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Types of Depression
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:
Melancholic depression is a relatively uncommon type of
depression. It affects only 1-2 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 counseling or psychotherapy.
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
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a depressed mood 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 see the
depression also lifting.
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).
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:
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an even more severely depressed mood 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).
Atypical depression
Atypical depression is a name that has been given to
expressions of depression that contrast with the usual
characteristics of non-melancholic 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, expecting that others will not like or approve of
them).
The features of atypical depression include:
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The individual can be cheered up by pleasant events
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Significant weight gain or increase in appetite (especially
to comfort foods)
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Excessive sleeping (hypersomnia)
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Arms and legs feeling heavy and leaden
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A long-standing sensitivity to interpersonal rejection —the
individual is quick to feel that others are rejecting of
them.
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