Depressive Disorders

Depressive disorders involve persistent and severe sadness that interferes with one's ability to function in everyday life. Several types of disorders fall under this category, including: Disruptive mood dysregulation disorder, Major depressive disorder, Persistent depressive disorder (Dysthymia), Premenstrual depressive disorder, Seasonal affective disorder, Atypical depression, Psychotic depression/depression with psychotic features

The term depression is used to describe severe and prolonged episodes of sadness and low mood. How the depression episode occurs depends on the type of depression experienced, as there are several.

Symptoms

Disruptive mood dysregulation disorder involves extreme irritability, anger, and frequent intense temper outbursts. One is usually experiencing anger for most of the day nearly every day.  

Major depressive disorder involves several symptoms, including being depressed mood or loss of interest or pleasure. These symptoms include:  

  • Depressed mood for most of the day  
  • Significant weight loss or weight gain without dieting or a decrease or increase in appetite  
  • Insomnia or hypersomnia  
  • Psychomotor agitation or retardation  
  • Fatigue or loss of energy  
  • Feelings of worthlessness or excessive or inappropriate guilt  
  • Decreased ability to think or concentrate or indecisiveness  
  • Recurrent thoughts of death, recurrent suicidal ideations, or a suicide attempt or a specific plan for committing suicide  

Persistent depressive disorder (Dysthymia) has similar characteristics to major depressive disorder; however, the symptoms may appear more infrequent and come in a milder form than MDD, but they last longer (at least two years). The symptoms include:  

  • Depressed mood for most of the day  
  • Poor appetite or overeating  
  • Insomnia or hypersomnia  
  • Low energy or fatigue  
  • Low self-esteem  
  • Poor concentration or difficulty making decisions  
  • Feelings of hopelessness  

Premenstrual depressive disorder may appear similar to premenstrual syndrome (PMS) but is much more severe. It is related to a woman's menstrual cycle, specifically right before menstruation, and the symptoms should also start to improve within a few days after the onset of menses. The symptoms include:  

  • Irritability or anger, or increased interpersonal conflicts  
  • Depressed mood, feelings of hopelessness, or self-deprecating thoughts  
  • Anxiety, tension, and or feelings of being on edge  
  • Decreased interest in usual activities  
  • Difficulties in concentration  
  • Feelings of fatigue or lack of energy  
  • Hypersomnia or insomnia  
  • Change in appetite, over-eating, or specific food cravings  
  • A sense of being overwhelmed or out of control  
  • Physical symptoms such as breasts tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain  

Seasonal affective disorder (SAD) is a type of depression usually related to seasonal changes. SAD mainly occurs in the winter, causing low energy and low moods, and the same symptoms are likely to be resolved during spring or summer. For others, however, less commonly, SAD brings depression symptoms during the spring and summer days and is then resolved during the fall or winter months. The symptoms of SAD are similar to those of major depressive disorder, and they include:  

  • Feeling sad or down for most of the day  
  • Losing interest in activities you enjoyed  
  • Low energy  
  • Sleeping too much  
  • Carbohydrate cravings, overeating, and weight gain  
  • Difficulties in concentration  
  • Feeling hopeless, worthless, or guilty  
  • Having thoughts of not wanting to live  

Atypical depression is similar to major depressive disorder; however, one's mood may brighten up in response to joyful activities or events (mood reactivity). In MDD, mood seldom changes in response to positive changes, activities, or events. Symptoms of atypical depression include:  

  • Depressed mood that changes in response to positive events  
  • Increased appetite or weight gain  
  • Sleeping too much without having much energy in the daytime  
  • Heavy feeling in your arms or legs  
  • Sensitivity to rejection or criticism  

Psychotic depression/depression with psychotic features is an extremely severe form of major depressive disorder in which symptoms of psychosis accompany symptoms of depression. Psychosis (or psychotic episodes) most commonly involve delusions (inaccurate thoughts or beliefs) and/or hallucinations (hearing, feeling, smelling, seeing, or tasting things that are not present in reality). Aside from the MDD and psychotic symptoms, individuals may also experience agitation, anxiety, constipation, hypochondria, insomnia, intellectual impairment, or physical immobility.  

Prevalence

Prevalence rates differ depending on the type of depressive disorder. The DSM-5 has indicated the prevalence rates of each depressive disorder globally. The disruptive mood regulation disorder falls in the 2%-5% range. As for major depressive disorder, the prevalence rate is approximately 5%, while persistent depressive disorder is approximately 0.5%. For premenstrual dysphoric disorder, the rate falls between 2% and 8%. The prevalence rates of seasonal affective disorder (SAD) can reach between 0.5% and 3% of the general population.

Prognosis

Depressive disorders, when treated promptly, generally have a good prognosis. When one commits to complying with the prescribed medications and to regular cycle therapy sessions, one will be able to gain the best possible benefit from the treatment process. The prognosis, however, may not be as good when depressive symptoms are left untreated and they reach a high severity level. For example, a psychotic depression episode is an indicator of a highly severe form of depression; therefore, the treatment process may take a longer time to reach the best benefits.

When to seek help

While any individual has felt sadness or loneliness at some point in their lives as a reaction to their daily struggles, it is important to be aware when those feelings become overwhelming or inhibit their ability to function. Depressive symptoms may feel like a slippery slope, and when they are left untreated, they are subject to worsen over time and may even lead to suicidal behavior or committing suicide. One should be aware of the warning signs and symptoms of the different depressive disorders in order to know when to seek help.

Treatment

Using medications alone or psychotherapy alone (such as cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy, and others) may help to relieve the symptoms of depressive disorders. Using a combination of medications and psychotherapy, on the other hand, will yield the best possible results from the treatment process. Adhering and committing to both types of treatment will most likely enhance the functioning of individuals suffering from a depressive disorder.