Subtypes of Depression

The DSM-5 lists several different subtypes of depression. These subtypes—what the DSM-5 refers to as specifiers—are not specific disorders; rather, they are labels used to indicate specific patterns of symptoms or to specify certain periods of time in which the symptoms may be present. These specifiers are listed following the description of major depressive disorder along with whether it is a single or recurrent episode. They add clarification about the type of depression and are designated as follows:

• anxious distress: a person experiences anxiety in the form of tenseness, restlessness, lack of focus, fear, or of losing control
• mixed features: a person experiences some manic symptoms alongside depression, such as elevated moods, increased energy, or talkativeness
• melancholic features: a person experiences lack of interest or pleasure in activities
• atypical features: a person dealing with depression may also experience elevated moods for certain periods of time or around particular people, show weight gain or increased appetite, or excessive sleep
  

  Figure 1. Other catatonic symptoms can include lack of speech and strange movements.

• mood-congruent psychotic features: a person may also experience delusions or hallucinations
• catatonia: a person may show catatonic symptoms, such as staying still or immobilized for long periods of time
• seasonal pattern: (formerly known as seasonal affective disorder) applies to situations in which a person experiences the symptoms of major depressive disorder only during a particular time of year (e.g., fall or winter); in everyday language, often referred to as the winter blues
• peripartum onset: symptoms appear during pregnancy or in the four weeks following birth

Peripartum Onset Depression

Another subtype, peripartum onset (commonly referred to as postpartum depression), applies to women who experience major depression during pregnancy or in the first four weeks following the birth of the child (APA, 2013). These women often feel very anxious and may even have panic attacks. They may feel guilty or agitated and be weepy. They may not want to hold or care for their newborn, even in cases in which the pregnancy was desired and intended. In extreme cases, the mother may have feelings of wanting to harm her child or herself. In a horrific illustration, a woman named Andrea Yates, who suffered from extreme peripartum-onset depression (as well as other mental illnesses), drowned her five children in a bathtub (Roche, 2002). Most women with peripartum-onset depression do not physically harm their children, but most do have difficulty being adequate caregivers (Fields, 2010). A surprisingly high number of women experience symptoms of peripartum-onset depression. A study of 10,000 women who had recently given birth found that 14% screened positive for peripartum-onset depression, and that nearly 20% reported having thoughts of wanting to harm themselves (Wisner et al., 2013).

Persistent Depressive Disorder

People with persistent depressive disorder (previously known as dysthymia) experience mild to moderate depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder. People with persistent depressive disorder are chronically sad and melancholy, but do not meet all the criteria for major depression. However, episodes of full-blown major depressive disorder can occur during persistent depressive disorder (APA, 2013).

There are no known biological causes that apply consistently to all cases of persistent depressive disorder, which suggests diverse origins for the disorder. However, there are some indications that there is a genetic predisposition to persistent depressive disorder as depression is found in as many as 50% of family members of someone with persistent depressive disorder. In a study using identical and fraternal twins, results indicated that there is a stronger likelihood of identical twins both having depression than fraternal twins. This provides support for the idea that persistent depressive disorder is in part caused by heredity. Other factors linked with persistent depressive disorder include stress, social isolation, and lack of social support.

A combination of antidepressant medication and psychotherapy has consistently been shown to be the most effective line of treatment for people diagnosed with persistent depressive disorder. Working with a psychotherapist to address the causes and effects of the disorder, in addition to taking antidepressants to help eliminate the symptoms, can be extremely beneficial. This combination is often the preferred method of treatment for those who have persistent depressive disorder. Looking at various studies involving treatment for persistent depressive disorder, 75% of people responded positively to a combination of cognitive behavioral therapy (CBT) and pharmacotherapy, whereas only 48% of people responded positively to just CBT or medication alone.