Types of depression
It’s important for doctors to know which type of depression you have, so they can prescribe the most effective treatments. Each type of depression has different symptoms and causes.
In Australia, the five main types of depression include:
- major depressive disorder
- major depressive disorder (with melancholia)
- psychotic depression
- persistent depressive disorder (or dysthymic disorder)
- perinatal depression (also called antenatal and postnatal depression).
There is a range of contributing factors for developing depression. These factors can be biological – brain chemistry, genes and personality traits. Or they can be life events – such as trauma and long term stress; or a combination of these factors. Read more about the causes of depression.
Major depressive disorder is the most common type of depression in Australia.
A major depressive disorder is a depressed mood or loss of interest or pleasure in usual activities, together with four or more of the following (nearly every day):
- significant weight loss or gain
- reduced appetite
- insomnia (can’t sleep) or hypersomnia (too much sleep)
- psychomotor agitation (restlessness) or retardation (slowing down of thoughts and reduced physical movement)
- fatigue, less energy
- feelings of worthlessness or excessive guilt
- reduced ability to concentrate, indecisiveness
- recurrent thoughts of death or suicide or suicide attempts.
There are different severities of major depressive disorder
Although some of these symptoms and stress is evident, the disorder leads to only ‘minor impairment of social or occupational functioning’.
Symptoms lie somewhere between mild and severe.
Many symptoms are present. The ‘intensity of symptoms is seriously distressing and unmanageable’.
In severe major depressive disorder, these symptoms cause marked interference with occupational and social functioning’.
A stepped care approach to treating major depressive disorder
Clinicians and researchers from the Black Dog Institute have developed a 'stepped care approach' to treating patients with major depressive disorder.
Essentially, it involves managing patients according to how severe their depression is when they first see their doctor.
Care is 'stepped up' if the initial treatment is not providing a sufficient response. Read more about treatments for depression.
This type of depression is usually severe. It is marked by a loss of pleasure in almost all activities, or inability to enjoy once pleasurable things (also called anhedonia).
- despondency, despair, feeling ‘empty’
- early morning wakening
- slowing down of movement or restlessness
- significant weight loss
- excessive guilt.
People experiencing major depression with melancholia usually find that their symptoms are worse in the morning.
When a patient has major depressive disorder with melancholic features, they require management from a GP together with a psychiatrist.
Psychotic depression is a term used when major depressive disorder is associated with delusions, hallucinations and feelings of paranoia.
It is less common than other types of depression.
Psychotic depression is severe, and has a better response rate when treated with a combination of an anti-depressant and antipsychotics, rather than just one of these treatments alone.
Doctors need to be careful to examine side-effects, and sometimes electroconvulsive therapy (ECT) has a better result.
Persistent depressive disorder (or dysthymia) has similar symptoms to major depression.
The main difference is that symptoms may be less severe, but go on for a prolonged period of more than two years.
As these symptoms have been present for so long, people may not realise they have depression, until someone else notices. They might just think they’ve always been like this.
Dysthymia is characterised by a persistent ‘down’ feeling for more than two years, together with some of the other symptoms of depression.
Dysthymia can be treated with a combination of therapies, such as psychotherapy combined with an antidepressant and lifestyle changes.
Perinatal depression is depression that occurs during pregnancy or after the birth of a baby and affects 15-20% of women in Australia.
Pregnancy and birth is a time of new challenges and demands, changes in hormones, and adjustment to new routines.
Feeling extremely tired, irritable and having less interest in sex is a normal response after childbirth.
However, if you think your 'baby blues' is severe or has been going on for more than two weeks, it's a good idea to talk to your GP about it.
Read more about pregnancy and depression.
Seasonal affective disorder (SAD) is more common in the northern hemisphere (in places with less sunlight). As SAD is thought to be connected to light exposure, it has a marked seasonal pattern. Depression and mood issues occur during winter months, and ease off in spring and summer.
Pre-menstrual dysphoric disorder (PMDD) (also known as severe premenstrual syndrome). Symptoms are so severe they interfere with how a woman can operate in daily life, such as at work and in her close relationships.
Bipolar disorder is sometimes included as a depression. Read more about bipolar disorder.