Defining Depression


Major Depressive Disorder (major depression) Characterized by multiple symptoms that interfere with the ability to work, sleep, eat, enjoy once-pleasurable activities or function normally. When very severe, one may feel unable to get out of bed, sometimes called vegetative depression; when symptoms include hallucinations and delusions, called psychotic depression.

Treatment: Usually medication (SSRIs or other antidepressants), therapy to address the underlying causes of depression, learning life-coping skills and support.

Dysthymic Disorder (dysthymia) Characterized by milder symptoms than major depression but lasting longer, two years or more.

Treatment: Combination of antidepressant medication, therapy and support.

Minor Depression Milder, shorter-lasting symptoms than either major depression or dysthymia, yet longer lasting than just "the blues."

Treatment: May need therapy or support only, or short-term therapy with medication.

Bipolar Disorder Characterized by alternating episodes of extreme lows (depression) with extreme highs (mania) that may include restlessness, racing thoughts, impulsiveness, and feelings of grandiosity or irritability. Less common than major depression or dysthymia, runs in families.

Treatment: Determined by psychiatrist, may include antidepressants in combination with a mood-stabilizing medication such as lithium; in severe cases, electroconvulsive therapy (ECT).

Perinatal and Postpartum Depression: Can be triggered by hormonal changes during pregnancy and after childbirth; psychosocial factors, feelings of isolation and family history may all play a role; lasts for weeks or months after hormonal changes have settled; can interfere with normal functioning, including parenting duties. May be hard to recognize because symptoms—fatigue, mood swings and weight changes—mimic those expected during these life periods.

Treatment: Talk therapy and support groups with other pregnant women or new moms, assistance with chores and tending to your baby; sometimes antidepressant medication, such as certain SSRIs (selective serotonin reuptake inhibitors) should be tried during pregnancy and breastfeeding and could be considered less risky than letting the depression continue but should be monitored by a specialist.

Premenstrual Dysphoric Disorder (PMDD) Extreme form of PMS with symptoms including depression, anxiety, irritability and mood swings that interfere with normal functioning usually the week or two before menstrual period; caused by unusual physical responses to normal hormonal changes.

Treatment: May include hormonal medications such as oral contraceptives, non-steroidal anti-inflammatory medications (NSAIDS such as ibuprofen) to minimize physical complaints, anti-anxiety medications such as alprazolam (Xanax), antidepressants and some nutritional supplements (especially vitamin B-6).

Seasonal Affective Disorder Depression that occurs during winter months when there is less natural sunlight.

Treatment: Exposure to broad-spectrum light, usually in the morning through use of an at-home light box (available at drugstores and hardware stores), alone or in combination with antidepressant medications and/or therapy.

Sources: Women and Depression booklet, National Institute of Mental Health; Anita Clayton, MD, David C. Wilson Professor of psychiatry at the University of Virginia; William Beardslee, MD, psychiatrist at Children's Hospital Boston, professor of child psychiatry at Harvard Medical School and author of When a Parent Is Depressed: How to Protect Your Children from the Effects of Depression in the Family (Little, Brown and Company, 2002).

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