Common Types of Depressive Illness

Melancholia
Early in the twentieth century, depression was classified as either reactive or endogenous. Reactive depression was thought to be milder in nature, and caused by an outside event. Endogenous depression was considered more severe and was thought to begin spontaneously, without an external cause. Usually the person had weight loss and sleeping problems, slowed thinking, and agitation or retar­dation of movement. Another name for this type of depres­sion is melancholia. This term captures the anguish of the sufferer better than the word ‘depression’.

Both of these types – indeed – are now thought to be different manifestations of the same disorder. The illness can change from mild to severe, sometimes has an external cause, and sometimes occurs spontaneously.

Psychotic Depression
In some cases, depression becomes so severe that the person develops delusions and hallucinations. (‘Psychosis’ means the person is out of touch with reality.) Delusions are frightening fixed ideas that are not open to argument. If you have a depressive delusion, you may think that you are already dead, or that you are responsible for all the evil in the world. Auditory hallucinations are usually experienced as disem­bodied voices telling you to kill yourself, or saying that you are worthless. Psychotic depression is an emergency situation, because the delusions and hallucinations are so compelling and real to you that you may feel forced to act on them.

Double Depression
Double depression is the condition of dysthymia interspersed with episodes of major depression. These episodes can develop even though the person is already receiving treat­ment for dysthymia. At that point, the treatment will be reviewed and adjusted.

Seasonal Affective Disorder
Carol used to be outgoing and fun to be with. However, for the past three years she has hibernated in the winter. She feels exhausted after working eight hours. She drags herself home and naps in front of the television. When friends call her to go out, she doesn’t have the energy. She feels unhappy and lonely but can’t shake off the tiredness. Even when her friends beg her, she finds some excuse to avoid them; the grey skies and cold weather defeat her. As soon as the days begin to get longer in the spring, her energy returns. She doesn’t know how many more years she can tolerate the ‘winter blues’.

Carol has a condition called seasonal affective disorder (SAD). Certain individuals are very sensitive to the alter­ations of light and dark that come with the long nights and short days of winter. The condition improves with light therapy.

Atypical Depression
Ratna had difficulty getting up in the morning. Her limbs felt like lead, and it often took her about two hours to get ready for the day. She had gained about twenty pounds, though she wasn’t eating that much more, and she felt sluggish and heavy. She was ashamed about her weight gain and lack of motivation. She had started to avoid spending time with her friends and family because their remarks about her appear­ance hurt her.

Overeating, oversleeping, terrible fatigue, and heightened sensitivity to rejection are the core symptoms of atypical depression. Women are more frequently affected than men. For example, someone like Ratna may develop the signs of a major depressive episode, but with retardation of movement, too much eating, and too much sleeping rather than symptoms such as agitation, not eating, and not sleeping.