Chronic Vs. Acute Depression

Depression can look different for everyone. For some, the mental health condition is a long-term set of low-level symptoms that are almost always present and can linger for years. Others experience intense symptoms with a rapid or sudden onset which may or may not be related to situational factors. 

Read on to learn more about the differences between chronic and acute depression, its symptoms, and how therapy can be an effective treatment tool.

According to the mental health experts at the Mayo Clinic, depression is a common mood disorder generally involving feelings of intense sadness and a noticeable lack of interest or enjoyment from most aspects of daily life.

Chronic vs. acute: What’s the difference?

Researchers at Johns Hopkins Medicine describe chronic depression—also called persistent depressive disorder or dysthymia—as a milder but longer-lasting form of depression. Symptoms must occur for at least two years to qualify as dysthymia.   

One study about the differences between chronic and acute major depression concluded that they “differed in dysfunctional attitudes, which might actually reflect a distinguishing pattern of chronicity.” They also found that chronic depression patients tended to report higher socially avoidant behavior. This meant that treatment was generally more difficult to obtain and maintain for chronic depression patients. 

What does depression look like?

It's important to remember that depression can look different for everyone. If a person doesn't often express their emotions, knowing when they are having trouble can be challenging. 

Common depression symptoms include:

• Intense feelings of sadness, hopelessness, or emptiness
• Decreased speech, movement, and thought speed
• Anxiety or restlessness
• Anhedonia—trouble taking an interest in or pleasure from things you used to enjoy 
• Significant changes to sleep or eating habits
• Loss of energy and persistent fatigue
• Feelings of worthlessness, misplaced or exaggerated guilt, or fixating on past failures
• Social isolation
• The sense that you will always feel like this and there’s little point to treatment
• Difficulty thinking, concentrating, or making decisions
• Unexplained pain with no obvious cause, such as headache, muscle pain, or stomachache
• Symptoms may also include suicidal thoughts or actions

The medical community doesn't have a definitive answer for what causes depression. The current consensus among mental health experts is that the disorder develops due to a complex interaction of genetic and environmental factors. Studies show that as much as 40% of people with depression can trace it to a genetic cause, though many develop the disorder with no family history. 

According to the Cleveland Clinic, types of depression include:

• Major Depressive Disorder (clinical depression)
• Persistent Depressive Disorder (chronic depression)
• Disruptive Mood Dysregulation Disorder (intense irritable depression in children)
• Premenstrual Dysphoric Disorder (mood symptoms related to the menstrual cycle)
• Depressive Disorder Related To Medical Condition (depression caused by a physical illness like heart disease or hyperthyroidism)
• Seasonal Affective Disorder (depression related to seasonal changes)
• Perinatal Depression (depression during and after pregnancy)
• Atypical Depression (variations on typical depression presentation)

Many things can contribute to your likelihood of developing a depressive disorder. According to the National Institute of Mental Health, risk factors for depression include genetics and family history, personal life experiences, drastic life changes, past trauma, certain physical illnesses or medication interactions, irregularities in brain function and neurochemistry, hormonal imbalances, daily life circumstances, stress level, physical health, sleep patterns, childhood experiences, trauma, low self-esteem, and lack of emotional support from friends or family.

The effects if left untreated

If left untreated, depression can have numerous effects on your physical, emotional, and psychological health. You may experience worsening or more frequent symptoms due to changes in your brain’s neural pathways over time as depression “rewires” your mind. Untreated depression can also lead to physical problems, such as digestive issues, fatigue, muscle or head pain, and other medical complications. 

Diagnosis

If you are concerned you have chronic or acute depression, talk to your doctor or healthcare provider to start the diagnosis process. In general, you’ll have an exam and your medical history taken to rule out an underlying physical condition that could be causing your symptoms. If nothing is found, the doctor may refer you to a mental health specialist such as a counselor, therapist, psychologist, or psychiatrist. 

From there, expect to complete several psychological evaluations to determine how your symptoms and their effects fit a specific depressive disorder so a tailored treatment plan can be developed. 

Treatment

Like many mental health conditions, the most effective treatments for depression often involve a combination of psychotherapy (talk therapy), meaningful lifestyle and cognitive changes, adaptive coping skills, and, if appropriate, medication. With appropriate treatment, experts say that up to 90% of people diagnosed with depression respond well and see an improvement in their symptoms over time.

Cognitive behavioral therapy (CBT)

CBT is a therapeutic approach centered on helping patients identify harmful thoughts and behavior patterns so they can change how they think to shift toward healthier habits. During therapy, you may examine past experiences and how they affect the way you think, act, and feel. 

Therapy often includes three stages:

• Acute—Six to eight weeks of therapy to relieve symptoms enough to allow you to function in daily life.
• Continuation—Four to nine months of therapy centered on continued symptom relief until they stop and sustain the progress you've made.
• Maintenance—Long-term therapy is often recommended for people with a high risk for recurring depression. The "relapse prevention" stage of treatment can sometimes last for years, helping the patient manage symptoms that don't fade. Many patients with chronic depression require maintenance treatment.

Medication

Prescription medications can address the neurochemical imbalances commonly associated with depression. Antidepressants can help address the symptoms, making them easier to manage. However, they do not treat the underlying issues causing changes to your mood, cognitive patterns, or actions. 

Daily life

Depression can look different for everyone—and so can the ways you find to live with it. While therapy and medication are the most commonly prescribed treatments, a significant portion of symptom relief comes with learning how to cope with situations and your emotional reactions. An adaptive repertoire of coping skills that grow alongside you can be critical to the success of your depression treatment. Coping skills help you manage your stress and depression symptoms so you can function without unnecessary emotional interference.  

Tips for coping with depression symptoms include:

• Avoid social isolation and withdrawal by staying connected with friends and family. 
• Exercise releases beneficial neurochemicals, so get regular physical activity. 
• Feel accomplished and boost your self-esteem by crossing something off your to-do list. 
• Avoid alcohol or substance use as a coping mechanism. It can be counterproductive and dangerous. 
• Eat a healthy, well-balanced diet so your body receives the necessary nutrition. 
• Keep a daily journal. Write about how you felt that day, any struggles with symptoms, triggers you can identify, and which coping skills helped you. 
• Establish a regular self-care routine to safeguard mental, physical, and emotional well-being. 
• Develop healthy sleep hygiene. 
• Attend psychotherapy reliably. 
• Pay attention to the little things that make you feel better. 
• Challenge the negativity depression can put on your self-talk “voice.”
• Be unconditionally kind and compassionate to yourself. 
• Remember that today isn’t necessarily an indicator of how tomorrow will be. Changing your mindset can help shift your mood.
• Address specifics instead of generalizing. 
• Use positive thinking and affirmations to change cognitive patterns. 
• Spend time with your pet, basking in its unconditional love and releasing oxytocin into your system. 

When to reach out for help

If your depression symptoms are severe enough to substantially interfere with your ability to function at home, work, school, or other parts of your life, come on suddenly or are extreme, and persist for at least two weeks, you may want to speak with a healthcare provider about an evaluation for acute depression. If your symptoms are milder, but last two years or longer, you may have chronic depression. 

How therapy can help

Whether you have chronic or acute depression, help is available. Working with a licensed therapist online through a virtual therapy platform like BetterHelp puts professional support and guidance only a few clicks away. Parents or caregivers seeking online therapy for kids from 12 to 19 should contact TeenCounseling. Online treatments are usually less expensive, have shorter wait times, and offer flexible appointment formats like phone, video call, and asynchronous online chat. 

Recent information from the American Psychological Association shows that online therapy offers similar outcomes to in-person treatments. The study indicates that some patients with no therapy experience showed a substantial increase in the effectiveness and duration of therapeutic outcomes. Others said they found it easier to present personal details with the therapist due to the increased physical distance. The unparalleled convenience of receiving treatment at home helped many patients attend more reliably, which helped boost the effects of psychotherapy.