My Mind, My Body, My Journey™ 

October is Depression Awareness month, where we recognize the leading cause of disability in the world as measured by years lived with disability¹. The book Prozac Nation was published in 1994 by author Elizabeth Wurtzel who documented her experiences with atypical depression. This book, despite having mixed reviews, shed light on the impact of depression and was later adapted into a movie. A quote that is commonly referenced in the book is “that’s the thing about depression: a human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.”

In my opinion, this quote speaks to why depression is the leading cause of global disability because it is recurrent, and each episode could last for years. There are also many types of depression that can make it difficult to treat and properly diagnose. If you refer to my previous blog post regarding the need for mental health reform, it briefly touches on the differences in education and training among mental health professionals and the impact of politicians in determining which professions are more likely to have employment opportunities. In that post I also discuss the lack of cultural competency among providers that leads to misdiagnosis of people of color and improper treatment and care. Early and accurate diagnosing is crucial to the successful treatment of any health condition. One study noted that, African/Black Americans and Puerto Rican patients were more likely to be diagnosed with Schizophrenia even when measures of psychopathology do not indicate that a diagnosis of Schizophrenia is justified². Epidemiological accounts of Schizophrenia suggest that the prevalence of the disorder is similar across all racial and ethnic groups; however, research shows that Schizophrenia is consistently diagnosed at higher rates in the African/Black American population². Further research has shown that African/Black Americans are 2.4 times more likely to be diagnosed with Schizophrenia when compared to White patients³. These disparities exist even with the same symptoms being reported, where White patients are diagnosed with mood disorders and Black patients are diagnosed with Schizophrenia³.

I believe that knowledge is power, so I want to share the common types of depression, to assist those with seeking care, advocating for loved ones, and finding a therapist to meet your needs. Medically speaking, depression is defined as a mood disorder that causes persistent feelings of depressed mood or sadness and a profound loss of interest in things that usually bring you pleasure. Depression impacts how you feel, think, and behave, which impacts your ability to function and carry on with daily life. Some areas impacted include sleep, appetite, weight, hopelessness, difficulty with concentration, thoughts of harming yourself, and thoughts of wanting to end your life. People can also have symptoms of psychosis which could increase the likelihood of misdiagnosis. When psychosis occurs during depression the symptoms are mood congruent meaning they coincide with the depressed mood. Some people have reported visions of death and dying and/or voices telling them to die. A qualified and competent licensed mental health provider will be able to recognize that psychosis can occur in a variety of medical conditions including both physical and mental health conditions. If you are working with a provider whose default diagnosis is Schizophrenia when they see psychosis, you want to find a different provider regardless of whether you have a “fit” with this provider.

The types of depressive disorders include:

1. Major depressive disorder (MDD)**
   1. This is the type of depression which is often referred to as clinical depression. The key symptoms include depressed mood, lack of interest in activities normally enjoyed, changes in sleep, weight, fatigue, concentration difficulties, feelings of guilt and worthlessness, and thoughts of dying and suicide. Symptoms must last at least two weeks to meet criteria for a MDD diagnosis.
2. Persistent Depressive Disorder (PDD) (formerly known as Dysthymia)
   1. This disorder was commonly referred to as “low level” or even “high functioning depression” among providers and the public. I would caution the use of those words because someone with PDD could have periods of moderate and severe depression. This form of depression is more chronic in that the episodes of depression last longer than two years in adults, and longer than a year in children and adolescents. Many individuals with PDD often have experienced several major depressive episodes, which could include thoughts of self-harm and/or attempts, which is why I would avoid use of terms such as “low level” or “high functioning.” With this type of depression, people may experience brief periods (i.e., less than two months) of not having depression. The symptoms include feelings of sadness, anger and irritability, low-self-esteem, sleeping too much, or not being able to fall asleep. Fatigue, low-energy, and feelings of hopelessness are also common.
3. Bipolar Disorder (formerly known as Manic Depressive Disorder) **
   1. This disorder is one of the most misunderstood of all the mental health diagnoses. I have often heard the term being used incorrectly such as people saying the weather patterns are “Bipolar” and people saying that they are “Bipolar” because “one minute they are happy and then the next minute they are sad.” Bipolar disorder is characterized by periods of abnormally elevated mood which is known as mania or hypomania depending on the symptoms. People with Bipolar disorder also experience episodes of major depression, which can factor into the risk of suicide. People with mania can have psychosis such as delusions and hallucinations and can go days without sleeping and not feel tired. One of the ways to distinguish mania from depression would be exploring how the person feels when they haven’t been able to sleep. The person with major depression may report being tired and concerned by the lack of sleep, while the person experiencing an episode of mania may report feeling completely fine and energized and may deny the need for sleep.
4. Postpartum Depression (PPD) (also known as Perinatal Depression or Depression with perinatal onset) **
   1. Pregnancy can bring about significant hormonal changes that can impact a woman’s mood. Because depression can occur during pregnancy and last up to a year after the birth of the child many have begun to use the term perinatal depression. Symptoms can include mood changes, anxiety, irritability, appetite changes, problems bonding with your baby, panic attacks, thoughts of harming yourself, and thoughts of harming the baby. Symptoms of psychosis can also be present such as confusion, delusions, or hallucinations. Women with histories of MDD, PDD, and bipolar disorder are at greater risk of experiencing perinatal depression. However, it is worth noting that perinatal depression can occur in women with no history of mood and/or mental health concerns.
5. Premenstrual Dysphoric Disorder (PMDD)
   1. Hormonal changes during your menses are also common causes of mood concerns in women. In addition to experiencing premenstrual syndrome (PMS), which includes the following symptoms: irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings (often sugar and/or carbohydrates), body aches, and breast tenderness; some women can experience a form of depression called premenstrual dysphoric disorder (PMDD). PMDD is accompanied by extreme fatigue, severe stress and anxiety, mood swings, crying spells, binge eating episodes, problems concentrating, and feeling hopeless, or self-critical. These symptoms typically resolve after menses similarly to PMS in women with no other history of mood concerns. For women who have MDD, PDD, or bipolar disorder, hormonal changes during menses can make their symptoms worse.
6. Seasonal Affective Disorder (SAD) (also known as major depressive disorder with a seasonal pattern)
   1. This type of depression is more common among those who live further from the equator and is linked to weather changes that have an impact on our circadian rhythm. Light therapy can be particularly helpful with treating this form of depression. Symptoms include sleepiness, weight gain, low mood, and sadness during the winter months that resolve during the spring.
7. Atypical Depression (also known as depressive disorder with atypical features)
   1. This type of depression refers to those who experience symptoms of depression, but also have symptoms that are not common with depression, such as overeating, sleeping too much, or extreme sensitivity to rejection. People who experience this type of depression may experience feelings of happiness when a positive event occurs.

** refers to the types of depression where symptoms of psychosis can be present as part of the disorder

Resources for depression include the crisis and suicide hotline 988, which is available 24/7/365 via phone and text. Depending on where you live there may be other 24/7/365 resources for mental health. Your insurance provider may also have 24/7/365 hotlines. The National Maternal Mental Health Hotline is a good 24/7/365 resource for pregnant and/or postpartum women. You can reach this line via phone or text at 1-833-852-6262. Due to the Affordable Care Act, insurers are required by law to provide coverage for mental health treatment. The Mental Health Parity and Addiction Equity Act of 2008 also requires equal coverage of mental health and substance use conditions by insurers.  Lime green is the awareness color for depression, so survivors, mental health providers, and other supporters can wear lime green ribbons to show support and raise awareness of the impact of depression.

If you or your loved one is experiencing depression, please remember that you are not alone, help is available. Making the choice to seek therapy is not a flaw or weakness on your part. It shows your courage to get better. Don’t be afraid to seek help, grow, and heal.

Wishing you health and happiness

References

1. Depression Facts & Statistics. Anxiety and Depression Association of America Website. https://adaa.org/understanding-anxiety/depression/facts-statistics. Updated June 7, 2023. Accessed October 22, 2023.
2. Schwartz R C & Blankenship D M. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry. 2014; 4 (4): 133-140. doi: 10.5498/wip.v$.i4.133. 
3. Schwartz EK, Docherty NM, Najolia GM, & Cohen AS. Exploring the racial diagnostic bias of Schizophrenia using behavioral and clinical-based measures. Journal of Abnormal Psychology. 2019; 128 (3): 263-271. doi: 10.1037/abn0000409.