Types Of Depression: Can Adults Experience Multiple Levels Of Depression?
If you’ve been diagnosed with depression, you may wonder how to move forward. Major depression, or major depressive disorder, is one of the most common mental health conditions, affecting millions of US adults. However, while many people live with depression, this condition can affect adults differently depending on an individual’s lifestyle, depressive disorder subtype, or symptoms.
To better understand this condition, it can be helpful to look at the depressive disorders listed in the DSM-5 and how to find support for these unique conditions.
What is depression?
Depression is more than sadness. As a diagnosable mental illness, clinical depression is a chronic and sometimes debilitating condition that can affect all dimensions of daily life, including work, school, self-care, and relationships.
The symptoms of depression can be mild, moderate, or severe and may include but are not limited to the following:
- Low energy and mood
- Sadness or grief throughout the day
- Guilt or shame
- Thoughts of hopelessness or worthlessness
- Loss of interest in former hobbies or other enjoyable activities
- Sleep challenges, whether oversleeping or experiencing insomnia
- Changes in appetite
- Restlessness
- Challenges with focus, memory, and decision-making
Depending on their specific diagnosis and life circumstances, adults can experience multiple levels of depression. In some cases, a person may be diagnosed with “double depression,” which occurs when someone with persistent depressive disorder (PDD), formerly known as dysthymia, experiences an episode of major depressive disorder (MDD).
Types of depression
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines ten depressive disorders that can be diagnosed by a professional, including the following:
- Disruptive mood dysregulation disorder
- Major depressive disorder (MDD)
- Persistent depressive disorder (PDD)
- Premenstrual dysphoric disorder
- Substance or medication-induced depressive disorder
- Depressive disorder due to another condition
- Other specified depressive disorder
- Unspecified depressive disorder
- Postpartum depression (PPD)
- Seasonal affective disorder (SAD)
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Each depressive disorder has unique symptoms and presentations. In addition, each person’s experience of depression is unique, and you may prefer to use additional language to describe your experience and symptoms. Below are further examinations of the most common depressive disorders.
Major depressive disorder (MDD)
Major depressive disorder (MDD), also known as major depression or clinical depression, is one of the most common depression diagnoses, alongside PDD.
To be diagnosed with MDD, a person must experience at least five symptoms, including a major depressive episode involving a depressed mood and loss of interest in formerly pleasurable activities for at least two weeks.
During a depressive episode, a person with MDD may experience other signs of depression, such as changes in sleep patterns, appetite, focus, and sense of self-worth.
Persistent depressive disorder (PDD)
PDD is characterized by a continuous, long-term depressed mood throughout the day, for more days than not. This condition may also be called dysthymia, another term for chronic depression with less severe symptoms than MDD. In the DSM-5, however, PDD is the officially recognized term for this condition.
To receive a diagnosis of PDD, a person’s depression symptoms must last for at least two years. Other diagnostic criteria for PDD include:
- The presence of two or more common symptoms of depression, as outlined in the DSM-5, such as poor appetite, thoughts of hopelessness, or low self-esteem
- Persistent symptoms throughout the two years, not subsiding for more than two months at a time
While PDD is not as severe as major depressive disorder, the symptoms can interfere with a person’s daily life and well-being.
Postpartum depression
Postpartum depression affects parents after the birth of a child. Although this condition is commonly associated with mothers after childbirth, postpartum depression can affect people of all gender identities and adoptive and surrogate parents – not only the gestational parent.
People experiencing postpartum depression may report feelings of guilt and anxiety about their ability to care for their child or themselves. Other common symptoms include frequent crying, irritability, fatigue, and intense emotional highs and lows, which may appear within a week after birth or develop gradually.
Seasonal affective disorder (SAD)
People living with SAD experience depressive episodes during certain seasons, commonly during the cold, dark winter months. The symptoms of SAD are like those of MDD and may include sleeping difficulties, changes in appetite and weight, and low mood and energy.
Doctors often encourage individuals with SAD to get more sunlight during the winter months and prioritize a healthy, active lifestyle in addition to standard depression treatments like psychotherapy and medication. Light therapy has been proven effective in the treatment of this condition.
Other specified or unspecified depressive disorder
In the most recent version of the DSM-5, the authors replaced depression not otherwise specified (NOS) with two different terms to improve diagnosis: “other specific” and “unspecified.” If a person’s symptoms fall in the category of depressive disorders but do not meet the diagnostic criteria of any type, a physician may use these terms to describe their symptoms and prescribe a more personalized treatment.
How do physicians accurately diagnose depression?
Noting the different types of depression, individuals should consult a licensed physician or mental health professional for an accurate diagnosis. Online resources for people with depression can serve as starting points, but only a medical professional is trained to properly examine, diagnose, and treat a person living with depression.
The DSM-5 offers a guiding framework for depression diagnoses. As noted previously, person’s symptoms may align with one type of depression or meet the criteria for double depression or unspecified depression.
To make a diagnosis, your physician will ask about your current symptoms and health history and may also get information about your family’s health history and other factors that could influence your well-being and treatment plan.
Although you may feel overwhelmed or unsure about your diagnosis, an empathic therapist or psychiatrist is trained to make you feel less alone and more informed about your treatment options.
Treating depression
Treatments for depression can vary depending on your diagnosis but often involve a combination of therapy, medication, and other coping strategies or lifestyle changes recommended by your care team.
Some of the most common treatments and coping strategies for depression include:
- Self-care: Regardless of your mental health status, self-care is an essential aspect of a healthy life. Importantly, self-care doesn’t need to be elaborate. Some simple ways to care for your mind, body, and soul include dancing, singing a favorite song, eating a snack, or even just drinking a glass of water.
- Lifestyle changes: After receiving a diagnosis of depression, some people choose to evaluate their current lifestyles and make healthy adjustments as needed. These could include more exercise and daylight, a greater emphasis on whole foods, or better sleep hygiene.
- Anti-depressant medications: Medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic anti-depressants (TCAs) influence levels of neurotransmitters in the brain. Medications can be helpful for some people, but always require a prescription and careful monitoring by a physician.
- Social support: Healthy relationships can improve your mental health and even help you manage the symptoms of depression. A large body of research highlights the value of social support to reduce the severity of depression symptoms and promote long-term recovery.
- Psychotherapy: Therapy is one of the most common and effective treatment options, particularly for people living with chronic or multiple levels of depression.
If your symptoms are persistent and impacting several areas of your life, you may benefit from working with a psychotherapist to understand your diagnosis and develop strategies to enrich your daily life.
Support options
Counseling or therapy may be an invaluable part of depression treatment. While some people prefer the traditional format of in-person therapy, others appreciate the convenience and flexibility of online therapy through platforms like BetterHelp. Online therapy platforms mean clients can reach out for support from their homes when it is difficult to get out of bed due to depression.
Researchers continue to explore the value of online therapy in various studies, including a 2019 study of depression prevention via digital cognitive-behavioral therapy for insomnia (dCBT-I). In previous studies, dCBT-I has effectively improved symptoms of insomnia and depression, and this study reaffirmed these findings. Based on a sample of 358 patients who received dCBT-I, depression severity was significantly lower at the one-year follow-up compared to the control group, and depression remission rates were 51% higher.
Online therapy programs have the potential to address a range of mental health conditions while reaching more patients, particularly those who may not have connection to quality mental healthcare in face-to-face settings.
Takeaway
Depression can cause a diverse array of symptoms, including low mood and a loss of interest in activities that were once enjoyable. Although depression can be complicated, an accurate diagnosis allows clients to manage symptoms. Using the main types of depression as a guide, a mental health professional can help you develop a treatment plan that addresses your mental health history, current depression symptoms, and overall health goals. Consider reaching out to a therapist to get started.
Is it possible to have multiple types of depression?
Individuals can have multiple types of depression at once—a condition often called "double depression." In double depression, an individual typically has persistent depression (called persistent depressive disorder PDD) with isolated episodes of major depression (major depressive disorder MDD).
What are the four levels of depression?
Symptoms of depression vary in type and severity from person to person. It's often a complex condition, with some individuals displaying four distinguishable phases or levels. These include:
- Wellness—This stage is free from depressive symptoms. Treatment at this phase involves sustaining feelings of wellness via different methods to make it easier for individuals to cope with the onset of a depressive episode when it arises.
- Distress—During this stage, individuals may experience shorter periods of moderate or mild depression. Interventions such as self-care practices and peer support are typical at this phase.
- Depressive Disorder Stage—This stage is marked by more prolonged periods of severe depression that disrupt daily functioning. Treatment during the depressive disorder stage focuses on recovery and remission and often includes therapy and antidepressant medication if necessary.
- Refractory or Recurrent Stage—Refractory or recurrent depression is typically resistant to treatment and requires more intensive therapeutic methods and pharmaceutical intervention. Suicidal thoughts and urges may emerge during this stage. The goal of treatment in this phase is to stabilize the patient and assist them with coping.
What are the seven forms of depression?
There are many types of depression with varying degrees of severity. Seven of the most commonly diagnosed include:
- Major Depressive Disorder (MDD)
- Persistent Depressive Disorder (PDD)
- Bipolar Disorder
- Psychotic Depression
- Treatment-Resistant Depression
- Atypical Depression
- Seasonal Affective Disorder (SAD)
What are the ten hits of depression?
The American Psychiatric Association's guidelines for depression are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). While it's the most widely used diagnostic tool for clinicians, the DSM-V can be used in conjunction with other methods, such as the Nedley four-hit method.
The Nedley four-hit hypothesis theorizes that specific factors (or "hits") can predict the development of depression. There are ten potential categories— four or more of which could trigger a depressive episode.
Genetic
The individual has a first-degree relative with a history of depression or who has died by suicide.
Developmental
- Experienced depression in adolescence.
- Raised by someone other than both biological parents.
- Has experienced sexual abuse.
- Being raised or living with someone with a substance use disorder.
Lifestyle
- Doesn't adhere to a regular exercise routine.
- Lacking exposure to daylight for at least 30 minutes a day. (Could substitute with a medical-grade light box.
- Lack of adequate fresh air.
Circadian Rhythms
- The individual experiences regular bouts of insomnia.
- Often sleeps more than nine hours or less than six hours per day.
- Has irregular sleeping and eating habits.
Addiction
- Regular alcohol use.
- Regular cigarette or tobacco use.
- Heavy caffeine use.
- Engages in recreational drug use.
- Daily consumption of benzodiazepines.
- Chronic use of narcotics for more than 30 consecutive days.
Nutrition
- Lack of dietary tryptophan.
- Inadequate omega-3 consumption.
- Low intake of folic acids.
- Low vitamin B intake.
- High cholesterol diet.
- A diet high in saturated fats and sugars.
- Anorexia or marked weight loss.
Toxicity
- Exposure to high levels of lead, mercury, arsenic, bismuth, or other toxins.
- High risk of exposure to toxins.
Social
- Lack of friendships or social support.
- Stressful or negative life events.
- They are categorized in a "low" social class.
- Raised by grandparents during childhood.
- Has an immediate family member with a substance use disorder.
Presence of a Medical Condition
- Contracted hepatitis C.
- Sustained a recent head injury.
- Had a stroke or heart disease.
- Diagnosed with terminal cancer.
- Has Parkinson's disease.
- Has uncontrolled diabetes.
- Has severe postpartum stress or premenstrual tension syndrome.
- Has an improperly treated thyroid or adrenal gland disease.
- Diagnosed with lupus.
Frontal Lobe Condition
- Adhering to a low carbohydrate diet.
- Excessive consumption of meats, cheeses, or rich foods.
- Entertainment addictions including TV, movies, and the internet.
- Frequent sexual stimulation activating the right frontal lobe.
- Frequent exposure to syncopated rhythm music.
- Conscious suppression of frontal lobe activity.
- A lack of abstract thinking.
- Acting against one's conscience or ethical values.
What are the worst types of depression?
The "worst" type of depression is a subjective concept, as people experience depression differently based on factors like circumstance and available support. People experience common depression symptoms differently, as well. For example, a marked change in eating habits is a common physical symptom. Although the category is the same, some people may lack appetite, resulting in weight loss, while others may experience an increase in appetite, resulting in weight gain.
That said, there are some depressive disorders with other symptoms that may need more complex intervention from a mental health specialist. Some of these include:
- Treatment Resistant Depression—This type of depression features more severe symptoms with longer, more frequent depressive episodes. Symptoms are typically more challenging to manage and treat, but intervention with brain stimulation therapies may help. People with this type of depression often experience severe anhedonia and anxiety and may be prone to suicidal ideation and behavior.
- Bipolar Depression— Bipolar depression is characterized by often unpredictable depressive and manic episodes. These episodes may cycle rapidly, swinging between "highs" and "lows." Individuals may experience mixed-state bipolar episodes where symptoms of mania and depression mix.
- Psychotic Depression—In addition to many of the more common depression symptoms, people with psychotic disorders experience psychotic symptoms. These may include thoughts or beliefs outside of reality, paranoia, and hallucinations (auditory hallucinations are the most common). Physical symptoms of psychotic depression may include psychomotor agitation (constant fidgeting) or psychomotor retardation (slowing of bodily movements).
For more information about these types of depression and others, visit the Anxiety and Depression Association of America website (ADAA.org). If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 988 and is available 24/7.
What are the ten major causes of depression?
What causes depression is still a topic of study, and theories about risks and triggers are ever-changing. (For example, see the Nedley four-hit hypothesis above.) There are some relatively common factors found throughout the research. Potential causes for depression include:
- Adverse childhood experiences, including abuse.
- Family history of depression.
- Traumatic or overwhelming life events.
- Personality and styles of thinking.
- Other psychological disorders.
- Physical health conditions.
- Medication side effects.
- Substance use.
- Poor sleep, diet, and exercise habits.
- Pregnancy and giving birth.
What is the strongest stage of depression?
According to the four-stage model, the "strongest" level is the refractory or recurrent stage. In this stage, the depression may be resistant to treatment and require more intensive treatment.
What triggers double depression?
What causes or triggers double depression is typically similar to what causes other types of depression: a combination of physical, environmental, and psychological factors.
Is it normal to have multiple mental disorders?
Multiple diagnosis is prevalent for individuals with psychiatric disorders. Research indicates that over 50% of people diagnosed with a mental health condition have or will have two or three disorders throughout a lifetime. Roughly 30% of people will experience four or more.
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