I. Major Depressive Disorder or Unipolar Depressive Disorder
Major depressive disorder, also known as unipolar depressive disorder comprises of depression which may occur only once in a person’s lifetime, or in episodes that usually last for at least 2 weeks.
Usually women in early adulthood are prone to major depression. Recurrence and duration of the episode increases with the age. Generally there is a phase of normal mental health between the episode but minor fraction (around 15%) may have suicidal tendencies necessitating hospitalization.
It is characterized by:
- Sleep disturbances
- Loss of Interest or pleasure
- Loss of Energy
- Loss of Concentration
- Change in Appetite
- Psychomotor retardation- Slowing down of mental and physical activities besides restlessness.
- Suicidal ideations- persistent thoughts of death, inclination towards suicide or suicidal attempt.
- Depressed mood
II. Manic-Depressive Disorder or Bipolar Disorder
Bipolar disorder is a mood disorder having both mania and depression and involves extreme changes in mood from high (manic) to low (depressive), or mixed episodes and then back again with periods of normal mood in between. Some may only display signs of mania. The mood swings are unpredictable.
Womenof 20 to 30 years of age are more prone to have bipolar disorder and they are likely to present with depression where as men of the same age group are more likely to have manic episodes over the life time. Men and women equally suffer with bipolar disorder. This disorder tends to run in families.
Depressive episodes are similar as seen in Unipolar depression.
Maniais distinct period of abnormal and persistently elevated, excitable and irritable mood. Episode of Mania is characterized by:
- Distractibility- Short attention span.
- Insomnia- Decreased need for sleep.
- Grandiosity- Feeling of self- importance.
- Flight of ideas- Racing thoughts.
- Psychomotor Agitation- increase in goal directed activity
- Pressured Speech- increasingly talkative with unnecessary excessive emphasis.
- Thoughtlessness- engaging in pleasurable activities that have high possibility of untoward consequences (excessive spending sprees, foolish investments, sexual misdemeanor)
Severe forms of mania might be associated with firm persistent false beliefs (delusion) that can’t be shaken, inspite of substantial and obvious proof against it. In fact, the person is said to have develop persecutory delusions (feelings of suspicion, persecution).
III. Anaclitic Depression
It is a type of depression usually observed in infants who have made normal bonding with their mothers and were suddenly separated thereafter and placed in institutions or hospitals. As a result the child may fail to thrive and becomes withdrawn, unresponsive and is more vulnerable to physical illness. The child usually recovers when the mother returns or when surrogate mothering is provided. Separation beyond six months may lead to irreversible changes and at times even death.
IV. Depression in Children
It may start as a sudden change in mood and functioning or be present over a long period of time as sadness and irritability. Family environment is seen to play a major role in precipitating the problem. The symptoms vary depending on the age-group.
- Pre-school children May present with lack of smiling, loss of interest in play and lack of involvement in all activities. The child may become irritable or cry easily and their activities may become destructive towards self, others and property.
- School aged children The child’s school performance deteriorates, hemisses or refuses to go to school and avoids friends. The child may become irritable, argumentative and quarrelsome.
- Adolescents They have a tendency to miss school and find excuses for not being able to finish the assignments. They may indulge in alcohol and drug abuse, anti-social behaviour( like stealing, fighting, rash driving, destruction of property, etc). Physical complaints like headaches, stomach-aches, change in appetite and sleep patterns are common. Interpersonal loss (e.g. death of a friend) and discord with family, friends or partners significantly increases the risk of depression in this age group.
V. Depression in Elderly
Elderly people are at a risk of depression because of their social, economic and medical circumstances. With increasing age, levels of certain enzymes ( such as mono amine oxidase) in the brain increase which makes depression more likely. It may occur with a medical or neurological brain disease which has symptoms similar to depression. This overlapping in symptoms may delay diagnosis and hence treatment. Elderly people often feel uncomfortable discussing their feelings and instead complain of physical symptoms like disturbed bladder and bowel movements, aches and pains, memory loss and disturbed eating and sleeping patterns which are often misinterpreted as signs of dementia.
VI. Postpartum Depression
Many women suffer from mild depression during the first week after delivery, it is commonly known as Postpartum blues or Baby blues. It is usually time limited but may progress to postpartum depression if the symptoms persist for over four weeks. The mother is easily irritable, loses interest in all activities, may have negative feelings towards the infant or express concerns about her ability to care for her child. Some medical illnesses (e.g. hypothyroidism) may mimic postpartum depression and need to be carefully evaluated.
VII. Pre-menstrual Syndrome
It is a pattern of mood, behaviour and physical symptoms occurring at a specific time during the menstrual cycle. The symptoms usually resolve for some period of time (at least one week) between the cycles before the blood flow starts. The lady becomes easily irritable, easily fatigued, has difficulty in concentrating and over eats with specific food cravings. Physical symptoms like breast tenderness, sensation of bloating, weight gain, headaches are often present.
VIII. Seasonal Affective Disorder
Episodes of depression triggered by change in season especially at the onset of winters. It is characterized by recurrent depression usually beginning with the season and ending with it. The usual symptoms are decreased activity, social withdrawal, loss of interest in sex, increased craving for carbohydrates, increased appetite, oversleeping and weight gain. It is believed to be caused by increased melatonin secretion (hormone secreted by pineal gland of brain) . Other than medications it is uniquely treated by exposure to light (light therapy) which appears to suppress melatonin production and its depressive effects.
IX. Dysthymic Disorder
It is a slow onset depression often beginning before the age of 20. It is persistent for at least two years. The person often complains that he has always been depressed. The symptoms are similar to unipolar depression but less severe lasting for a period of not more than two months at a time. A person with dysthymia often overcompensates his low self-esteem and feeling of inadequacy by dedicating his life to jobs that require dependability and great attention to the detail. They invest whatever energy they have in work leaving none for leisure or family/social activities which often results in marital friction. It may progress to unipolar depression.
X. Cyclothymic Disorder
Numerous alternating episodes of depression and hypomania present over a period of two years is known as cyclothymic disorder. It is slow in onset and usually starts before the age of 21. The symptoms though similar to bipolar disorder are less severe and the duration of each episode is less than two months. The mood shifts are often without any external contributory factor for e.g. a person may go to sleep in a good mood but wake up in tears. Repeated romantic breakups are common and they often shift jobs and places, losing interest fast and leaving in dissatisfaction. The person may start working with great enthusiasm but their efforts rarely bring fruits. It is often associated with substance abuse and alcoholism. It may progress to bipolar depression.