Melancholic Depression is basically a sub type of Clinical Depression. It is regarded as a severe form of depression that is more common in women than men.

It is characterised by lack of interest of individual in activities that were once pleasurable. Also, individuals become slower in response to the temporary positive life events.

Causes of Melancholic Depression

Melancholia Depression is supposed to be caused due to biological factors. It is believed to be genetically inherited in the offspring from their parents.

Common Risk Factors

  • Stressful situations excluding life changing events
  • Individuals who suffer from bipolar depression I
  • Individuals who suffer from bipolar depression II
  • Individuals with psychotic features
  • Elderly patients who have dementia

Symptoms of Melancholic Depression

  • Anhedonia
  • Severe weight loss,
  • Psychomotor agitation
  • Psychomotor retardation
  • Insomnia with early morning awakenings
  • Feeling of guilt or worthlessness
  • Diurnal variation with worse symptoms in the morning hours

Treatment of melancholic Depression

  • Antidepressants
  • Electroconvulsive therapy
  • Supportive psychotherapy
  • Deeper psychotherapy

Catatonic Depression

Catatonic Depression is basically a sub type of Clinical Depression. It is characterised by state of neurogenic motor immobility and behavioural abnormality expressed in form of Stupor.

Diagnostic criteria for Catatonic Depression

As per DSM-IV guidelines, a patient with catatonic depression must have at least two of the following signs.

  • Motor immobility including waxy flexibility or stupor (as evidenced by catalepsy)
  • Excessive motor activity
  • Extreme negativism (motiveless resistance to all instructions)
  • Maintenance of a rigid posture
  • Consistent posturing, stereotyped movements
  • Prominent mannerisms or grimacing
  • Echolalia

Symptoms of Catatonic Depression

  • Excessive Movement (Purposeless)
  • High resistance to suggestions
  • Loss of voluntary movement
  • Inability to react to one’s environment
  • Inappropriate voluntary movements
  • Involuntarily repeating some words meaninglessly
  • Extreme loss of motor skills or hyperactive motor activity
  • Holding rigid poses for hours
  • Stereotyped and repetitive movements
  • Waxy flexibility
  • Meaningless phrases

If not treated, patients with catatonic excitement may get exhausted. The catatonic depression may manifest itself in form of following syndromes.

  • Kahlbaum syndrome (retarded catatonia)
  • Malignant catatonia (neuroleptic malignant syndrome)
  • Excited forms (delirious mania)
  • Autism spectrum disorders

Treatment of Catatonic Depression

The treatment of Catatonic depression is done by experienced psychiatrist after careful and thorough evaluation.

Psychiatrist may recommend various anti-depressants and other therapies like ECT for treating the catatonic state.

Antidepressants used

  • Benzodiazepines are commonly prescribed in higher doses during initial stages of treatment.
  • Intramuscular lorazepam (1-2 mg) produces marked improvement in half an hour
  • Zolpidem is also used in diagnosis

Other Therapies

  • Electroconvulsive therapy (ECT) is very effective treatment for catatonic depression that targets the underlying causes.
  • Antipsychotics are also used however they require extreme caution as they can lead to worsening of symptoms and cause serious adverse effects
  • NMDA antagonists such as amantadine or memantine are effective against benzodiazepine resistant catatonia
  • Topiramate is also used for treating resistant catatonia.

Atypical depression is basically a subtype of clinical depression. It exhibits less severe and fewer number of symptoms than clinical depression. This type of depression differs from major depression. The patient may also experience moments of happiness sometimes.

The symptoms of atypical depression may last for months or even stay forever. The mood of the patients is governed by the outside events like success or failure, etc.

Causes of Atypical Depression

Chemical imbalance in the brain is responsible for causing Depression in the patients. The changes in the level of neurotransmitters such as dopamine, serotonin, and nor-epinephrine are supposed to cause depression.

Risk factors for Atypical Depression

  • Feeling of Guilt or worthlessness
  • Physical, sexual, or emotional abuse
  • Family history of depression
  • Significant loss due to death, divorce, or separation
  • Interpersonal conflicts
  • Unfortunate life event such as losing a job, retiring, etc
  • Serious illness like cancer, heart disease, stroke, or HIV
  • Drug or alcohol abuse
  • Isolation from family, friends, or other social groups

Symptoms of Atypical Depression

The atypical depression differs from major depression in terms of its mood reactivity. Usually, patient with atypical depression will feel better if case something positive happens. However, mood of patients with major depression does not improve with any positive changes.

Apart from feeling better temporarily in event of positive life changes, a patient diagnosed with atypical depression must have any two of the following criteria.

Common Symptoms of Atypical Depression

  • Excessive sleeping (hypersomnia)
  • Excessive eating (hyperphagia)
  • feeling of heaviness in the limbs
  • Weight gain
  • Increased reactivity
  • Increased sensitivity to rejection at social and work relationships
  • Feeling of being weighed down

Treatment of Atypical Depression

Psychiatrists recommend combination of various therapies for obtaining optimal results in patients with atypical depression.

The patients of atypical depression usually do not respond to tricyclic antidepressants (TCAs) (older class of drugs).  Psychiatrists recommend antidepressants as the suitable treatment for atypical depression.

  • Antidepressants including monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs)

MAOI drugs including selegiline, isocarboxzaid, phenelzine and tranylcypromine

SSRIs including fluoxetine, sertraline, paroxetine, escitalopram, fluvoxamine, citalopram

  • Cognitive-behavioural therapy/ Psychotherapy
  • Physical exercise
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation
  • Tran cranial magnetic stimulation (TMS)
  • Light therapy
  • Lifestyle and home remedies
  • Alternative medicine including Herbal remedies and supplements

Double Depression

As the name suggests, double depression involves episodes of two types of depression. It refers to the occurrence of episodes of Major depression along with Dysthymia.

A patient with double depression has dysthymia and he/she further experiences an episode of major depression.  The diagnosis of dysthymia is done followed by the major depression.

Signs and Symptoms of Double Depression

A double depression differs from a major depression in a way that it exhibits effect of the underlying dysthymia.

The signs and symptoms of double depression involve severely depressed mood along with following symptoms.

  • Loss of interest in things those were once pleasurable
  • Thoughts of suicide or death
  • Hopelessness
  • Low energy or agitation
  • Thoughts of worthlessness or guilt
  • Loss of appetite or overeating
  • Insomnia or sleeping too much
  • Poor concentration
  • Low self-esteem

Treatment of Double Depression

The goal of treatment therapy of double depression involves treatment of both Major Depression and Dysthymia.

  • Medications like antidepressants
  • Cognitive-behavioural therapy/ Psychotherapy
  • Physical exercise
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation
  • Tran cranial magnetic stimulation (TMS)
  • Light therapy
  • Lifestyle and home remedies
  • Alternative medicine including Herbal remedies and supplements

Endogenous Depression

Depression without any reason? Yeah, this special depression does not have any apparent reason.

Although patients show all the symptoms of depression, however there is no apparent cause for it. As it seems to originate from within, it is called as endogenous depression (coming from within).

As per the researchers, Endogenous depression may results from biochemical changes within the body.

Symptoms of Endogenous Depression

The symptoms of endogenous depression range from mild to severe in nature.

  • Lack of concentration
  • Inability to make spontaneous decisions
  • Guilt
  • Little to no sex drive
  • Disinterest in work and routine activities
  • Feel tired all day
  • Lack of motivation
  • Irritability
  • Prolonged fatigue
  • Difficulty falling asleep
  • Disturbed sleep patterns
  • Experience bodily aches

Treatment

Endogenous depression is supposed to be caused by brain changes and imbalances of serotonin or other neurotransmitters. It runs in the families.

Treatment may involve the combination of various therapies.

  • Anti-depressant medications that maintain or improve serotonin level
  • Diet, herbs, and amino acids for raising serotonin levels
  • Cognitive Behavioural Therapy or CBT
  • Food items and natural supplements such as omega-3 fatty acids, vitamin B compounds, and folic acid

Chronic Depression

A Dysthymia is also called as Chronic Depression where symptoms of depression last for long-term (two years or more). It is less severe than Major depression.

Patients affected from Dysthymia are able to function adequately however they are consistently sad or unhappy.

Signs and Symptoms of Chronic Depression

The symptoms of Chronic Depression are similar to that of Major Depression however they lack in their severity and intensity.

Common symptoms of Chronic Depression

  • Depressed mood
  • Lack of interest in activities that were once pleasurable
  • Significant weight loss or weight gain
  • Difficulty in sleeping
  • Excessive movement or slowing down
  • Fatigue
  • Feeling of worthlessness or guilt
  • Difficulty in concentrating or making decisions
  • Suicidal thoughts
  • Changes in appetite
  • Mental and physical sluggishness
  • Persistent aches or pains
  • Headaches, cramps
  • Digestive problems
  • Suicidal Tendency

Treatment of Chronic Depression

Although dysthymia is a serious disease, it can be treated. The early diagnosis and medical treatment effectively reduces the intensity and duration of depression symptoms.

Your psychiatrist may use various treatment therapies for treating dysthymia including Anti-Depressants medications, Psychotherapy, light therapy, ECT (Electroconvulsant therapy (ECT), etc.

“Baby Blues” is common in mothers who have recently delivered the baby. However, if the signs of depression persist for longer than a week in new moms, it suggests the occurrence of postpartum depression.

Postpartum depression differs from “baby blues” in a way that it does not disappear quickly. Mothers with postpartum depression experience feeling of worthlessness, fatigue, restless, etc.

In rare cases, new moms may develop serious complications and become hysterical. They may find it difficult to eat or sleep. In such conditions, mothers need to be hospitalized.

Causes of postpartum depression

According to the researchers, the changes in levels of hormones during and after pregnancy are responsible for postpartum depression. Other factors that may result in postpartum depression are body, mind, and lifestyle factors.

Physical changes

During the postpartum period, a mother experiences great changes in the body that may affect her mood and behaviour for days or even weeks. It is due to the sharp decline in the levels of estrogens and progesterone hormones after childbirth.

These low levels results in mood swings, fatigue, anxiety, and other symptoms of postpartum depression.

Fatigue

After giving birth to a child, majority of women may feel very tired. It usually takes weeks for a woman to recover. Also, women are required to take care of child around the clock, along with household tasks.

These factors contribute to fatigue and lack of sleep for months in new moms.  It eventually leads to postpartum depression.

Lifestyle factors

Lacks of support from family members or inability to breastfeed baby are other lifestyle factors that may cause postpartum depression.

Symptoms of postpartum depression

Symptoms of postpartum depression in new mother can be summarised as follows:

  • Baby blues that stay for more than a week
  • Strong feelings of depression after one or two months after childbirth
  • Feelings of sadness, doubt or guilt
  • Helplessness that interfere in normal activities
  • Inability to take care for yourself
  • Trouble doing tasks at home
  • Changes in appetite
  • Lack of interest in things that were once pleasurable
  • Lack of interest in the baby
  • Worry about the baby
  • Anxiety or panic attacks
  • Thoughts of harming the baby
  • Suicidal tendency

Diagnostic tests of postpartum depression

A doctor will perform the following diagnostic procedures for postpartum depression. There is no X-ray or laboratory test involved.

  • Full patient medical history/evaluation
  • Personal and family psychiatric history
  • Physical Assessment
  • Thorough evaluation of symptoms
  • Questionnaire such as the Edinburgh Postnatal Depression Scale

In some cases, doctors may recommend blood tests for ruling out other serious illnesses. The early diagnosis and effective treatment helps a lot in treating postpartum depression.

Treatment of postpartum depression

The treatment for postpartum depression after childbirth may involve medication and other therapies. In most of the cases, doctors employ combination of these therapies for obtaining optimal results

  • Antidepressants that can be safely given to breastfeeding mothers comprises of paroxetine, sertraline, and nortriptyline.
  • Cognitive behavioral therapy (CBT)
  • Interpersonal therapy (IPT)

Tips for treating postpartum depression

  • Ask your family members and friends for help with baby’s needs
  • Share your feelings with your partner, family, and friends.
  • Avoid any major life changes after childbirth
  • Avoid stress and remain positive
  • Keep yourself busy and take time out for entertainment
  • Socialise with friends
  • Spend time alone with your partner
  • Take complete bed Rest
  • Sleep while your baby is sleeping
  • Share the experiences of other mothers
  • Contact various hotlines and support groups that are dedicated for women with postpartum depression

Mood swings that range from very mild to extreme forms give this depression its interesting name; Bipolar Disorder.

Bipolar disorder or manic depression is basically a complex mood disorder that is characterised by alternate periods of clinical depression and maniac phase.

This complex genetic disorder differs from Major depression and Maniac phase. The mood swings may happen gradually over a period of few hours or it may occur rapidly within few minutes (rapid cycling).

Apart from dramatic mood swings, patients with bipolar disorder showcase disturbances in thinking, impairment in social functioning and distortions of perception.

Types of Bipolar Disorder

There are basically two subtypes of bipolar disorder including Bipolar I disorder and Bipolar II disorder.

Bipolar I disorder: Minimum one manic episode + with or without major depressive episodes

Bipolar II disorder: Minimum one episode of major depression + at least one hypomanic episode

Causes of Bipolar Disorder

The exact cause of Bipolar Disorder is not known. Researchers believe that genetic component has a role to play in causing Bipolar Disorder.

Symptoms of Bipolar Disorder

The symptoms of Bipolar Disorder include the symptoms related to Major Depression and symptoms related to Mania.

Symptoms of Major depression

  • Depressed mood
  • Lack of interest in activities that were once pleasurable
  • Significant weight loss or weight gain
  • Difficulty in sleeping
  • Excessive movement or slowing down
  • Fatigue
  • Feeling of worthlessness or guilt
  • Difficulty in concentrating or making decisions
  • Suicidal thoughts

Symptoms of Mania with Bipolar Disorder

  • Racing thoughts
  • Extravagant notions
  • Inapt elation
  • Improper irritability
  • Feeling of Disconnected
  • Unsuitable social behaviour
  • Increased sexual desire
  • Increased talking speed
  • Markedly increased energy
  • Poor judgment
  • Severe insomnia

Bipolar II Disorder

Bipolar Disorder II is also called as Hypomania and it is characterised by milder periods of elation.

It also exhibits episodes of mild or major depression.

As per the DSM-IV guidelines, the hypomania differs from mania in terms of “the degree of severity.”

Signs of Hypomania with Bipolar II Disorder

  • Increased energy and libido
  • Irresponsible behaviours
  • Extreme focus on projects at home
  • Decreased need for sleep
  • Exuberant and elated mood
  • Extreme focus on projects at work
  • Increased productivity
  • Increased confidence
  • Risk-taking behaviours
  • Increased creativity

Diagnosis of Bipolar Disorder

A psychiatrist will perform the following diagnostic procedures for Bipolar Disorder. There is no X-ray or laboratory test involved.

  • Full patient medical history/evaluation
  • personal and family psychiatric history
  • Physical Assessment
  • Thorough evaluation of symptoms

In some cases, doctors may recommend Lab tests for ruling out other serious illnesses. The early diagnosis and effective treatment helps a lot in treating bipolar disorder.

Moreover, doctors may ask you to consult with your family members for identifying the times when your mood was too high. Mania drastically affects thinking, ability to take correct decisions and social behaviour of the patient.

Treatment of Bipolar Disorder

There are various treatment therapies available for treating Bipolar Disorder. The doctors usually employ the combination of various therapies to obtain the optimal results.

Medications

  • Antidepressants
  • Mood stabilizers such as lithium
  • Anticonvulsants, Antipsychotics, and benzodiazepines for stabilizing mood
  • Antidepressants with mood stabilizers for boosting the depressed mood
  • Stimulants for boosting the antidepressant drug action

Other Therapies

  • Cognitive-behavioural therapy/ Psychotherapy
  • Physical exercise
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation
  • Tran cranial magnetic stimulation (TMS)
  • Light therapy
  • Music therapy
  • Group therapy
  • Lifestyle and home remedies
  • Alternative medicine including Herbal remedies and supplements

A Dysthymia is also called as Chronic Depression where symptoms of depression last for long-term (two years or more). It is less severe than Major depression.

Patients affected from Dysthymia are able to function adequately however they are consistently sad or unhappy.

In fact, patients who have Dysthymia, may also experience episodes of Major Depression (once or more) sometimes.

Causes of Dysthymia

There is no exact cause known for Dysthymia. Researchers believe that the dysthymia may result from either a single cause or a combination of one or more causes.

Dysthymia may be related to the following factors

  • Brain changes involving Serotonin (neurotransmitter that helps brain in coping with emotions)
  • Major life stressors
  • Chronic illness
  • Medications
  • Relationship or work problems

Signs and Symptoms of Dysthymia

The symptoms of Dysthymia are similar to that of Major Depression however they lack in their severity and intensity.

Common symptoms of Dysthymia

  • Depressed mood
  • Lack of interest in activities that were once pleasurable
  • Significant weight loss or weight gain
  • Difficulty in sleeping
  • Excessive movement or slowing down
  • Fatigue
  • Feeling of worthlessness or guilt
  • Difficulty in concentrating or making decisions
  • Suicidal thoughts
  • Changes in appetite
  • Mental and physical sluggishness
  • Persistent aches or pains
  • Headaches, cramps
  • Digestive problems
  • Suicidal Tendency

Diagnosis of Dysthymia

A psychiatrist makes the diagnosis of Dysthymia based on the symptoms present in the patient.

The criteria for distinguishing Dysthymia involve the following.

  • Symptoms must have lasted for a longer period of time (two years of more)
  • Symptoms must be less severe than symptoms of major depression
  • Symptoms should not result due to substance abuse or any medical condition
  • Symptoms should cause clinically significant distress
  • Symptoms should cause impairment in social and occupational areas of your life

A psychiatrist will perform the following diagnostic procedures for Dysthymia. There is no blood test, X-ray or laboratory test involved.

  • Full patient medical history/evaluation
  • personal and family psychiatric history
  • Physical Assessment
  • Thorough evaluation of symptoms

Treatment of Dysthymia

Although dysthymia is a serious disease, it can be treated. The early diagnosis and medical treatment effectively reduces the intensity and duration of depression symptoms.

Your psychiatrist may use various treatment therapies for treating dysthymia including Anti-Depressants medications, Psychotherapy, light therapy, ECT (Electroconvulsant therapy (ECT), etc.

Psychotherapy

It is also known as talk therapy where patient is imparted wit coping skills for dealing with stresses related to everyday life. This therapy also assists in increasing compliance to medication and maintaining healthy lifestyle habits.

Psychotherapy may involve one-on-one therapy, group therapy, or family therapy.

Antidepressants

Your psychiatrist may recommend effective antidepressants with minimum side effects after assessing your physical and mental health.

Antidepressants exert their effect gradually over a period of time and may take many weeks to work optimally. Patients may need to take anti-depressants for at least six to nine months.

Some commonly used antidepressants used for treating Dysthymia are as follows:

  • Selective serotonin reuptake inhibitors (SSRIs): Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft
  • Serotonin norepinephrine reuptake inhibitors : Effexor, Cymbalta, Pristiq
  • Tricyclic antidepressants :  Elavil, Asendin, Anafranil, Norpramin, Adapin, Sinequan, Tofranil
  • Monoamine oxidase (MAO) inhibitors :  Marplan, Nardil, Parnate,EMSAM
  • Trazodone : Desyrel
  • Other antidepressants : Mirtazapine, Bupropion

Other Treatments Available for Dysthymia

  • Light Therapy: It is effective in patients with seasonal depression
  • Electroconvulsant therapy (ECT): It is recommended in patients who are not responding to antidepressant medications.
  • Lithium/Anticonvulsant: It is recommended in patients who are experiencing manic episodes.

Are you feeling sad or experiencing lack of interest in anything lately with symptoms lasting for entire day?

If yes, then you need to visit your doctor as you may be suffering from major depression (clinical depression). The most common sign of clinical depression is profound sense of hopelessness and sadness.

Major depression causes profound effect on the lifestyle of affected patients who find it difficult to work, eat, sleep, concentrate and enjoy social activities. While some patients may have clinical depression only once during their lifetime while others may experience it numerous times.

Symptoms of Major Depression

It is a common form of depression that has widespread occurrence among masses. It is characterised by the occurrence of major depressive episode lasting for entire day for at least two weeks.

Common symptoms of Major Depressive Disorder

  • Depressed mood
  • Lack of interest in activities that were once pleasurable
  • Significant weight loss or weight gain
  • Difficulty in sleeping
  • Excessive movement or slowing down
  • Fatigue
  • Feeling of worthlessness or guilt
  • Difficulty in concentrating or making decisions
  • Suicidal thoughts

In order to classify the condition as major depression, one of symptoms should be either depressed mood or loss of interest. Moreover, the symptoms must be present every day (most part of the day) for at least two weeks.

Risk Factors of Major Depression

There are certain risk factors that trigger Major depression in individuals.

  • Individuals with family history of depression
  • Individuals who have had traumatic childhood experiences
  • Individuals with family history of alcoholism
  • Individuals with biological family members who have had committed suicide
  • Individuals who have faced unfortunate life events like death of loved ones, divorce,
  • Individuals who have few friends
  • Individuals who have had failed personal relationships
  • Postpartum depression in women who have given birth to child recently
  • Individuals with depressed mood as a child
  • Patient suffering from serious illness such as HIV/AIDS, heart disease, cancer, Alzheimer’s disease
  • Individuals with low self-esteem and feelings of being deprived
  • Individuals who have experienced major life changes such as job change, retirement
  • Individuals who have experienced physical, sexual, or emotional abuse
  • Individuals who are self-critical or pessimistic
  • Individuals who are addicted to alcohol, nicotine or illicit drugs

Diagnosis of Major Depression

The diagnosis of the major depression is performed by doctors after thorough medical examination of the depressed patient.

Common Diagnostic Procedures

  • Full patient medical history
  • Physical Assessment
  • Thorough evaluation of symptoms
  • Standardized questionnaires like Hamilton Rating Scale for Depression, and the Beck Depression Inventory

Doctors may perform certain selected investigations in order to rule out other causes.

  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection
  • Adverse affective reactions for medications
  • Adverse affective reactions for alcohol misuse
  • Evaluation of Testosterone levels for diagnosing hypogonadism
  • Subjective cognitive complaints in older depressed people

Treatment of Major Depression

There are various treatment therapies available for treating Major Depression. The doctors usually employ the combination of various therapies to obtain the optimal results.

  • Medications like antidepressants including Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), Norepinephrine and dopamine reuptake inhibitors (NDRIs), Tricyclic antidepressants, Monoamine oxidase inhibitors (MAOIs), Atypical antidepressants and other medication strategies.
  • Cognitive-behavioural therapy/ Psychotherapy
  • Physical exercise
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation
  • Tran cranial magnetic stimulation (TMS)
  • Light therapy
  • Music therapy
  • Group therapy
  • Lifestyle and home remedies
  • Alternative medicine including Herbal remedies and supplements
  • Mind-body connections
  • Coping and support

Prevention of Major Depression

There is no exact way for preventing Major depression in individuals. However, individuals can take certain precautionary measures for effectively managing the disease.

  • Aware of the causes or triggers of the disease
  • Learn ways of controlling stress
  • Increase your resilience
  • Learn various ways of boosting low self-esteem
  • Develop circle of friends and social support
  • Treatment at the early occurrence of a problem
  • Long-term maintenance treatment for preventing relapse of depression

Are you aware of the various types of depression? Do you know that patient may even feel high in depression rather than perceived notion of having gloomy and sad feeling always?

Although, Depression is among most common psychological disorders; however not many people are aware of various forms of depression.

Let’s briefly discuss the various types of depression.

Depression may be classified into various types based on following factors.

  • Prevalent features
  • Duration
  • Severity of symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines various types of depression on the basis of standard criteria for various psychiatric disorders.

Major Depressive Disorder (Clinical Depression)

It is a common form of depression that has widespread occurrence among masses. It is characterised by the occurrence of major depressive episode lasting for entire day for at least two weeks.

Common symptoms of Major Depressive Disorder

  • Depressed mood
  • Lack of interest in activities that were once pleasurable
  • Significant weight loss or weight gain
  • Difficulty in sleeping
  • Excessive movement or slowing down
  • Fatigue
  • Feeling of worthlessness or guilt
  • Difficulty in concentrating or making decisions
  • Suicidal thoughts

Dysthymia

Patients who are under depression for long term (2 or more years) are said to be affected by Dysthymia.

Patients suffering from Dysthymia usually have at least two (or more) of the following symptoms for minimum period of 2 years.

  • Low self-esteem
  • Difficulty in concentrating
  • Difficulty in making decisions
  • Feeling guilty or hopeless
  • Decrease or increase in eating
  • Difficulty sleeping or increase in sleeping
  • Low energy or fatigue

The occurrence of symptoms does not persist for over two months at a time. It is less severe and more persistent than Major Depression.

Atypical Depression

This type of depression differs from major depression. The patient may also experience moments of happiness sometimes. The symptoms of atypical depression may last for months or even stay forever. The mood of the patients is governed by the outside events like success or failure, etc.

Symptoms of atypical depression

  • Overeating
  • Oversleeping
  • Fatigue
  • Extreme sensitivity to rejection
  • Weightgain

Manic Depression or Bipolar Disorder

The Bipolar depression is characterised by alternative periods of mania and depression. The shift between the states can be rapid. In some cases, patient may only experience maniac phase without any depressive episodes.

Manic episode usually lasts of at least one week marked by persistent elevated or irritable mood.

  • Increase in activity
  • Inflated self-esteem
  • Rapid thoughts or ideas
  • Difficulty in concentrating
  • Decreased sleep
  • Compelled to keep talking
  • Increase in activity
  • Excessive involvement in pleasurable and risky activities

Seasonal depression (SAD)

It is also called as seasonal affective disorder and it has fixed pattern of occurrence every year.

The symptoms usually begin in the fall or winter season and these disappear in spring or early summer.

Psychotic Depression Serious

 

The psychotic depression is marked by the presence of symptoms of psychosis including delusional thoughts.

  • Hallucinations
  • Delusions
  • Unrealistic thoughts

Postpartum Depression

The postpartum depression occurs in mothers who have had recently delivered a baby. It is characterised by occurrence of major depressive episode in new moms within one month after delivery.

Agitated Depression

It’s quite common to associate depression with state of low energy and slow physical or mental activity. Well, it is not always the case and Depression may manifest itself in form of physical and emotional agitation.

Agitated state of depression is basically a type of major depressive disorder that is characterized by physical and emotional restlessness, insomnia, and irritable mood.

The patients with agitated depression are driven by hypomania. They experience episodes of anger, agitation and irritability. Another name for agitated depression is mixed mania. Agitation is specifically severe in agitated depression patients.

Diagnostic Criteria for Agitated Depression

A psychiatrist does the diagnosis of agitated depression after carefully evaluating the symptoms of the patient. In some cases, agitation may also result from other severe cases of depression.

According to the Diagnostic criteria of Statistical Manual of Mental Disorders (DSM-IV), a patient is said to have agitated depression in case he/she meets both the following criteria.

  • Major depressive episode
  • Any two of the following manic episodes
  • Motor agitation
  • Psychic agitation
  • Racing thoughts

Forms of Agitated Depression

The agitated depression comprises of following three major forms.

  • Psychotic Agitated Depression (Severe form of melancholia)
  • Non-psychotic Agitated Depression (moderate form of agitation)
  • Excited Agitated Depression (Patient feels racing thoughts)

Treatment of Agitated Depression

The psychiatrists usually recommend the combination therapy including Psychotherapy and Medicines for treating agitated depression.

  • Psychotherapy involves imparting anger management skills and relaxing techniques to the patients.
  • Medication comprises of following medicines.
  • Mood stabilizers such as valproic acid and lamotrigine
  • Atypical antipsychotics such as olanzapine, ziprasidone and aripirizole

Psychotic depression

Hallucinations and delusions may be experienced by depressed patient in severe cases. Such form of depression is called as Psychotic depression that is characterised by severe depressive illness with co-existing psychosis.

Psychotic depression may be seen in patients hospitalised for depression. The psychosis may manifest in form of hallucinations, delusions, or unrealistic experiences. It is more common in patients suffering from schizophrenia.

Patients may see or hear imaginary sounds, voices and visuals. Unlike the manic depressive episodes, the hallucinations in psychotic depression are not “positive” and patient complains of frightening sounds and images.

Symptoms of Psychotic Depression

Patients with psychotic depression may present following symptoms.

  • Intellectual impairment
  • Physical immobility
  • Agitation
  • Insomnia
  • Anxiety
  • Psychosis
  • Constipation
  • Hypochondria

Treatment of Psychotic Depression

The treatment for psychotic depression is done by experienced psychiatrists in the hospital.

Medications used for treating psychotic depression include combinations of antidepressants and antipsychotic medications.

Common Antipsychotic/ Neuroleptic drugs are quetiapine, ziprasidone, risperidone, and olanzapine.

These affect neurotransmitters and are better tolerated than earlier antipsychotics drugs.

The antipsychotic medications are usually effective and patients are usually recovered within a year. In some cases, psychiatrists may recommend electroconvulsive therapy (ECT) for those patients who do not respond to medications.

As the psychotic depression is a serious disease, it is imperative for the patients to work closely with the doctors so that doctors can prescribe most effective drugs with minimum side effects.