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Diagnosing Depression

Depression is classified based on the way the illness takes shape. Determining the precise pattern of symptoms that accompany a depression is very important because it helps to determine which particular treatment is most likely to be effective for it. Here are the major types of depression:

• Depression with Psychotic Features

This is the most severe and dangerous type of depression with the highest rate of suicide, aggression, and need for hospitalization. The victims lose their grip on reality and experience either wildly distorted beliefs (delusions) or wildly distorted perceptions (hallucinations). They need hospitalization and aggressive treatment to get them back to reality.

Typically, the delusions or hallucinations are filled with negative feelings about themselves. They may be convinced that they are responsible for the ills of the world. They may feel that their insides are "rotting out." They may hear voices calling their name, cursing and criticizing them, saying they deserve to die, or rehashing past misdeeds.

People with psychotic depression are at the highest risk to hurt themselves and other people. They have a potentially deadly combination: low self- esteem, poor judgment, delusional thinking, and hallucinations.

The initial goal of treatment is to eliminate the psychotic symptoms as quickly as possible. This usually involves taking the combination of an antipsychotic medication and an antidepressant medication. If this does not work, electro convulsive therapy (ECT) is indicated, that has a 95 percent chance of success. This depressions is very severe and dangerous. Stay on the medication for a long time to avoid possible recurrences

• Depression with Melancholic Features

This is another severe form of depression.

Sufferers of depression with melancholic features withdraw into a dense cocoon of misery that nothing can penetrate. Nothing seem to make them happy. Even the most joyful events in life seem empty and have no meaning to them.

The victims of this depression are frigid and have lost the capacity to experience pleasure.

Other symptoms include the disappearance of appetite, severe weight loss, and a terrible problem getting any sleep.

The victims feel that their body is almost as broken as their mind.

Some people become so impaired that they are unwilling or unable to dress, may stop washing or feeding themselves, may stop eating, and may wind up spending the entire day alone lying in bed ruminating in a frantic and agitated state. This can lead to a medical emergency with dehydration, malnutrition, exhaustion, and suicide risk.

Here is a typical scenario:

You wake up at 3 A.M. feeling absolutely rotten, desperate, and agitated. You turn on TV but can't watch, pick up a book but can't read, try soothing music but feel irritated by it. You return to bed-but toss, turn, and fret in the endless hours before dawn. As the sun rises, you begin pacing around the apartment but feel no relief or comfort and finally go back to bed. You feel worthless wasting time in bed but you are too washed out to get up.

Your mind is filled with self-criticism, ruminations, catastrophization, and worries. 

As the day progresses, you feel a bit better. By late afternoon you are relieved enough to eat a light meal and get dressed. The evening is not fun, but it is not an agitated torture. By 3 A.M. the next morning, however, you are back in the lowest circle of hell.

Treatment

Psychotherapy is totally ineffective for this type of severe depression. The victim may view the psychotherapy as added burden and hence the condition can get worse. Antidepressant medication is usually the treatment of choice but electro convulsive therapy (ECT) may be necessary if rapid results are needed or if the medicine has not worked very well.

• Depression with Atypical Features

Depression with atypical features is distinguished by the fact that the characteristic pattern of symptoms is just the exact opposite of what was described for the melancholic type.

The sufferers of depression with atypical features will respond to negative or positive external events. They will feel deeply depressed or somewhat hopeful depending on the latest situation they are faced with. Their mood will brighten considerably when dining out with friends or enjoying a good movie. But when they are alone, their mood will slip back into the dark depths of depression.

This type of depression usually follows an interpersonal rejection by a lover, boss, or close friend.
People with atypical depression tend to overeat and oversleep, whereas people with melancholia often are characterized by weight loss and insomnia.

People with atypical depression feel paralyzed or too tired to get out of bed. Chocolate is particularly important as a comfort food.

Treatment

Useful:

• Serotonin reuptake inhibitors (SSRI) like Prozac, Paxil, Zoloft, or Luvox

• Monamine oxidase inhibitors (MAOI) like Nardil or Parnate.

• Psychotherapy can also be useful.

Not Useful:

• Tricyclic antidepressants.

• Seasonal Depression

This depression almost always begin and end around the same time of the year because it is triggered and turned off by shifts in the length of the day/night cycle.

People who suffer from seasonal depression or seasonal affective disorder are especially sensitive to the diminishing hours of daylight in the late fall or early winter and go into a kind of depressive hibernation. The episodes usually begin in November or December, are at their worst in December and January, and usually improve with the lengthening of daylight in the spring.

• Postpartum Depression

This is a very frequent and completely normal consequence of childbirth. In normal cases, the depression wears off soon after the child birth as the hormonal and psychological systems get back on track. Unfortunately, some women develop a severe depression that begin in the weeks following delivery. It impairs their ability to mother the child and fall in love with it. This makes them feel even more depressed and inadequate thinking that they cannot be a good mother.

At the extreme, the postpartum depression may lead to dangerous delusions (worst of all, thinking the baby is in some way deformed or cursed) or hallucinations (that may command violent acts). This can occasionally culminate in a tragic episode of suicide and/or infanticide, or both.

Postpartum depression risk is high for:

• Women who have had depression after previous pregnancies

• Women who are prone to bipolar depression

• Women who have gone off antidepressant medication during pregnancy to protect the fetus from possible harmful effects.

• Dysthymic Disorder

This is a chronic form of depression. It starts at an early age and remains with the victims through their life. It places a constant and dark cloud over their heads, day in and day out.

Dysthymia involves symptoms similar to those of major depression. The symptoms are milder but longer lasting, with a minimum duration of two years. People with dysthymia are frequently lacking in zest and enthusiasm for life, living joyless and fatigued existences that seem almost natural outgrowths of their personalities.

It can be especially tough to spot Dysthymic Disorder as the victims had been this way all their lives. There is no baseline of brighter outlook against which to compare the gloom that they feel.

Dysthymic Disorder is relatively common, occurring in approximately 4 percent of the general population.

According to DSM IV, you have Dysthymic Disorder if.

You have had depressed mood most days for at least two years, but the symptoms are less severe than the episodes for Major Depressive Disorder.

At least two of the following:

• Your appetite is poor or you are overeating.

• You sleep too little or too much.

• You are tired or your energy level is low.

• You feel down about yourself.

• Your concentration is poor or you have difficulty making decisions.

• You feel hopeless about the future.

Whereas Dysthymic Disorder is chronic, milder, and usually has an early onset, Major Depressive Disorder is more episodic, severe, and can begin later in life. If you start having chronic mild depression, you will probably wind up eventually also having superimposed episodes of more severe depression.