Depressive Disorders


There are a number of depressive disorders. Each has its own its own pattern of symptoms and its own DSM-5 definition.

Depression, in general terms, is a disorder of the brain that produces emotional, mental and physical symptoms of deep sadness, loss of interest, inability to concentrate, feelings of hopelessness, fatigue, irritability, restlessness, changes in eating patterns, aches and pains, cramps and digestive problems.

The exact causes of depression remain unproven. Despite this, there are a number of treatments, including medication and psychotherapy, as well as other physical treatments, like electroconvulsive therapy (ECT), which produce good to excellent outcomes.

Sadly, a majority of those who experience depression never seek treatment.

Major Depressive Disorder (MDD)

As its name would imply, major depressive disorder represents a significant experience of the symptoms of depression. MDD can be disabling, and patients who have had MDD once can often relapse. Suicide is a real risk with MDD, and patients should be screened for it.

Treatments include antidepressant medicines and psychotherapy, as well as other interventions in the most serious cases.

Persistent Depressive Disorder (PDD)

PDD, also known as dysthymia, is depression that lasts at least two years. The depression might be as severe as MDD at times, but is usually less severe.

Treatments are antidepressants and psychotherapy.

Psychotic Depression

This is depression that occurs in conjunction with psychotic symptoms, including delusions (false beliefs) and hallucinations (seeing and experiencing that which is not there.)

Treatment may include antidepressant and antipsychotic drugs, as well as psychotherapy.

Postpartum Depression

As many as 10% to 15% of women who have given birth may experience a severe depression during the months immediately following delivery. This is a more intense experience than normal hormonal changes, although hormones may have a great deal to do with causing this disorder. Other causes can include changes in blood volume, blood pressure, metabolism and thyroid hormones.

Symptoms include mood swings, insomnia, intense irritability or anger and difficulty bonding with the baby. Treatment is prescription antidepressants and psychotherapy.

Rarely, Postpartum Psychosis may develop, including hallucinations and delusions. This is an emergency and the patient should see a physician immediately.

Seasonal Affective Disorder (SAD)

This form of depression tends to appear and disappear in accordance with changes in the seasons. There is a version of SAD that generally coincides with fall and winter, and another version that is spring and summer based.

Fall/winter symptoms include irritability, hypersensitivity, oversleeping, a heavy, "leaden" feeling in the limbs, and carbohydrate cravings. Many sufferers of the fall/winter version respond to light therapy, but some need medication or psychotherapy to gain full relief.

Symptoms for spring/summer sufferers include insomnia, depression, weight loss and agitation or anxiety. Medication and psychotherapy are the treatments for this version.

This disorder is thought to be related to a disruption in the body’s circadian rhythms, changes in serotonin levels and a fluctuation in melatonin.

Bipolar Disorder

Bipolar disorder is a complex disorder with a number of variants. It causes a cycling between periods of major depression and various manifestations of mania, including anger, irritability, euphoria, excess energy, racing thoughts, excessive talking, insomnia, impulsivity and recklessness.

The variant forms of bipolar disorder include:
Bipolar Disorder I
Bipolar Disorder II
Bipolar Disorder not otherwise specified
Cyclothymic Disorder
Rapid Cycling Bipolar Disorder

Bipolar disorder can be difficult to treat. Medications, including mood stabilizers, atypical antipsychotics and antidepressants are used cautiously, because not every sufferer responds the same way. Psychotherapy is also effective.

Other treatments given as necessary include electroconvulsive therapy (ECT) for unremitting depression and sleep therapy for insomnia.

Sources: National Institutes of Health (Depression), Mayo Clinic, ChildMind and National Institutes of Health (Bipolar Disorder)


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