• MonuMental

Depressive Disorders

Updated: Dec 2, 2021



Introduction


Most people have heard of depression, a mental illness that they associate with feeling sad all the time. While depression is a mental illness that can cause you to feel sad, there is a lot more to depression than just sadness. There are actually multiple types of depression, categorized as depressive disorders.

Depression is a very common mental health disorder that can affect people of all genders and races; it also can affect children, teens, and adults.


Types of Depressive Disorders:


Depressive Episodes: A depressive episode is a period of time when a person experiences depressive symptoms. In order to be considered a depressive episode, symptoms must persist for at least two weeks, but can last for months at a time. Symptoms also must be present most of the day and for most days. Symptoms may include a low mood, excessive tiredness, thoughts of death, and other symptoms of depression. Depressive episodes are more common in people with other mental health conditions and are thought to occur more often in women than men.


Mood Dysregulation Disorder: Mood dysregulation disorder, also known as disruptive mood dysregulation disorder, or DMDD, is a childhood disorder. The diagnosis is given to children between the ages of 6 and 18. Symptoms also must be present for at least 12 months. DMDD is a new diagnosis, and was put in the DSM for the first time in the fifth edition, which came out in 2013. Symptoms include being irritable or angry, or having outbursts, as well as having a disruption in life or functioning due to these symptoms.


Major Depressive Disorder: Major depressive disorder is what most people think of when they think of depression. It involves feelings of low mood, sadness, anger and irritability at small things as well as changes in eating or sleeping habits, wait loss or weight gain, difficulty concentrating, and loss of interest in activities. Depression can also manifest itself as aches and pains. Treatment for depression can involve medications and therapy.


Dysthymia: Dysthymia, or persistent depressive disorder, also known as chronic depression, is a continuous depression that can last for many years. Symptoms can include feelings of emptiness, loss of interest, changes in eating and sleeping habits, or interference with school, work, or relationships. People with dysthymia are sometimes thought to have these symptoms as part of their personality, and think (or have people think about them) that they cannot have fun, or they are gloomy and mellow in general.



Depressive specifiers (things that go along with depression, such as other symptoms and conditionals)


Mixed Features: mixed features is a depressive specifier that involves other symptoms. These symptoms are usually noticed by other people, and not necessarily by the person themselves. They can include needing less sleep, waking up much earlier than normal, being more talkative than one typically is, having a higher self esteem to the point where it’s unrealistic, or being overly involved in activities with an elevated mood.


Atypical Features: Atypical features is a depressive specify diagnosis given to those with MDD (or dysthymia) but who’s symptoms change with mood. This with this will likely have a better mood when good things happen. Other symptoms of having atypical features are eating more or gaining weight, sleeping more, being more sensitive to rejection, or having a feeling of being weighed down. Atypical featured depression symptoms can be like the opposite of those with melancholic depression.


Peripartum Onset: Postpartum or Peripartum depression is a specify or MDD that occurs during or after pregnancy. Symptoms include feelings of guilt and disruption in daily living, thoughts of hurting oneself or the baby, insomnia, and feelings of anxiety. It occurs during pregnancy or during the first four weeks after but symptoms last longer. Peripartum onset depression can also come with psychotic features.


Full Remission: When one with a depressive disorder is able to attain and maintain a “normal” level of functioning, or the level they were at before symptoms started.


Partial Remission: A period of time (typically 2 months) in which symptoms are improved, but still present, without full criteria for depression being met. Score of 8-15 in the HAM-D17. *Relapse is the return of symptoms after being asymptomatic.*


Psychotic Features: Depressive disorders with psychotic features is when a patient has depression, along with experiencing delusions, hallucinations, or both.


Anxious Distress: Anxious distress with depression involves depressive symptoms as well as symptoms of anxiety including being tense, restless, or having a lot of fear.


Catatonia: Catatonia is a state of being in which one may not be aware or responsive to the world around them. Symptoms include catalepsy, stereotypies, stupor, negativism, and mutism. When catatonia is experienced in tandem with depression, it is known as MDD with a catatonic specify.


Melancholic Features: Melancholic features of depression include not finding pleasure in anything, and waking up at least two hours earlier than normal. Symptoms are usually worse in the mornings. Other symptoms of melancholic depression include excessive guild and changes in weight.


Seasonal Pattern: MDD with a seasonal pattern is when a person experiences symptoms around the same time of year for at least two years. It used to be a separate diagnosis called seasonal affective disorder, but under the DSM-5 is categorized as a subset of major depressive disorder.


Recurrent Brief Depression: Recurrent Brief Depressive Disorder, or RBD, is a form of depression in which a person has short depressive episodes, around 3 to 4 days, every month. Symptoms of RBD are the same as those of depressive episodes. People with recurrent brief depression are known to be especially likely to consider or attempt suicide.


D.E With Insufficient Symptoms: Only one symptom is present for at least two weeks. Symptoms cause distress and a decrease in functioning, but criteria for a depressive episode is not met.





Symptoms of depression: Symptoms of depression can vary depending on the specific depressive disorder, and the person, but often include feelings of low mood, irritability, feelings of guilt, decreased energy, difficulty concentrating, and much more.




Treatment For Depression:


Therapy: There are multiple types of therapy used to treat depression. Psychotherapy is an umbrella term for the many different types of therapy used to treat mental health.

Cognitive behavioral therapy (CBT): Helps patients recognize and modify distorted thinking and behavior patterns. In CBT, patients learn the skills they need to better help themselves.

Interpersonal Therapy (IPT): IPT is a short term and structured form of therapy that focuses on relationships. Skills learned in interpersonal therapy involve those relating to communication and conflict resolution.

Psychodynamic therapy: This type of therapy focuses on past conflict and trauma.

Behavioral activation: Behavioral activation therapy focuses on finding things that evoke positive feelings, and pleasure within the environment.

Electroconvulsive therapy (ECT): Used for patients who are suicidal, or are a danger to themselves, including those who are psychotic. ECT can also be used if the patient's response for medication or other therapy is not good. It will stimulate seizure to change brain chemistry.

Hospitalization: Patients may be hospitalized when symptoms get very severe, or they are a danger to themselves or others.


Medications: Some medications are also used to treat depression. Oftentimes, they are used with therapy. Medications work differently for everyone, and have different levels of benefit. There are many medications that can be used for depression, but they are often put into categories, as shown below.

Selective Serotonin Reuptake Inhibitors (SSRI) are often used as first line treatment. Many have few side effects. Examples of these include Prozac/Fluoxetine, Zoloft/Sertraline, Celexa/Citalopram, etc.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) are similar to SSRI but were more recently created. They are also first line treatments, but block norepinephrine as well.

Norepinephrine and Dopamine Reuptake Inhibitors (NDRI) are another type of drug to treat depression, by blocking norepinephrine and dopamine.

Tricyclic antidepressants are used for more hard to treat cases. They were one of the first types of antidepressants developed.

Monoamine oxidase inhibitors (MOI) are also older, and are similar tricyclic antidepressants


Resources:

https://www.nami.org/Home

https://www.samhsa.gov/find-help/national-helpline

1-800-662-4357 (help)

@hocomonumental



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Sources:

https://ada.com/conditions/depressive-episode/

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007 https://www.webmd.com/depression/guide/depression-types#1 https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929 https://www.webmd.com/depression/guide/atypical-depression#1-3 https://www.gulfbend.org/poc/view_doc.php?type=doc&id=528 https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression/Major-Depressive-Disorder-with-Peripartum-Onset

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC161656/ https://pubmed.ncbi.nlm.nih.gov/16194772/ https://www.icsi.org/guideline/depression/diagnose-and-characterize-major-depression-persistent-depressive-disorder-with-clinical-interview/ https://www.verywellmind.com/treatments-for-depression-1065502

https://adaa.org/understanding-anxiety/depression-treatment-management



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