Commonly there are multiple “types of depression” and depends where you look.
It’s normal to feel down once in a while, but if you’re sad most of the time and it affects your daily life, you may have clinical depression.
A condition that is treated with talk therapy, medication, supplements, exercise, psychedelics, and changes to your lifestyle
There are many different types of depression.
Depression changes your brain structurally and chemically.
Whatever the causes of depression, your first step is to let your doctor know how you’re feeling.
You be referred to a mental health specialist or try online therapy to help figure out the type of depression you have.
This diagnosis is important in deciding the right treatment for you.
“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end"
1| Major Depressive Disorder (MDD)
When people use the term clinical depression, they are generally referring to major depressive disorder (MDD). Major depressive disorder is a mood disorder characterized by a number of key features:
- Depressed mood
- Lack of interest in activities normally enjoyed
- Changes in weight
- Changes in sleep
- Fatigue
- Feelings of worthlessness and guilt
- Difficulty concentrating
- Thoughts of death and suicide
2| Persistent Depressive Disorder (PDD)
Dysthymia also known as persistent depressive disorder refers to a type of chronic depression present for more days than not for at least two years.
It can be mild, moderate, or severe.
People might experience brief periods of not feeling depressed, but this relief of symptoms lasts for two months or less. While the symptoms are not as severe as major depressive disorder, they are pervasive and long-lasting.
Persistent depressive disorder symptoms include:
- Feelings of sadness
- Loss of interest and pleasure
- Anger and irritability
- Feelings of guilt
- Low self-esteem
- Difficulty falling or staying asleep
- Sleeping too much
- Feelings of hopelessness
- Fatigue and lack of energy
- Changes in appetite
- Trouble concentrating
Treatment for persistent depressive disorder often involves the use of medications and psychotherapy.
Dysthymia can affect anyone but is two to three times more likely in women than in men.
Symptoms gradually persist over many years; onset is considered early if the dysthymia develops before age 21 and late if onset is at age 21 or after.
Lifetime prevalence rates are between 3% and 6% in Canadian adults over age 18, and just under 3% in U.S. adults.
The estimated one-year prevalence of dysthymia is between 0.8% and 3.1%.
3 | Bipolar Disorder
Bipolar disorder is a mood disorder characterized by periods of abnormally elevated mood known as mania. These periods can be mild (hypomania) or they can be so extreme as to cause marked impairment with a person’s life, require hospitalization, or affect a person’s sense of reality. The vast majority of those with bipolar disorder also have episodes of major depression.
In addition to depressed mood and markedly diminished interest in activities, people with depression often have a range of physical and emotional symptoms which may include:
- Fatigue, insomnia, and lethargy
- Unexplained aches, pains, and psychomotor agitation
- Hopelessness and loss of self-esteem
- Irritability and anxiety
- Indecision and disorganization
4 | Postpartum Depression (PPD)
Pregnancy can bring about significant hormonal shifts that can often affect a woman’s moods.
Dysfunctional copper regulation is now known to be one of the leading causes of postpartum depression.
During pregnancy, the mother’s copper level will more than double to compensate for the fetus. In normal cases, the mother is able to bring her copper levels back down, but when she can’t, this can result in postpartum depression.
Depression can have its onset during pregnancy or following the birth of a child.
Mood changes, anxiety, irritability, and other symptoms are not uncommon after giving birth and often last up to two weeks. PPD symptoms are more severe and longer-lasting.
Such symptoms can include:
- Low mood, feelings of sadness
- Severe mood swings
- Social withdrawal
- Trouble bonding with your baby
- Appetite changes
- Feeling helpless and hopeless
- Loss of interest in things you used to enjoy
- Feeling inadequate or worthless
- Anxiety and panic attacks
- Thoughts of hurting yourself or your baby
- Thoughts of suicide
PPD can range from a persistent lethargy and sadness that requires medical treatment all the way up to postpartum psychosis, a condition in which the mood episode is accompanied by confusion, hallucinations, or delusions.
5 | Premenstrual Dysphoric Disorder (PMDD)
Among the most common symptoms of premenstrual syndrome (PMS) are irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, and breast tenderness.
Premenstrual dysphoric disorder (PMDD) produces similar symptoms, but those related to mood are more pronounced.
PMDD symptoms may include:
- Extreme fatigue
- Feeling sad, hopeless, or self-critical
- Severe feelings of stress or anxiety
- Mood swings, often with bouts of crying
- Irritability
- Inability to concentrate
- Food cravings or binging
6 | Seasonal Affective Disorder (SAD)
Seasonal affective disorder, or SAD, is a type of depression that appears at certain times of the year. It usually begins in the fall when the days get shorter and lasts through the winter. SAD doesn’t only happen in the colder months though. A less common form of seasonal affective disorder affects people in the summer months and usually starts in the spring. It isn’t really clear what causes SAD, but it’s thought that winter SAD may be caused by lack of sunlight.
If you experience depression, sleepiness, and weight gain during the winter months but feel back to normal in spring, you may have a condition known as seasonal affective disorder (SAD).
SAD is believed to be triggered by a disturbance in the normal circadian rhythm of the body.
Light entering through the eyes influences this rhythm, and any seasonal variation in night/day pattern can cause a disruption leading to depression.
Prevalence rates for SAD can be difficult to pinpoint because the condition often goes undiagnosed and unreported. It is more common in areas further from the equator.
SAD is more common in far northern or far southern regions of the planet and can often be treated with light therapy to offset the seasonal loss the daylight.
7 | Atypical Depression
A typical depression is a depression that shares many of the typical symptoms of major depression or dysthymia but is characterized by an improved mood in response to positive events.
Based on these symptoms, you may be diagnosed with atypical depression (current terminology refers to this as the depressive disorder with atypical features). It’s a type of depression that doesn’t follow the same “type” patterns of the illness.
Atypical depression is characterized by a specific set of symptoms related to
- Excessive eating or weight gain
- Excessive sleep
- Fatigue, weakness, and feeling “weighed down”
- Intense sensitivity to rejection
- Strongly reactive moods
Atypical depression is actually more common than the name might imply.
The other types of depression
We know that brain imaging studies show that depression is not a character flaw or personal weakness.
It is associated with biological changes in the brain and body.
People with depression often have too much activity in the deep limbic system—the brain’s emotional centers.
Not everyone with depression has the same underlying brain patterns.
Dr. Daniel Amen from Amen Clinics and BrainMD identifies 7 different types of brain patterns associated with depression. Knowing what your brain type is the key to getting the most out of your effective treatment.
A SPECT (single-photon emission computed tomography) scan evaluates blood flow and activity in the brain.
It can show you three things
- healthy activity
- too much activity
- too little activity
A healthy “active” scan shows the most active parts of the brain with blue representing the average activity and red (or sometimes red and white) representing the most active parts of the brain.
Type 1: Pure Anxiety
Many people who experience depression also have other mental health conditions. It’s estimated that up to 60-75% of people with depression also have anxiety. Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry, and/or panic.
Did you know that depression and anxiety occur together 75% of the time?
Pure Anxiety often results from too much activity in the basal ganglia, setting one’s “idle speed” on overdrive.
Common symptoms of Pure Anxiety include:
- Frequent feelings of nervousness or anxiety
- Panic attacks
- Avoidance of people or places due to a fear of having anxiety or panic attacks
- Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor)
- Periods of heart-pounding, nausea, or dizziness
- Tendency to predict the worst
- Multiple persistent fears or phobias (such as dying or doing something crazy)
- Conflict avoidance
- Excessive fear of being judged or scrutinized by others
- Being easily startled or a tendency to freeze in anxiety-provoking or intense situations
- Shyness, timidity, and getting easily embarrassed
Biting fingernails or picking skin
Type 2: Pure Depression
Pure Depression often results from excessive activity in the deep limbic system—the brain’s emotional center. People with this type struggle with depressive symptoms that range from chronic mild sadness to crippling major depression, where it’s difficult to even get out of bed.
Common symptoms of Pure Depression include:
- Persistent sad or negative mood
- Loss of interest in usually pleasurable activities
- Restlessness, irritability, or excessive crying
- Feelings of guilt, worthlessness, helplessness, hopelessness, or pessimism
- Sleeping too much or too little, or early-morning awakening
- Appetite changes and/or weight loss or weight gain
- Decreased energy or feeling “slowed down”
- Thoughts of death or suicide, or suicide attempts
- Difficulty concentrating, remembering, or making decisions
- Persistent physical symptoms (such as headaches, digestive problems, or chronic pain)
- Chronic low self-esteem
- Persistent feeling of being dissatisfied or bored
Type 3: Mixed Anxiety / Depression
Mixed Anxiety/Depression involves a combination of both Pure Anxiety symptoms (listed above) and Pure Depression symptoms (listed above).
This type shows excessive activity in the brain’s basal ganglia and the deep limbic system.
One type may predominate at any point in time, but symptoms of both are present on a regular basis.
Type 4: Over-focused Anxiety / Depression
Over-Focused Anxiety/Depression involves excessive activity in the brain’s anterior cingulate gyrus, basal ganglia, and/or the deep limbic system. People with this type—which occurs more frequently in the children or grandchildren of alcoholics—have trouble shifting attention and often get locked into anxious and/or negative thoughts or behaviours.
This can look like:
- Obsessive-compulsive disorder (stuck on negative thoughts or actions)
- Phobias (stuck on a fear)
- Eating disorders (stuck on negative eating behaviour)
- Posttraumatic stress disorder or PTSD (stuck on a past traumatic event)
- Common symptoms of over-focused Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression, plus at least 4 of the following:
- Excessive or senseless worrying
- Upset when things are out of place or things don’t go the way you planned
- Tendency to be oppositional or argumentative
- Tendency to have repetitive negative or anxious thoughts
- A tendency toward compulsive or addictive behaviours
Intense dislike for change - Tendency to hold grudges
- Difficulty seeing options in situations
- Tendency to hold onto own opinion and not listen to others
- Needing to have things done a certain way or you become upset
- Others complain you worry too much
- Tendency to say “no” without first thinking about the question
Type 5: Temporal Lobe Anxiety / Depression
Temporal Lobe Anxiety/Depression is related to too little or too much activity in the temporal lobes (involved in moods, emotions, and memory), in addition to overactivity in the basal ganglia and/or deep limbic system.
Common symptoms of Temporal Lobe Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression, plus at least 4 of the following:
- Short fuse or periods of extreme irritability
- Periods of rage with little provocation
- Often misinterpreting comments as negative when they are not
- Periods of spaciness or confusion
- Periods of panic and/or fear for no specific reason
- Visual or auditory changes, such as seeing shadows or hearing muffled sounds
- Frequent periods of déjà vu
- Sensitivity or mild paranoia
- Headaches or abdominal pain of uncertain origin
- History of head injury
- Family history of violence or explosiveness
- Dark thoughts that may involve suicidal or homicidal thoughts
- Periods of forgetfulness or memory problems
Type 6: Cyclic Anxiety / Depression
Cyclic Anxiety/Depression is associated with extremely high activity in the brain’s basal ganglia and/or deep limbic system.
These areas of excessive activity act like “emotional seizures” as the emotional centers hijack the brain for periods of time in a cyclical pattern.
Cyclical disorders, such as bipolar disorder, cyclothymia, premenstrual tension syndrome, and panic attacks are part of this category because they are episodic and unpredictable.
Common symptoms of Cyclic Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression plus periods of time with at least 4 of the following:
- Abnormally elevated, depressed or anxious mood
- Decreased need for sleep, feeling energetic on dramatically less sleep than usual
- Grandiose notions, ideas or plans
- Increased talking or pressured speech
- Racing thoughts
- Markedly increased energy
- Poor judgment leading to risk-taking behaviour (departure from usual behaviour)
- Inappropriate social behaviour
- Irritability or aggression
- Delusional or psychotic thinking
Type 7: Unfocused Anxiety / Depression
Unfocused Anxiety/Depression is associated with low activity in the prefrontal cortex (PFC) in addition to high activity in the basal ganglia and/or deep limbic system.
The PFC is involved with attention, focus, impulse control, judgment, organization, planning, and motivation. When the PFC is underactive, people often have problems with these executive functions.
Distinguishing Unfocused Anxiety/Depression from ADD/ADHD can be difficult because of the similarity in symptoms.
However, brain imaging provides a window into the brain to see the areas with too little or too much activity.
This allows for a more accurate diagnosis.
Symptoms of Unfocused Anxiety/Depression include at least 4 items from the Pure Anxiety and/or Pure Depression symptoms, plus at least 4 of the following:
- Trouble staying focused
- Spaciness or feeling in a fog
- Overwhelmed by the tasks of daily living
- Feeling tired, sluggish or slow-moving
- Procrastination, failure to finish things
- Chronic boredom
- Distractibility
- Forgetfulness
- Difficulty expressing feelings
- Lack of empathy for others
A variation of Unfocused Anxiety/Depression is caused by overall reduced blood flow and activity in the cortex along with too much activity in the basal ganglia and/or deep limbic system.
This pattern may be related to physical illness, drug or alcohol abuse, hypoxia (lack of oxygen), infections (such as Lyme disease), traumatic brain injury, or exposure to toxic mold or other environmental toxins.
Symptoms of this variation also include frequent feelings of sickness, mental dullness, “brain fog,” or cognitive impairment.
