The diagnostic category referred to as Major Depressive Disorder appears in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Although the term is not commonly used in countries that use the ICD-10 system, the diagnosis of depressive episode is similar to an episode of major depression. Clinical Depression is also used to describe acute or chronic depression that is severe enough to need treatment. Minor depression is a less-frequent terminology used to describe a sub clinical depression that does not fit the criteria for major depression; however, at least two symptoms are required to be present for two weeks for the diagnosis of minor depression.
Depression Types: Dysthymia
Dysthymia is a mild form of depression that has the duration of a minimum of two years. The diagnosis is based on an ongoing, persistent depressed mood for at least two years. Although the symptoms are not as acute as in Major Depression, patients with Dysthymia are susceptible to co-occurring episodes of Major Depression. Often, this disorder starts in adolescence and persists throughout an individuals lifespan. Patients diagnosed with major depressive episodes and dysthymic disorder concurrently are said to suffer from double depression. Dysthymic disorder develops first, and one or more major depressive episodes occur at a later time.
Bipolar I Disorder involves an episodic illness in which moods may swing between mania and depression. In the U. S., Bipolar Disorder was referred to as Manic Depression earlier. However, the medical community no longer considers this term appropriate. Nevertheless, depression has a dominating influence (in terms of disability and potential for suicide) role in the disorder. The term “Manic Depression” is commonly used among laypersons.
Bipolar II Disorder is defined as an episodic illness that primarily reflects depression, but includes episodes of hypomania.
Postpartum Depression, or Post-Natal Depression, is clinical depression types that is seen in women within two years of giving birth. Physical, mental and emotional exhaustion coupled with sleep-deprivation, can bring the onset of Clinical Depression.
Depression Types: Anxiety
Various depression types and anxiety types are classified separately by the DSM-IV-TR. However these do not include hypomania, which is described as part of the Bipolar-Disorder category. Aside from formal systems of classification, depression and anxiety can occur together. They can be comorbid: occurring together, with overlapping symptoms, and with mood congruence. They can occur together, independently, and without mood congruence too. In an attempt to narrow the gap between the DSM-IV-TR classification and practical clinical encounters, experts such as Herman Van Praag have introduced new terminology, such as anxiety/aggression-driven depression. This concept is defined as an “anxiety/depression spectrum” for these two disorders as opposed to the mainstream perspective of discrete diagnostic categories.
Although there is no specific classification for the comorbidity of depression and anxiety in the DSM or ICD, the National Comorbidity Survey (U.S.) suggests that 58 percent of those with major depression also suffer from lifetime anxiety. Going along with this finding, two widely accepted clinical colloquialisms include:
agitated depression – a state of depression that is characterized by anxiety; and includes ; suicidal tendencies; insomnia (not early morning wakefulness); nonclinical (meaning “does not meet the standard for formal diagnosis”) and nonspecific panic; and a general sense of dread.
akathitic depression – a state of depression that is characterized by anxiety or suicidal tendencies; and includes akathisia but does not include symptoms of panic.
Even symptoms of mild anxiety can have a major consequence on depressive illness. The combination of the two categories of illnesses can have grave consequences. A pilot study by Ellen Frank et al., at the University of Pittsburgh, reported that depressed or Bipolar-Disorder patients with lifetime-panic symptoms experienced significant delays in their remission. These individuals also experienced higher levels of residual impairment, or the lack of ability to get back into a normal lifestyle.
Depression Types: Hypomania
Hypomania is a state of mind or behavior that is less than (hypo) Mania. A person in a hypomanic state commonly reveals behavior that contains all the signs of a full-blown Mania (e.g., marked elevation of mood that is characterized by euphoria, hyper activity, uninhibited behavior, impulsivity, a decreased need for sleep, hypersexuality). However, these symptoms, which can be perceived as disruptive and sometimes out of character
Hypomania is a diagnostic classification that includes both anxiety and depression. It is characterized by a state of anxiety that takes place in the context of a clinical depression. Patients who are hypomanic often describe a sense of extreme generalized or specific anxiety, recurring panic attacks, night terrors and guilt. This happens during a state of retarded or somnolent depression. This is the kind of depression in which a person is lethargic and not able to function properly. The terms retarded and somnolent are shorthand for states of depression that include lethargy, hypersomnia, a lack of motivation, a collapse of activities of daily living (ADLs), and social withdrawal. This is similar to the symptoms of an “agitated” or “akathitic” depression.
When we look at the hypomania-depression types connection, there should be a distinction between anxiety, panic and stress. Anxiety can be understood as a physiological state that is brought on by the Sympathetic Nervous System. Anxiety is not dependant on outside influence for occurrence. Panic is related to the “fight or flight” process. It is brought about by environmental stimuli; and it involves the Sympathetic Nervous System and the cerebral cortex. Lastly, stress is a psychosocial reaction influenced by how a person perceives a threatening, external event. This kind of filtering is based on an individual’s own ideas, assumptions, as well as expectations. When put together, these ideas, assumptions, and expectations are called social constructionist.
To conclude, researchers at the University of California, San Diego, led by Hagop Agiskal, MD, have discovered convincing evidence for the co-occurrence of hypomanic symptoms linked to a diagnosis of Depression when the diagnosis does not meet the criteria for Bipolar Disorder. Symptoms include irritability, misdirected anger, and compulsivity; also may not present in a pronounced manner in order to be considered a hypomanic episode, as described by a Bipolar II Disorder. As it was stated in the aforementioned Frank study, this specific course of the illness, with the onset of anxiety, may play a significant role on the overall course of the depression.
This concept of co-occurring anxiety and depression types is supported by a study by Giovanni Cassano, MD, of the University of Pisa and his colleagues, on the As it was stated in the aforementioned Frank study, this specific course of the illness, with the onset of anxiety, may play a significant role on the overall course of the depression.
This concept of co-occurring anxiety and depression is supported by a study by Giovanni Cassano, MD, of the University of Pisa and his colleagues, the Spectrum Promect, who discovered a correlation between lifetime hypomanic and manic symptoms and the severity of the depression.
The presence of manic/hypomanic within patients with Unipolar Depression challenges the U neurotransmittersnipolar-Bipolar dichotomy. Cassano et al., as well as many other researchers, argue in favor of a revision of the approach to psychiatric diagnosis to include clearer definitions of the mood spectrum, so as to make more accurate diagnostic evaluations. This method, although controversial, is beginning to be given due consideration by several behavioral-health professionals regarding the depression types.