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Types of Depressive and Mood Disorders


An Overview

In this article we offer an overview of Depressive Illnesses and Mood Disorders. We examine the diagnostic criteria and nature of Major Depression, Dysthymia, Bipolar Disorders, Seasonal Affective Disorder and Postpartum Depression. We also talk briefly about depression as a reaction to ongoing life stresses.

Prevalence of Depression and Mood Disorders

There is ample evidence to suggest that Depression and Mood Disorders are extremely common. The research of Kessler and his colleagues suggest that 20% of Americans will experience a Depressive Disorder over their lifetime (ref. 3), and that almost 1 out of every 10 Americans will experience a Depressive or Mood Disorder within a 12 month period (ref. 4). Finally, estimates suggest that nearly 7% of Americans will experience a Major Depressive Episode, in a given year (ref. 2). There is also strong evidence to suggest that approximately twice as many women as men will experience depression during the course of their life time (approximately 20-26% for women and 8-12% for men). Moreover, there is evidence that Depression places people at risk for suicide (ref. 5), with some estimates suggesting that as many as 50% of those who attempt suicide are experiencing a Major Depressive Episode (ref. 6).

Types of Depression

Major Depressive Disorder (or Episode):

According to standard practice guidelines, if you have a Major Depressive Disorder you need to experience at least 5 of the following symptoms.

  • Depressed mood: feeling sad, down
  • Feelings of worthlessness: including hopelessness, despair, & guilt
  • Inability to enjoy life
  • Changes in appetite
  • Sleep disturbance
  • Difficulties concentrating: including difficulty making decisions
  • Loss of energy: feelings of tiredness and fatigue
  • Psychomotor agitation (restlessness) or retardation (sluggishness)
  • Suicidal ideation

These symptoms need to last for at least two weeks, occur daily (or almost daily and be present during most of the day), and significantly interfere with functioning, e.g., you are unable to concentrate or focus on your work, avoid interacting with others, or have no energy to accomplish what you need to do. In addition, these symptoms have to be a significant departure from how you normally feel and function.

Dysthymia or Dysthymic Disorder

Dysthymic Disorder is a less severe and more chronic form of depression. Persons with Dysthymia typically are depressed the majority of the time (but symptoms are not as severe as those associated with a Major Depressive Episode or Disorder), have experienced depression for over two years (one year for children and adolescents), and have not been free of depression for more than two months at any point during the past two years.

The accepted practice guidelines for diagnosing Dysthymia specify that you must experience a least two of the symptoms listed below and that these symptoms must be severe enough to cause you distress and interfere with your functioning.

  • Poor appetite or overeating
  • Insomnia or hypersomnia (excessive sleeping)
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

Bipolar Disorders

According to standard practice guidelines, people with Bipolar Disorder have significant depressive symptoms, as well as periods in which their mood is significantly elevated. Historically, Bipolar Disorder was referred to as Manic-Depressive Disorder. Manic episodes are characterized by excessive happiness, unrealistically positive sense of self (often involving a sense of uniqueness, special talents, and feelings of invincibility), increased energy (often accompanied by a significantly decreased need for sleep), racing thoughts, a tendency to be grandiose, poor judgment, excessive seeking out of pleasurable activities, and at times even delusions and hallucinations. In some instances, persons with Bipolar Disorder may have an irritable and angry mood, rather than a positive and excessively happy mood.

Experts have identified different types of Bipolar Disorders, depending upon:

  • the pattern of moods one experiences (whether the individual has experienced manic, hypomanic, mixed or depressive episodes)
  • which mood one is currently experiencing or has most recently experienced
  • how quickly the individual’s mood changes

Diagnosing Bipolar Disorder can be complicated because of the disorder can take many different forms. Common symptoms of Manic and Hypomanic Episodes are noted below. However, for more detailed information about diagnosis and types of mood disorders please check the resources listed at the end of this section.

Mania: To be diagnosed with a Manic episode a person must experience an elevated, expansive or notably irritable mood (that lasts at least one week). These feelings must be severe enough to disrupt or impede functioning in a major life area (work, school, family or social). Finally, three or more of the following symptoms need to be present to diagnose a Manic episode:

  • Grandiosity, an unrealistically positive sense of self
  • Decreased need for sleep
  • Excessive talking, or feeling the need to talk excessively
  • Racing thoughts, flight of ideas (ideas jump from topic to topic)
  • A tendency to focus on the unimportant or irrelevant
  • An increase in goal-directed activity (a tendency to be over-focused on work, social or sexual goals)
  • Excessive involvement in pleasurable activities such as spending or sexual activities, particularly ones where there is a risk of significantly negative consequences

Hypomania. Hypomanic episodes are less intense/severe than manic episodes. They are characterized by the same symptoms, but to a lesser degree of intensity. However, symptoms are clearly noticeable by others, and represent a marked change in a person’s behavior. For example, a normally quiet person may become very outgoing, spend more and be promiscuous. The behaviors/symptoms need to reflect a significant deviation from normal functioning, but are not as severe as in a manic episode. In addition, no psychotic symptoms occur in conjunction with a hypomanic episode.

Cyclothymia. Cyclothymia refers to a milder form of Bipolar Disorder. Cyclothymia is characterized by episodes of hypomania, rather than full-blown mania, along with episodes of depression. Cyclothymia is also thought of as a more chronic illness. Specifically, to diagnose Cyclothymia, symptoms must be present for over two years, with no more than 2 months symptom free.

Postpartum Depression

The amount of information and research on Postpartum Depression is far less extensive than on other types of depression. However, experts agree that the period after childbirth can leave women vulnerable to depression. It is not uncommon for many woman to experience what has been referred to as the “baby blues” or “postpartum blues,” a brief period in which women may be more sensitive, moody and even tearful. The “baby blues” are thought to typically resolve within 1-2 weeks. A much smaller percentage of women (estimates vary from 8% to up to 15%) experience Postpartum Depression. Postpartum Depression refers to a more significant period of depression that occurs after childbirth. Women with a history of depression are thought to be more at risk for Postpartum Depression. While the symptoms of Postpartum Depression are not as clear cut as those associated with Dysthymia or a Major Depression, common symptoms are thought to include:

  • Depressed mood, feelings of sadness
  • Appetite disturbance
  • Sleep problems, insomnia
  • Tiredness, fatigue, exhaustion
  • Feelings of irritability and anger
  • Loss of interest in sex
  • Inability to enjoy life
  • Feelings of guilt, worthlessness or inadequacy
  • Crying spells
  • Difficulty bonding with the baby
  • Withdrawal from family and friends
  • Thoughts of harming the baby or one’s self

Though quite rare, some women may develop a Postpartum psychosis. This is a rare condition which occurs shortly after birth. Postpartum psychosis is extremely severe and is characterized by the depressive symptoms noted above, feelings of confusion, hallucinations and delusions, and attempts to harm one’s self or the baby.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is a type of depression that typically occurs in the fall and winter, when days are shorter and there is less sunlight. While there is far less research on SAD than on Major Depression or Bipolar Disorder current estimates are that approximately 4% to 6% of Americans will experience SAD, and that women experience SAD far more often then men. Symptoms associated with SAD are thought to be similar to Dysthymia and Major Depression, with symptoms beginning in the fall or winter, and fading in the spring. There is evidence that those living in Northern states have a much greater rate of SAD than those living in the south or southwest.

Adjustment Disorder with Depressed Mood

While not considered a depressive disorder, some people experience a depressed mood and difficulties coping in response to stressful events (death of a loved one, divorce, unemployment and the like). An Adjustment Disorder is typically diagnosed when a person has experienced a recent stress and is having more difficulty than normal coping with this stress. For example, an individual who feels down and hopeless and has difficulties motivating him/herself, following a job loss, might have an Adjustment Disorder with Depressed Mood. For an Adjustment Disorder to be diagnosed an individual must have experienced a specific stressor, and have symptoms in the mild or to moderate range. If more severe symptoms are present, it is likely that the stressor has triggered a Major Depressive Episode.

References cited in our discussion of Depression & Mood Disorders

Ref. 1. Antonuccio, D.O., Danton, W., & DeNelsky, G. Psychotherapy Versus Medication for Depression: Challenging the Conventional Wisdom With Data Professional Psychology: Research and Practice. December 1995 Vol. 26, No. 6, 574-585.

Ref. 2. Jacobson, N.S. Cognitive-Behavior Therapy Versus Pharmacotherapy: Now That the Jury's Returned Its Verdict, It's Time to Present the Rest of the Evidence. Journal of Consulting and Clinical Psychology February 1996 Vol. 64, No. 1, 74-80.

Ref. 3. Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication, Archives General Psychiatry. 2005;62:593-602.

Ref. 4. Kessler, R.C., Chiu, W.T., Demler, O., Walters, E.E. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives General Psychiatry. 2005;62:617-627.

Ref. 5. Gibbons, R.D., Hur, K., Bhaumik, D.K., Mann, J.J. The Relationship Between Antidepressant Medication Use and Rate of Suicide. Archives General Psychiatry. 2005;62:165-172.

Ref. 6. Oquendo, M.A., Malone, K.M., Ellis, S.P., Sackeim, H.A., Mann, J.J. Inadequacy of Antidepressant Treatment for Patients With Major Depression Who Are at Risk for Suicidal Behavior. American Journal of Psychiatry, 1999, February, 156:190-194.

Ref. 7. Turner E., Matthews, a., Linardtos, E., et al. Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, January 2008, pp 252-260.

Ref. 8. Kirsch, I., Deacon, B., Huedo-Medina, T., et al. Initial severity and antidepressant benefits: A meta analysis of data submitted to the food and drug Administration. PLoS Medicine, February 2008, 5 (2), e45.

Ref. 9. Barlow, D. H. Psychological interventions in the era of managed competition. Clinical Psychology: Science and Practice, 1994, 1, 109–122.

Ref. 10. Elkin I, Shea MT, Watkins JT, et al: National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Archives of General Psychiatry, 1989, 46:971-982.

Ref. 11. Psychotherapy Relationships that work, (ed) Norcross, John. Oxford University Press, 2002.

Ref. 12 Lemmens, G.M.D., Eisler, I., Buysse, A., Heene, E.,  Demyttenaere, K.  The Effects on Mood of Adjunctive Single-Family and Multi-Family Group Therapy in the Treatment of Hospitalized Patients with Major Depression. Psychotherapy and Psychosomatics,  2009, 78:98-105 

Ref. 13. Jacobson, N.S., Fruzzetti, K., Dobson, M., & Whisman, H. Couples therapy as a treatment for depression: II. The effects of relationship quality and therapy on depression. Journal of consulting and Clinical Psychology, 1996, 61, 516-519.

Ref. 14. Johnson, S.M, & Lebow J. The coming of age of couple therapy: A decade review. Journal of Marital and Family Therapy, 2000, 26, 9-24.

Ref. 15. Miklowitz D.J., Otto M.W., Frank E., Reilly-Harrington N.A., Wisniewski S.R., Kogan J.N., Nierenberg A.A., Calabrese J.R., Marangell L.B., Gyulai L., Araga M., Gonzalez J.M., Shirley E.R., Thase M.E., Sachs G.S. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program (STEP). Archives of General Psychiatry, 2007, Apr;64 (4):419-426.

Ref. 16. Miklowitz DJ. A review of evidence-based psychosocial interventions for bipolar disorder. Journal of Consulting and Clinical Psychology, 2006, 67(Supplement 11):28-33.

Ref. 17. M. Terman, J.S., Terman, F.M., Quitkin, P.J., McGrath, J.W. Light therapy for seasonal affective disorder. A review of efficacy. Neuropsychopharmacology. 1989, Mar;2(1):1-22.

Ref. 18. Golden R.N., et al. The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 2005, 162(4): 656–662.

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