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5. Types of depression

Whole textbooks are written about the classification of different types of depression. The terminology can be very confusing.

Some of the headings that have been used include:

5.1 Primary and secondary depression

 

  • Primary depression means the illness has developed on its own.
  • Secondary depression means the depression has been caused by another illness – the depression is a complication of another medical problem such as the thyroid gland over- or under working, or as a result of taking certain medications.

 

Medicines that can contribute to depression include steroids, and some of the antihypertensive drugs (given for high blood pressure).

Alcohol, our favorite drug, is a strong depressor of mood and, if used in excess, depression can occur.

Depression would then be secondary – or follow from alcohol abuse. There are many other causes.

5.2 Neurotic depression and psychotic depression

So-called neurotic depression has an unfortunate name. What it actually means is that the depressed person is, no matter how ill they are, always in touch with reality.

This makes an important distinction between neurotic depression and psychotic depression.

A psychotic person loses touch with reality (and this may be in one small area only), or their beliefs may be wide ranging in their abnormality.

People can become psychotic in the setting of many types of mental illness – not only some types of depression.

People suffering from psychotic illnesses have delusions. This means that the person has a fixed false belief which is not in keeping with the generally accepted beliefs of their culture.

If I said that I believe the world is flat, I would be deluded – we know the world is not flat – but had I lived at the time of Socrates and said the world was flat, I would not have been deluded but just expressing a piece of current, ancient Greek knowledge.

Delusions in illnesses usually have far more significance than this and can cause great suffering.

If, for instance, you believe that the water supply is being poisoned by your neighbor, you will be very frightened and you will stop drinking.

5.3 Endogenous and exogenous depression

This terminology is little used now and is probably not that helpful.

Endogenous depression refers to a depressive illness that comes (from within) – it happens with no obvious cause.

Exogenous depression refers to the sort of depression that happens as a response to a stressful event, like a divorce, or bereavement – it had an outside ‘cause’.

There was a life-event, or happening that caused the depression. This may at first seem persuasive but, in fact, if you look at any group of depressed people they are all more likely to have big things (life-events) happening in their lives in the two years before their illness developed, compared with people who are currently well.

If you are ill with depression, you will respond to treatment in the same way whether or not your illness is ‘explainable’. It makes no difference.

5.4 Unipolar and bipolar affective disorder (or manic-depressive disorder)

About 1 in 10 people with depression will have a manic-depressive illness, also called bipolar affective disorder.

Besides spells of low mood and depression, they will experience mood swings in the other direction. In severe cases, psychotic features can occur.

These are very important and useful ways of describing depressive illness.

Unipolar depression means a depressive illness that has happened in a person who is either experiencing normal mood, or is depressed.

These are the states that they feel, the mood does not swing further. Somebody with bipolar illness on the other hand, characteristically experiences normal, depressed, and ‘high’ or elated moods at different times.

Their mood swings between normal, too bright, and too low – they experience the two poles of mood experience. They visit both ends of the spectrum of mood – very up and very down – and this can be extremely incapacitating.

It is important to make the distinction because people with manic-depressive illness respond better to a different set of treatments than people who become ‘only’ or solely depressed.

The two types of illnesses – unipolar and bipolar illness – are different in other important ways. For example, if you are bipolar (or manic-depressive), you are more likely to have a family member who is similarly ill than if you have a unipolar depressive illness.

Question: My mum has manic-depressive (bipolar) disorder. What are the chances of getting it, or of my children having it?

Answer: About 1% of the population will develop bipolar disorder, so it is much less common than ordinary depression.

If a close relative (your parent, brother or sister) has bipolar illness, then your chances are greater, but probably still only about 20%, of having some kind of mood disorder and it may be less severe. It is still relatively unlikely to happen to you.

Rather than worrying about whether you will develop the same condition, perhaps the best advice is to ‘know yourself’ and be aware of what your moods are like. Then recognise and manage stressful situations that could unsettle you, as we shall describe later.

The relatives of people with bipolar disorder are often more creative and successful than the average, so having these genes somewhere in your family can sometimes have good side-effects.

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