How it is determined that patients have a particular type of depression? The classification of depression is done on the basis of DSM guidelines issued by American Psychiatric Association.

DSM is an abbreviated form of Diagnostic and Statistical Manual of Mental Disorders. It is used by psychiatrists for diagnosing the mental conditions. The DSM guidelines are also used by insurance companies for providing reimbursement for treatment.

Diagnostic criteria for Major Depression

For major depression, a patient should satisfy following two conditions.

  • Patient must meet five or more of the following symptoms for more than two weeks period
  • Symptom must be either depressed mood or a lack of interest

Symptoms for Major Depression

  • Depressed mood during entire length of day almost daily
  • Feeling of sadness, or tearful in children and adolescents
  • Depressed mood appear as a sign of constant irritability
  • Diminished interest in doing all activities throughout the day almost daily
  • Considerable weight loss when not dieting or even weight gain
  • Increase/Decrease in appetite daily
  • Sleep disturbances like Insomnia/increased sleeping hours daily
  • Restlessness or slowed behaviour
  • Lack of energy or fatigue almost daily
  • Feelings of worthlessness/excessive guilt almost daily
  • Difficulty in making decisions
  • Difficulty in concentrating
  • Suicidal thoughts almost daily

Moreover, there are certain features that are peculiar to major depressions.

  • Symptoms do not highlight mixed episode such as simultaneous mania and depression as in bipolar disorder.
  • Severity of symptoms interferes with normal activities at school, work, or social activities.
  • Symptoms do not result due to direct consequences of taking medication, drug abuse or any associated medical condition like hypothyroidism.
  • Symptoms do not result due to any temporary life event such as sadness after the death of a loved one.

Diagnostic Criteria 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

Diagnostic Criteria of Dysthymia

The diagnostic criteria of 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

Diagnostic Criteria of Postpartum depression

It is a common type of depression that starts four to eight weeks after delivery and may continue for months.

  • Depressed mood during entire length of day almost daily
  • Feeling of sadness, or tearful in children and adolescents
  • Depressed mood appear as a sign of constant irritability
  • Diminished interest in doing all activities throughout the day almost daily
  • Considerable weight loss when not dieting or even weight gain
  • Increase/Decrease in appetite daily
  • Sleep disturbances like Insomnia/increased sleeping hours daily
  • Restlessness or slowed behaviour
  • Lack of energy or fatigue almost daily
  • Suicidal thoughts

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 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.