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

“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

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.