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Depression is another term for Depressive Disorders, which are brain disorders based on abnormal brain circuit functioning, maladaptive thinking and behaviors, maladaptive coping to stressors, and mood dysregulation.
Depressive Disorders include the following DSM-IV diagnoses:
- Major Depressive Disorder
- Bipolar Depression
- Dysthymic Disorder
- Adjustment Disorder with Depressed Mood
- Substance-Induced Depression
- Depression Secondary to a General Medical Condition
- Grief and Bereavement
All these Depressive Disorders are characterized by the presence of a depressive episode. A depressive episode is highlighted by either depressed mood or lack of interest in pleasurable things (anhedonia). In addition to depressed mood or anhedonia, you also need to have 4 more symptoms of the following to meet the criteria for a depressive episode:
- Problems sleeping and multiple early morning awakenings
- Feelings of guilt or hopelessness
- Low energy level
- Poor concentration
- Poor appetite
- Being revved-up or slowed-down
- Thoughts of suicide or self-harm
Major Depressive Disorder
The prototypical Depressive Disorder is Major Depressive Disorder (Major Depression). It is characterized by the presence of a depressive episode for at least 2 weeks, and disrupts a person’s normal functioning at home and work, and disrupts relationships, jobs, and self-care. Mild to moderate cases require psychotherapy with a therapist, and moderate to severe cases often require antidepressant medication treatment, then psychotherapy once the depressive symptoms are under control.
Bipolar Disorder is characterized by mood swings, where the sufferer alternates between manic episodes, depressive episodes, or mixed episodes. When a person with bipolar disorder is in a depressive episode, it is difficult to distinguish it from depression associated with Major Depression (or Unipolar Depression). Some caveats: Bipolar Depression tends to be on the opposite spectrum of the manic episode, where a person with Bipolar Depression tends to experience more sleeping (hypersomnia), increased appetite, weight gain, extreme low energy, extreme moodiness to stressors, and rejection hypersensitivity. These symptoms of Bipolar Depression look like what is called Atypical Depression. Treatment of Bipolar Depression requires addressing the manic or mixed episode which will come or has previously occurred. Treatment with mood stabilizers is the standard of treatment, and antidepressants can make the mood swings more unstable.
Dysthymic Disorder is basically a depressive episode that lasts for at least 2 years, and is more chronic but less severe than Major Depression. Treatment is similar to the treatment for Major Depression.
Adjustment Disorder with Depressed Mood
People with Adjustment Disorder with Depressed Mood, also known as Situational Depression, experience a depressive episode in response to a known stressor, such as the loss of a loved one, or the breakup of a relationship. The depressive episode only occurs in association with a stressor, and the depressive episode resolves when the stressor is no longer there. Treatment is focused on addressing the stressor, and/or how to cope with it. However, if the depressive symptoms continue despite the stressor being removed, then the person may have developed Major Depressive Disorder.
Drugs of abuse, such as cannabis, alcohol, and cocaine, can cause a depressive episode. In addition, prescription drugs and chemicals, such as isotretinoin (Accutane), can cause depression. The depressive episode continues until the offending drug is removed- then the depressive episode lifts. Treatment is focused on addressing the drug abuse or removing the offending substance. However, with continued drug use, the sufferer may go on to develop a Major Depressive Disorder.
Depression Secondary to a General Medical Condition
A general medical condition, such as hypothyroidism, can cause a depressive episode. Treatment is geared towards addressing the underlying general medical disorder, and the depression lifts as a result.
Grief and Bereavement
Grief and bereavement can present as a depressive episode, after the loss of a loved-one. Treatment is focused on supporting the sufferer through their grief process. If depressive symptoms worsen, or if they continue way past the date of the loss, then Major Depression may develop.
So as you can see, depression is not so simple- it includes multiple depressive disorders as discussed above. When you have depression, look for which type you have listed above.
Carlo Carandang, MD, is a psychiatrist and licensed physician, who has over 15 years experience treating patients with depression and anxiety. In addition, Dr. Carlo has done research and taught students and doctors about depression and anxiety. His other popular website, AnxietyBoss.com, has received over 4 million views to date.