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

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.