“I’m depressed” is a phrase used quite often in everyday life.
In clinical psychology, however, depression does not simply mean feeling sad. What is more, depressive symptoms do not appear as a single clinical picture.
The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders), used in the classification of mental disorders, addresses depressive disorders under a number of different diagnostic categories.
Shared features of these disorders can include a sad, empty or irritable mood together with cognitive and physical changes that may affect a person’s functioning. The main points on which they differ are features such as the duration of the symptoms, their timing of onset and their possible causes.
So what are the different types of depression?
1. Major Depressive Disorder
The clinical picture that comes to most people’s minds when they hear the word “depression” is Major Depressive Disorder. In a major depressive episode it is not only feeling sad that matters; the following symptoms may be assessed:
- Depressed mood
- Loss of interest or pleasure in activities that were previously enjoyable
- Changes in sleep patterns
- Changes in appetite or weight
- Loss of energy
- Difficulty concentrating and making decisions
- Feelings of worthlessness or intense guilt
- Psychomotor retardation or agitation
- Thoughts of death
For diagnosis, the number of symptoms matters, but so do their duration, their severity and their impact on the person’s functioning in social, occupational or other important areas of life.
For this reason, feeling sad for a few days is not the same thing as major depressive disorder.
2. Persistent Depressive Disorder
Some people may experience depression not as distinct episodes but as a much longer-lasting state of low mood.
In DSM-5-TR, Persistent Depressive Disorder (also known as Dysthymia) is characterised by a depressed mood that continues in adults for at least two years, on most days and for the greater part of the day.
A person may sometimes begin to see this as simply a part of their life:
Yet the fact that a long-standing psychological pattern feels familiar does not necessarily mean it is an unchangeable part of the person’s personality.
3. Premenstrual Dysphoric Disorder
Another condition included in the depressive disorders category of DSM-5-TR is Premenstrual Dysphoric Disorder. Here the symptoms show a distinct temporal relationship with the menstrual cycle.
In the period before menstruation, marked changes in mood, irritability, low mood, anxiety and other emotional or physical symptoms may appear, and the symptoms may ease during certain phases of the cycle.
This is not the same as ordinary premenstrual complaints. In clinical assessment, the timing and severity of the symptoms and their impact on the person’s functioning are important.
4. Substance/Medication-Induced Depressive Disorder
Some depressive symptoms may arise in connection with the physiological effects of a substance or medication that is being used.
In this case, clinical assessment considers not only the presence of the symptoms but also when they began and their temporal relationship with the use of the substance or medication.
For this reason, discussing medications and substance use is clinically important when depressive symptoms are being assessed.
5. Depressive Disorder Due to Another Medical Condition
In some cases, depressive symptoms may be related to the direct physiological effects of another medical condition.
For this reason, a comprehensive assessment does not evaluate psychological symptoms entirely in isolation from the person’s physical health.
Where necessary, multidisciplinary collaboration between the psychologist, the psychiatrist and other health professionals may be important.
6. Other Specified and Unspecified Depressive Disorders
In some people, depressive symptoms may cause significant distress or loss of functioning yet may not meet all the diagnostic criteria for a specific depressive disorder.
For these clinical pictures, DSM-5-TR also includes the categories of Other Specified Depressive Disorder and Unspecified Depressive Disorder. The existence of these categories highlights an important point:
Can Depression Look Different in Children and Adolescents?
Yes. The depressive disorders section of DSM-5-TR also includes Disruptive Mood Dysregulation Disorder.
This diagnosis relates specifically to childhood and adolescence and describes a distinct clinical picture marked by chronic irritability together with severe temper outbursts that are out of proportion to the child’s developmental level.
Therefore, especially in children and adolescents, it is not enough to assess depressive disorders solely in terms of “looking sad”.
Does Depression Always Mean Looking Sad?
No. A person experiencing depression may continue to work, see their friends or appear quite functional from the outside.
Clinical assessment looks not only at how the person appears from the outside but, all together, at their mood, their thoughts, their physical symptoms, their behaviours, the duration of the symptoms and the loss of functioning in their life.
For this reason, expressions frequently used on social media such as “hidden depression” or “high-functioning depression” need to be distinguished from the official diagnostic categories in the DSM.
How Does the Psychodynamic Approach View Depression?
A diagnosis can help us describe what the symptoms a person experiences look like. In terms of therapy, however, another question is sometimes needed as well:
Experiences of loss, the intense criticism a person directs at themselves, feelings of worthlessness, recurring patterns in relationships, the way anger is expressed or one’s sense of self are among the areas that can be explored in a psychodynamic assessment.
The psychological stories of two people who receive the same diagnosis of depression can be quite different from one another.
How Does CBT Address Depression?
Cognitive Behavioural Therapy (CBT), on the other hand, focuses on the reciprocal relationship between a person’s thoughts, emotions and behaviours. For example, during a depressive episode a person may experience the following negative automatic thoughts:
- “I can’t manage to do anything.”
- “I’m inadequate.”
- “Nothing will ever get better from now on.”
As the person feels worse, they may withdraw from activities and social relationships. As activity decreases, positive experiences may also decrease, and this can contribute to the persistence of the depressed mood.
In the course of therapy, the aim can be to understand this cycle and address it in a way tailored to the individual.
Who Makes a Diagnosis of Depression?
An article on the internet, a social media post or an online depression test is not enough to make a diagnosis.
In a diagnostic assessment, the nature, duration and severity of the symptoms, the loss of functioning in the person’s life, their past psychiatric history, substance/medication use and, where necessary, medical factors must be evaluated together.
In particular, if depressive symptoms are accompanied by thoughts of self-harm or of ending one’s life, the situation should be assessed professionally without delay.
In Short: Depression Is Not a Single Clinical Picture
Although “depression” is used in everyday language as if it were a single condition, from a clinical point of view there are different depressive disorders. For this reason, the important question is not only “Am I depressed?”
It is also necessary to assess what the symptoms are, how long they have continued, when they appeared and to what extent they affect the person’s life.
A diagnosis is not a label that defines a person; it is one of the tools that helps us to understand the clinical picture in a systematic way.
If you are experiencing depressive symptoms and these symptoms are affecting your life, we can explore them together in an online therapy process.
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