Not all depression is alike. (Photo: Jennifer Fox for Yahoo Health)
When you think of someone with depression, you probably imagine a woman or man looking downtrodden. He or she stays in bed a lot and has little interest in everyday activities. There’s a permanent expression of sadness on his or her face.
While this depiction of depression is true for many, the reality is that depressive disorders can take all kinds of different forms, come in various intensities, and can strike anyone, says Karla Ivankovich, PhD, a counselor and adjunct professor of psychology at the University of Illinois, Springfield. In fact, “research is beginning to identify the millennial generation as higher risk for certain types of depression, like at work, evidenced by high absenteeism rates,” Ivankovich tells Yahoo Health. “The levels of stress that they are under, whether self-imposed or otherwise, makes them candidates for lots of mental health concerns.”
Depression is essentially a mental health epidemic, with more than 350 million people worldwide suffering from a depressive disorder, according to the World Health Organization. In addition to symptoms that can make it hard to function, the Centers for Disease Control and Prevention notes that depression also increases the risk for other conditions, like alcoholism, eating disorders, and panic or anxiety disorders, among others.
But how do you know if you have depression, and what should you be on the lookout for? And how do you know what kind of depression you have? (Yes, there is more than one type.) Read on for the experts’ advice.
How to Tell If You Actually Have Depression
First, you have to recognize the most common symptoms of depression, which hint that you might need more than a simple pick-me-up for your blues. Ivankovich says there are nine major depression symptoms you should be aware of that may hint your low mood or disinterest in old hobbies like running and Scandal are actually part of an undiagnosed depressive disorder:
- You feel hopeless that your life will improve, and helpless as a result.
- You have lost interest in things that once gave you pleasure.
- You feel drained and have very little energy.
- You’ve experienced a recent weight gain or weight loss.
- You’re sleeping too much or too little.
- You are more irritable than normal.
- You feel worthless or guilty, even if you can’t identify where these feelings come from.
- You have difficulty concentrating and remembering things.
- You have recurrent thoughts of death or suicide, or have experienced an increase in physical complaints (like headache or muscle aches) unrelated to another medical condition, and these are inhibiting social, occupational, or interpersonal relationships.
If you have any of these symptoms for two weeks or more, schedule an appointment with your doctor right away.
What Kind of Depression Is It?
All depression isn’t created equal. According to Ivankovich, the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places depressive disorders into three primary categories: major depression, persistent depressive disorder, and bipolar disorder. From there, a mental health professional might diagnose a person with a more specific type, like one of the following 10:
Major Depressive Disorder, Single and Recurrent Episodes
To be diagnosed with major depression, five out of nine symptoms (listed above) must be present during the same two-week period. “It also has to represent a deviation from a person’s normal functioning,” says Ivankovich. “Additionally, at least one of the symptoms must include depressed mood or a loss of interest or pleasure.”
While postpartum depression is not technically considered its own disorder in the DSM-V, the psychiatrists’ manual still acknowledges it. A more detailed specifier can be attached to a depressive or bipolar disorder — like “Major Depressive Disorder with Peripartum Onset,” where symptoms like hopelessness and fatigue occur either during pregnancy or within the first four months following childbirth.
Disruptive Mood Dysregulation Disorder
The mood disorder is characterized by severe and recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation, says Ivankovich — for instance, anger spurred by something simple like a broken glass or an offhand comment from a friend. “These occur, on average, three or more times a week for one year or more,” Ivankovich says.
Persistent Depressive Disorder (Dysthymia)
“Persistent” is the key word here, says Ivankovich. This form of depression equates to a low mood for most of the day, more days than not, for at least two years.
Premenstrual Dysphoric Disorder (PMDD)
Most women are familiar with the mood swings associated with PMS, but PMDD is a more severe form. Ivankovich says this disorder is characterized by more than one debilitating mood-related symptom (like irritability, tension, depression) occurring around the time of a woman’s menstrual cycle.
Substance/Medication-Induced Depressive Disorder
Substance abuse and certain medications, like corticosteroids and interferon-alpha, leave a person prone to depression. If the substance is causing depressive symptoms, then the condition falls in this category.
Depressive Disorder Due to Another Medical Condition
In certain cases, a medical condition can trigger depression, like a chronic pain syndrome or cancer. “You’ll see a disruption of normal activities, but the key diagnostic characteristic of this depressive disorder is that it is not the result of some mental disorder,” Ivankovich says. “Instead, it is a consequence of a medical condition that is not always linked to depression.”
Other Specified Depressive Disorder
Sometimes, symptoms don’t check all the boxes laid out by the DSM-5 — for instance, maybe a person has a condition similar to major depression, but there are only three symptoms present in a two-week span instead of five. “In this case, symptoms do not meet the full criteria for any of the disorders in the category,” Ivankovich says. If so, it’ll get the label above and the doctor will detail symptoms.
Unspecified Depressive Disorder
If you have depressive symptoms that are impacting your quality of life, but you don’t quite fit any of the typical types, your doctor can still diagnose you with depression. “The label ‘Unspecified’ is given when a disorder doesn’t meet the full criteria and clinician chooses not to specify why the criteria isn’t necessarily met,” Ivankovich says. In other words, this is at label is given only at a doctor’s discretion.
Bipolar 1 and Bipolar 2
Characterized by alternating spikes of highs followed by painful lows, bipolar disorders are separate mood conditions of which depression is a key component. “The mood cycle shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression),” says Ivankovich. Manic episodes generally last seven days, and depressive cycles generally last two weeks. The difference between Bipolar 1 and 2? There are no severe highs in Bipolar 2, only “hypomania.” With a Bipolar 1 episode, a person might need to be hospitalized during a bout of mania.
Some depressive disorders are easier to hide than others, but all require attention “Much of society believes that it’s best to ‘pull yourself up by the bootstraps’ and just deal with life, so I often ask patients if they would delay seeking treatment for hypertension or diabetes,” Ivankovich says. “Mental illness is still an illness — and it can be devastating. Don’t delay treatment. When symptoms last longer than a few weeks, it warrants a further look.”
How to Get Screened
Did you know that there’s a National Depression Screening Day (Oct. 8)? Watching his colleagues screen for general health conditions like blood pressure and heart disease, Douglas Jacobs, MD, an associate clinical professor of psychiatry at Harvard Medical School, decided to launch a program to promote mental health screenings. Now in its 25th year, the day is an annual reminder to check in with your overall mood, notes Michelle Holmberg, director of programs at Screening for Mental Health, Inc. There’s even an online screening tool you can take to help assess if you might be at risk for certain mood disorders.
With so much stigma still attached to mental health, Holmberg says the self-assessment is a good way to open the conversation about depression and other mood disorders with your doctor. “It’s intended to be brief, but validative,” she says. “And although you can take it anytime, we have this day every year to promote regular ‘check-ups from the neck up.”
When in doubt, if you’ve had symptoms of depression for two weeks or more, Ivankovich says to visit your general practitioner, family physician or a mental health agency. “Screenings are of primary importance in both of these settings,” she explains. “A family practitioner can assist in making an initial diagnosis and can refer for counseling, where a professional can help you develop coping strategies and learn better ways to process stressful situations. Ultimately, you’ll create a toolbox of techniques to draw from during your daily life.”
Just don’t suffer with symptoms of depression. After all — you wouldn’t refuse to treat a broken leg or a pain condition, would you? Depression is no different.
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