If It’s The Same Sadness, Why Are There Different Types Of Depression?
And How Does This Affect Your Treatment?
By Daniela M. White, MD
It Is The Same Illness, So Why Different Medications?
I’m sure that some of you wonder that after seeing your psychiatrist that you received a different medication than your friend, coworker, or even family member. You have many of the same complaints of feeling sad, lacking interest and the energy to do much, isolating, crying at the drop of a hat and having ruminating bad thoughts that sometimes life is not worth living. You appear to have the same feelings, the same complaints, but are receiving different treatments and sometimes, a different diagnosis. This article describes why this might be the case.
From the beginning, it is worth noting that feeling sad, and crying when something bad and unexpected happens is perfectly normal, and oftentimes is expected. Feeling of sadness by themselves, does not result in a diagnosis of clinical depression, unless several conditions are met at the same time.
Different Types of Depression
Even if the criteria for clinical depression is met, there are different types of depression, and they need to be approached with different treatments to obtain a response and eventually remission.
Response, in clinical terms, means that the treatment provides some relief.
Remission means that the symptoms become absent.
What is The Commonality Within A Depression Diagnosis?
In all the different types of depression, sadness is the main complaint, usually associated with low self-esteem, sometimes irritability and difficulties enjoying life and increased tendency to cry very easily. However, there are differences in duration, intensity and severity as well as the way these episodes are triggered that make the diagnosis and therefore treatment, different.
According to the Mayo Clinic, to get a diagnosis of clinical depression, one must meet the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. The DSM is also used by mental health providers to provide a diagnosis of mental health conditions and by insurance companies to provide reimbursement for mental health treatment.
To get a diagnosis of clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, and nearly every day. At least one of the symptoms must be either a depressed mood or a loss of pleasure or interest. Signs and symptoms may include the following:
- Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
- Feelings of worthlessness, or excessive or inappropriate guilt
- Fatigue or loss of energy
- Significantly reduced interest or feeling no pleasure in all or most activities
- Insomnia or increased desire to sleep
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
- Either restlessness or slowed behavior that can be observed by others
- Trouble making decisions, or trouble thinking or concentrating
- Recurrent thoughts of death or suicide, or a suicide attempt
For a diagnosis of clinical depression, your symptoms must be severe enough to cause noticeable problems in relationships with others, or interfere with your day-to-day activities, such as school, work, or social activities. Symptoms may be based on your own feelings, or on the observations of someone else.
Clinical depression can affect people of all ages, including children. However, clinical depression symptoms, even if they are severe, can usually get better with counseling, antidepressant medications or a combination of the two.
Types of Depression Diagnoses
The following list of diagnoses that most mental health clinicians might choose from when determining a diagnosis. The diagnosis is important because proper treatment depends on an accurate diagnosis:
- Persistent Depressive Disorder (or dysthymia):
- Major Depressive Disorder, unipolar
- Bipolar disorder, Depressed (bipolar disorder I, II and cyclothymia)
- Postpartum Depression
- Premenstrual Dysphoric Disorder
- Adjustment Disorder with depressive symptoms
- Depression secondary to medical conditions
- Substance Induced Depression
As an example of the difference between two types of depression, a lot of times people who have bipolar disorder spend most of their sick time depressed and not hypomanic, or in a state of elation. However, the treatment for a depressed episode of a bipolar disorder is typically a mood stabilizer and not an antidepressant that might make symptoms worse. Having one episode of mania or hypomania, indicates a diagnosis of bipolar disorder and the treatment should focus on that, avoiding as much as possible an antidepressant without a mood stabilizer to start with.
How To Get The Most Out Of An Appointment With Your Care Provider
The best thing that a patient can do is to be as open as possible during the psychiatric evaluation and be willing to work with your doctor without leaving information out that might be essential not only in treating the symptoms but to avoid causing new ones.
Diagnoses Can Change Over Time
It is also worth remembering that your initial diagnosis is a working one that can evolve over time as more clinical information becomes available from the sessions. It is also important to see your psychiatrist often before the diagnosis is fully defined and until remission is achieved.
See Your Doctor And Psychiatrist Regularly, Even If You Are Feeling Better
Your primary health care and mental health care should be given in a coordinated manner. That is to say, your primary care doctor and mental health provider should be aware of the care the other is providing. If you haven’t already done so, and you are feeling sad or depressed, we recommend that you first speak with your primary care doctor and get a complete physical exam. The goal of the physical exam would be to try and rule out a physical cause for your depression. During the physical exam, the doctor typically will focus on the most likely causes of depression, the endocrine and neurological systems of your body. The doctor will look for any health concerns that may be contributing to clinical depression symptoms. For example, hypothyroidism is typically caused by an under-active thyroid gland. The under-active thyroid is the most common medical condition that is associated with symptoms of depression. Other endocrine disorders that are associated with depression include hyperthyroidism, caused by an overactive thyroid, and Cushing’s disease, which is a disorder of the adrenal gland. Oftentimes, treating these issues can alleviate symptoms of depression. Also, your doctor might look at other medications that you are taking to see if any of the side effects include depression.
Not seeing your treating physician and mental health care provider regularly can leave side effects unaddressed or allow symptoms to progress or worsen.
Monotherapy Vs. Combination Drug Therapy
There are multiple medications and therapies now available. In psychiatry for bringing mental illness to remission, and it is not uncommon to try several medications before finding one or more that are effective. Combination drug therapy is a type of treatment that many doctors and psychiatrists have been increasingly utilizing during the past decade, especially for Major Depressive Disorder, where there is some research to suggest that taking antidepressants from multiple classes may be the best way to treat Major Depression.
Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study Pierre Blier, M.D., Ph.D., Herbert E. Ward, M.D., Philippe Tremblay, M.D., Louise Laberge, M.D., Chantal Hébert, R.N., and Richard Bergeron, M.D., Ph.D. March 1, 2010, American Journal of Psychiatry March 2010, Vol. 167, No. 3, pp. 281 – 288