Depression
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Definitions

Types

At the Institute we believe that there are three broadly different types of depression:

each with their own features and causes.

A possible fourth type of depression is

Why is this important? We believe that, as with any illness, the person suffering from it can’t be properly treated unless the specifics of their illness are understood.

We therefore believe that people who are depressed should receive a sophisticated assessment identifying their particular type of depression and its broad causes, whether biological, psychological or other.

Treatments should be selected according to the specific type of depression experienced by an individual, and its causes.

A description of the different types of depression follows.

Melancholic depression

Melancholic depression is the classic form of biological depression. Its defining features are:

  • a more severe depression than is the case with non-melancholic depression, with a lack of pleasure and difficulty in being cheered up
  • psychomotor disturbance (e.g. low energy, poor concentration, slowed or agitated movements)

Melancholic depression is a relatively uncommon type of depression. It affects less than 5 per cent of Western populations. The numbers affected are roughly the same for men and women.

Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example antidepressant drugs) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy.

Further information on treatments for depression
More information on the biology of depression

Non-melancholic depression

‘Non-melancholic depression’ essentially means that the depression is not melancholic, or, put simply, not primarily biological. Instead, it has to do with psychological causes, and is very often linked to stressful events in a person’s life, alone, or in conjunction with the individual’s personality style.

Non-melancholic depression is the most common of the three types of depression. It affects one in four women and one in six men in the Western world over their lifetime.

Non-melancholic depression can be hard to accurately diagnose because it lacks the defining characteristics of the other 2 depressive types (viz psychomotor disturbance or psychotic features). Also in contrast to the other 2 depressive types, people with non-melancholic depression can usually be cheered up to some degree.

People with non-melancholic depression experience

  • a depressed mood (see signs of depression) for more than two weeks
  • social impairment (for example, difficulty in dealing with work or relationships).

In contrast to the other types of depression, non-melancholic depression has a high rate of spontaneous remission. This is because it is often linked to stressful events in a person’s life, which, when resolved, tend to assist the depression to lift.

Non-melancholic depression responds well to different sorts of treatments (such as psychotherapies, antidepressants and counselling), but the treatment selected should respect the cause (e.g. stress, personality style).

Further information on treatments for depression
Read about the causes of depression

Psychotic depression

Psychotic depression is a less common type of depression than either melancholic or non-melancholic depression.
The defining features of psychotic depression are:

  • an even more severely depressed mood (see signs of depression) than is the case with either melancholic or non-melancholic depression
  • more severe psychomotor disturbance than is the case with melancholic depression
  • psychotic symptoms (either delusions or hallucinations, with delusions being more common) and over-valued guilt ruminations.

Psychotic depression has a very low spontaneous remission rate. It responds only to physical treatments (such as antidepressant drugs).

Further information on treatments for depression
Find about the causes of depression

Atypical depression

Atypical depression is a name that has been given to expressions of depression that contrast with the usual characteristics of depression. For example, rather than experiencing appetite loss the person instead experiences appetite increase; and sleepiness rather than insomnia. Someone with atypical depression is also likely to have a personality style of interpersonal hypersensitivity (that is, be hypersensitive to expecting others not to like or approve of them).

The features of atypical depression include:

  • The individual can be cheered up by pleasant events
  • Significant weight gain or increase in appetite (especially to comfort foods)
  • Excessive sleeping (hypersomnia)
  • Arms and legs feeling heavy and leaden
  • A long-standing sensitivity to interpersonal rejection —the individual is quick to feel that others are rejecting of them.