Types of depression

What is depression?

Depression can be generally described as a low mood or a lack of interest in once-enjoyable activities that lasts for an extended period. In most cases, depression is caused by environmental or biological factors, or a mixture of both. Anyone can be depressed, but clinical depression affects different groups at different rates. What’s more, different types of depression occur in different populations.

Common types of depression

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines various types of depressive disorders, their hallmark features, and the criteria required for a diagnosis. Each of the DSM-5 forms of depression are briefly outlined below.

Major depressive disorder

Major depressive disorder (MDD) describes a mental health condition in which you feel down, worthless, or sad most days for at least two weeks. Aside from general sadness, you might also have difficulty sleeping, significant changes in your appetite and weight, and an inability to think clearly or concentrate.

Moreover, a major depressive episode causes what the DSM calls a “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” ^[2] This means that MDD goes well beyond being sad or feeling melancholy. Instead, your mood severely affects your daily life for an extended time.

Major depressive disorder specifiers

The DSM-5 outlines eight types of major depressive disorder. Each has distinct characteristics that aid in making the appropriate diagnosis. These specifiers include the following:^[3]

• With anxious distress is marked by feelings of tension and fear.
• With mixed features is characterized by manic or hypomanic symptoms like grandiosity, elevated mood, and decreased need for sleep.
• With melancholic features includes a loss of interest in most or all activities, low reactivity to pleasurable stimuli, excessive feelings of guilt, and motor disturbances.
• With atypical features refers to a type of major depression featuring elevated mood in response to positive events, hypersomnia, and significant weight gain or changes in appetite.
• With psychotic features is a type of severe depression accompanied by hallucinations and delusions that may or may not be congruent with one’s mood.
• With catatonia is marked by significant decreases in psychomotor activity.
• With peripartum onset is major depression that occurs during pregnancy or within four weeks of delivering the baby.
• With seasonal pattern refers to major depression that occurs during specific times of the year, particularly in the fall and winter when days are shorter.

Further specifiers, including the number of episodes (e.g., single or recurrent), the severity (e.g., mild, moderate, or severe), and remission status (e.g., in partial remission or complete remission), are also outlined in the DSM-5.

Persistent depressive disorder

Persistent depressive disorder (PDD), formerly called dysthymia, is a less intense form of depression, but it lasts for a much longer period - at least two years.

Like MDD, PDD involves feelings of sadness and worthlessness most days and is often accompanied by low self-esteem, low energy, and changes in appetite, among other complications.^[4] Though PDD is less intense than MDD, it still causes clinically significant distress in daily life.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) combines a depressed mood and premenstrual syndrome. The DSM-5 stipulates that one of the following primary symptoms be present:^[5]

• Marked affective lability (e.g., extreme mood swings)
• Marked irritability
• Markedly depressed mood
• Marked anxiety

Likewise, PMDD typically involves lethargy, sleep difficulties, and feeling out of control or overwhelmed. These symptoms are so severe that they disrupt your ability to work, go to school, socialize, and participate in other activities of daily living.^[5]

Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder is a childhood type of depression that manifests before ten years of age. Its hallmark characteristics are frequent and intense irritability alongside angry outbursts. These episodes must be much longer and more intense than the situation warrants and must occur three or more times per week, on average, for at least a year.^[6]

Depressive disorder due to another medical condition

Sometimes, symptoms of depression are caused by a medical condition - heart disease, hypothyroidism, cancer, and Parkinson’s disease are just a few examples. Usually, if the medical condition is treated, the depressive symptoms improve, too.^[7]

Substance/medication induced depressive disorder

As the name indicates, substance/medication induced depressive disorder results from ingesting a substance or medication that results in a drastic change of mood, loss of interest in pleasurable activities, and other common characteristics of depression. These symptoms typically start shortly after taking a substance or medication or during a withdrawal period from the medication or substance. Alcohol, amphetamines, opioids, and hallucinogens are common culprits.^[8]

Unspecified depressive disorder

In some cases, depression symptoms are present, but they don’t meet the full criteria for any of the specific types of depression described above. In those instances, the DSM-5 allows for a diagnosis of unspecified depressive disorder.^[9]

Other forms of depression

Mood disorders with depressive features extend beyond the bounds of the DSM-5 category of depressive disorders. For example, bipolar disorder includes depressive features, as does cyclothymia. Of course, bipolar disorder also includes manic episodes, while cyclothymia is characterized by less severe mood swings.

Treatment resistant depression is another example. This type of depression is a term used for depressive disorders that don’t respond to several attempts at treatment, but isn’t a clinical diagnosis seen in the DSM-5. As the name indicates, this type of depression is persistent in that it’s resistant to initial attempts at treatment, be it therapy, medication, or both.

There are many forms of depression in the common vernacular that align with the types of depressive disorders discussed above. The “baby blues,” “postpartum depression,” “antenatal depression,” and “postnatal depression” all refer to major depressive disorder with peripartum onset. Similarly, “manic depression” refers to bipolar disorder, and “Seasonal Affective Disorder” refers to a major depressive episode with seasonal pattern.

What is the most common type of depression?

The most common type of depression is a major depressive episode. Approximately 21 million adults in the U.S. report having a major depressive episode at some point in any given year. Nearly 15 million people report having a severe episode.^[10]

The incidence of depression among American adults is highest in the 18-25 age bracket, nearly double the occurrence rate for people aged 26-49. The lowest rates of depression are among people 50 and over. Just 5.4 percent of older Americans report having had a recent depressive episode.^[10]

Major depressive episodes are more common among females than males. Studies show that about 10.5 percent of females have a major depressive episode at some point in any given year. Just 6.2 percent of males report having depression. Major depressive episodes are also more common among people who identify as mixed race - nearly 16 percent of multi-racial adults report depression within the last year.^[10]

The statistics for depression among adolescents closely mirror that of adults. More girls than boys report having major depression (25.2 percent versus 9.2 percent). Multi-racial teens report a much higher incidence of depression, too. For example, less than 19 percent of white teens report having been depressed in the last year, but nearly 30 percent of multi-racial teens report a recent bout of depression.^[10]

On a global scale, depression affects nearly 300 million people. Five percent of adults in the world have depression, including 6 percent of women and 4 percent of men. Roughly 10 percent of pregnant women worldwide experience major depression with peripartum onset. Depression might contribute to as many as 700,000 deaths by suicide each year.^[11]