5 Unofficial Types of Depression
Depression is like a salad. Just like dishes as varied as tuna nicoise, egg salad, and molded Jell-O studded with canned fruit cocktail are all legit salads, the hundreds of possible symptom profiles of depression are all legit depression. This week, Savvy Psychologist Dr. Ellen Hendriksen covers five of the most common faces of depression.
IN THIS ARTICLE YOU’LL DISCOVER
- Depression symptoms that almost all depressed people have
- Why depression is so hard to treat
- Five (unofficial) types of depression … each with a very different face.
Depression is like salad. Hear me out on this one.
Salads come in a staggering variety. A leafy green house salad, a creamy macaroni salad, even a Jell-O salad—they’re all salads. How do you group together such disparate examples? Two things: first, a salad is a variety of foods (you can’t have one ingredient and call it a salad). And second, a salad is bound together with a common dressing.
So it is with depression. With nine hallmark symptoms, of which you need five or more for an official depression diagnosis, there are hundreds of possible combinationsopens PDF file .
With nine hallmark symptoms, of which you need five or more for an official depression diagnosis, there are hundreds of possible combinations.
But across those combinations are some commonalities—think of those as the dressing that pulls a salad together. No matter what constellation of depression symptoms you have, it probably includes three things. According to a studyopens PDF file of almost 1,200 depressed individuals in the super-prestigious journal Nature Medicine
- 97% of depressed people struggle with their mood: feeling chronically unhappy, hopeless, or helpless.
- A tad more than 96% have what’s called anhedonia, which is when pleasure and satisfaction get crushed like a cigarette butt under a stiletto heel.
- And 94% feel fatigued. Whatever you call it—tired, exhausted or wiped out—it means you feel about as energetic as a sloth in slo-mo.
Those are the symptoms common to most depressed people. But beyond those three? There’s a huge range of symptoms and hundreds of possible profiles—the equivalent of ambrosia versus tabbouleh. And to make things more complicated, some of the symptoms are opposites. For example, losing your appetite or eating everything that’s not nailed down are both symptoms, as is feeling agitated and restless, feeling like you’ve been fitted with some cement shoes, or worse, both.
No matter the combination, depression is serious. The World Health Organization ranks depression as the third most common burden of disease worldwide and projects that by 2030 it’ll be number one.
With so many possibilities, you’d think depression would be hard to treat. And so it is. But there is hope on the horizon. The study in Nature Medicine found that fMRI scans can sort people into four distinct neurophysiological subtypes of depressionopens PDF file , which in turn can help predict what treatments might benefit them. But until fMRI scans or other biological measures become a part of diagnosis, we have to rely on the OG method of symptom detection: self-report.
So, when we listen to the experiences of people with depression, what do we hear? Some distinct profiles. And this week, from a by-no-means comprehensive list, here are five types of depression.
Five Unofficial Types of Depression
Type #1: Morning melancholy
Officially called the melancholic subtype, some researchers argue this profile should be its own diagnosis.
This type of depression is bleak and profound. Life’s pleasures evaporate. Nothing feels good. Even with a nice surprise or some good news, that feeling of cheer is just a blip that disappears after a few minutes.
It makes sense that folks with this depression type have no desire to go out or do their favorite things (or for that matter, eat) because what’s the point? It makes no difference.
To top it off, in addition to feeling despondent or empty, another common emotion is guilt—guilt about being ill, guilt about being alive.
The melancholic type is worst in the morning. Folks often report an improvement in mood and energy as the day goes on. But to add insult to injury, waking up hours before the alarm is common, which prolongs the worst of the misery.
Type #2: Anxious distress
A study in the journal Anxiety & Depression assessed 260 people with depression and found that a whopping 75% met criteria for what’s called the anxious distress specifier.
Anxiety is part of why depression often flies under the radar. We usually think of depression as feeling sad or not being able to get out of bed. We don’t think of it as feeling restless and fidgety, tense and exhausted, or being unable to get anything done because we’re distracted by worries and our attention span has shrunk to that of a fruit fly. Neither do we think of depression as a creeping dread that something awful is around the corner, nor the idea that we’re suddenly going to snap and totally lose it. But it is.
According to an article in The Lancet, anxiety is the tadpole to the frog of depression—it comes first, usually 1 or 2 years before—and then morphs into a different form. In other words, if we worry ourselves into this type of depression, anxiety can be both a precursor to and a symptom of that depression.
Further, the older we get, the more anxious our depressive episodes become. Is Great Aunt Mildred crying and freaking out over nothing again? It’s not just aging or eccentricity, it’s a reason to see the doctor.
Type #3: Lingering trauma
A meta-analysis of 57 different studies totalling nearly 7000 participants with PTSD found that more than half also had depression.
Interestingly, there was a hierarchy among traumas—survivors of military trauma and other person-to-person assaults like rape or sexual abuse were more likely to have depression than those who had survived non-interpersonal traumas like natural disasters.
This makes sense. Person-to-person traumas, in particular, change your beliefs about the world: I can’t trust anyone; people can turn on you at any moment; if I show any vulnerability, people will exploit my weakness. And those feelings can be profoundly depressing.
It’s possible that trauma feeds this type of depression and vice versa. Let’s take the trauma of bullyingopens PDF file . Of course, getting bullied can link directly to depression, but it’s also probable that kids who already grapple with depression—kids who already feel helpless and self-critical—are easier targets for the bullies of the world.
Type #4: Loss
The death of a loved one. A romantic breakup. Although those circumstances are very different, they both represent a loss. There’s no right way and no deadline to heal from a loss, but sometimes the natural healing process gets stuck and the result can be depression. And while “depression” is technically one of the five stages of grief, clinical depression that stretches on and on isn’t a stage, it’s a problem.
With loss and grief, both sleep and appetite evaporate. It’s as if the body goes on strike.
A fascinating study in The American Journal of Psychiatry looked at almost 5,000 people with depression to see if whatever prompted their depression was associated with particular symptoms.
An interesting profile emerged for depression caused by a breakup or death: sadness for sure, not being able to find pleasure in anything—those make sense. But interestingly, eating and sleeping also fell by the wayside. In some kinds of depression, people will stuff their feelings with food or sleep as a way to escape. With loss and grief, both sleep and appetite evaporate. It’s as if the body goes on strike.
Type #5: Failures and setbacks
Failing in spectacular or public fashion—things like job loss or failing out of college—sometimes sparks depression. This particular kind of depression goes along with bone-crushing fatigue, sleeping too much, and a pervasive pessimism, none of which is particularly conducive to job hunting or making up those incomplete classes. It’s as if “I just can’t” were a syndrome.
A couple additional symptoms of failure-related depression are guilt and rumination. Following a failure, it makes sense that individuals ruminate on what went wrong and what they could have done differently. When you ruminate, you spin upsetting thoughts around and around like a car’s wheels spinning on ice. You go nowhere, and all that passive thinking leads to guilt.
Now, there are exceptions to all of these types. Just as panzanella, egg salad, and tuna nicoise are all legit salads, exceptions to all five of these types are all legit depression.
Depression isn’t exactly known for being neat and easily categorized. But it is treatable. There’s no need for you or anyone you love to suffer. And while treatment can sometimes feel like more of an art than a science, the earlier you begin the more effective it is. But even if you’ve been depressed for decades, there is hope. And then? You can start enjoying the ambrosia of life again.
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About the Author
Dr. Ellen Hendriksen was the host of the Savvy Psychologist podcast from 2014 to 2019. She is a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. Her debut book, HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety, was published in March 2018.
