorce, life change, or job loss. Depression is often a deep sadness that persists for more than two weeks, and goes hand in hand with these other symptoms. That is often what people think of when they talk about depression but in reality depression can manifest in many different forms from traditional sadness, to low energy and lack of motivation or joy to excessive irritability, agitation and anxiety. In the real world depression displays in many forms. In terms of clinical diagnosis we will lay out a number of the actual DSM-IV diagnoses that encompass different kinds of depression 

TYPES OF DEPRESSION

MAJOR DEPRESSIVE DISORDER (MDD)

• This type of depression is the most severe, and is referred to as clinical depression, or Major Depressive Disorder (MDD). This is not the only type of depression, however it is the most common. 
• The diagnostic criteria (which is just DSM lingo for the symptoms) of MDD include at least 5 of the following for at least a two week period: Depressed mood, Loss of interest/pleasure, Weight loss or gain, Insomnia or hypersomnia. Psychomotor agitation or retardation, Fatigue, Feeling worthless or excessive/inappropriate guilt, Decreased concentration. At least one of the symptoms has to be depressed mood or loss of interest. 
• MDD is further delineated depending on the level of severity into 4 categories which are defined as (1) mild (2) moderate, (3) severe  (4) severe with psychotic features. 
• Finally depression is also defined by whether it is a “single episode” or “recurrent”. This has to do with the idea that for many people periods of depression can be episodic in nature, that is they come on and then resolve and sometimes return. So part of what your provider is assessing when they ask you about depression is whether this is the first time you have ever experienced a period or “episode” of depression (single episode) or whether you have had episodes in the past (recurrent). 

SPECIFIERS OF MDD

• With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.
• With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

WAYS MAJOR DEPRESSIVE DISORDER CAN ONSET

Major Depressive Disorder can also present in different, specific forms. These an include the following:

• Prenatal and Postpartum Depression: The diagnostic statistical manual of mental disorders, 5th edition (DSM5) categorizes these types of depression as MDD with a peripartum onset. 
  • Prenatal depression occurs during pregnancy, and can last for part or all of the term. 
  • Post partum depression usually occurs within 4 weeks of delivering a baby. 
• Seasonal Affective Disorder: This type of MDD presents itself during the colder, darker, fall and winter months and resolves itself in the warmer, brighter spring and summer months. 
• Atypical Depression” This type of MDD varies from the more typical variety because the patient might exhibit temporary or short term mood improvement as a result of positive life events. This is known as mood reactivity, and can be accompanied by rejection sensitivity and increased appetite. 

PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

• PMDD is a combination of PMS symptoms along with extreme irritability, anxiety, and even irrational or unexplained rage. PMDD symptoms often appear a few days before your period starts, and can last up until 4 days after it starts. While the symptoms are short term, they can be extremely disruptive and debilitating during those few days.
• PMDD can involve marked lability (e.g., mood swings, suddenly feeling sad or tearful, or increased sensitivity to rejection) marked irritability or anger. markedly depressed mood. marked anxiety and tension.
• Specifically symptoms include: Depressed mood, Anger or irritability, Trouble concentrating, Lack of interest in activities once enjoyed, Moodiness, Increased appetite, Insomnia or feeling very sleepy. Feeling overwhelmed or out of control.

PERSISTENT DEPRESSIVE DISORDER (PDD) Formerly known as Dysthymic Disorder or Dysthymia

• Symptoms of PDD are less severe than MDD, but last for at least two years or longer. 
• Symptoms of PDD include: Poor appetite or overeating, Insomnia or hypersomnia, Low energy or fatigue, Low self-esteem, Poor concentration or difficulty making decisions, Feelings of hopelessness.

DISRUPTIVE MOOD DYSREGULATION DISORDER (DMDD)

• This form of depression effects children ages 10 and up, which is when symptoms first start to surface. Like PMDD, symptoms include increased irritability and extreme anger outbursts. 

DEPRESSIVE DISORDER DUE TO A GENERAL MEDICAL CONDITION

• Another specific form of depression is depressive disorder specifically brought on by another medical condition, such as Alzheimer’s, Parkinson’s, a cancer diagnosis, stroke, or heart disease. This type of depression is most often alleviated by treating the medical condition that is causing it. 

BIPOLAR & OTHER UNSPECIFIED MOOD DISORDERS

• There are two basic forms of Bipolar Disorder, Bipolar I and Bipolar II. For Bipolar II someone has to have experienced both periods of hypomania as well as depressive episodes. 
• Hypomania is A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
• The symptoms of hypomania and Mania can include: diminished need for sleep, grandiosity, pressured speech or excessive talking, racing thoughts/ideas, distractibility. increased level of goal-focused activities. excessive pleasurable activities, often with painful consequences.
• For Bipolar I Disorder diagnosis you have to have experienced at least a period of true full blown mania and can include depressive episodes but does not have to for the diagnosis. 
• Mania is a more intense and heightened form of the same symptoms of hypomania usually lasting longer and can include psychotic symptoms. 

TREATMENT FOR DEPRESSION

As you can see there is a lot of overlap amongst the various forms of depression but also many different ways it can manifest. Understanding your own symptom picture can help you to make better sense of what triggers and factors may be impacting your mood and can help guide your treatment plan. While there are several different types of depression, most of them respond to the same overall types of treatment but there can be a lot of nuance to different modalities of therapy and medications. Most health professionals recommend a combination of therapy and meds, though many patients find that their symptoms can be managed by therapy alone. If you identify with any of these symptoms, please consider booking your intake appointment today, so that one of our clinicians can help you on your treatment journey! Also check out our blog from earlier this month on therapy for depression for more information and tips. 

To learn more about the benefits of therapy for depression, check out our blog archive here. Or, call our admin team today to set up your free phone consult with one of our St. Pete or Tampa FL or virtual therapists! Our team of caring therapists would be honored to support you on your mental health journey and how to help and support you in coping with the symptoms of depression. You can receive the support you deserve from our Tampa, FL-based practice by following these simple steps:

1. Contact Wellness Psychological Services 
2. Meet with a caring therapist 
3. Start finding joy in life again!

OTHER SERVICES OFFERED BY WELLNESS PSYCHOLOGICAL SERVICES

Wellness Psychological Services is proud to offer both in-person and online therapy for the residents of Florida. Our team also offers couples counseling, divorce discernment counseling, support through a divorce, for couples. We also offer mental health support services including anxiety treatment, trauma therapy, depression counseling, OCD treatment, stress management, and testing and evaluation services for individuals as well! Additionally, we are happy to offer eating disorder treatment,  PCIT therapy, DBT, child therapy, therapy for professionals, and health psychology. Feel free to learn more by visiting our blog page or FAQ today!