People throw around the word “depression” as if that word means only one thing. This is far from the case, therapeutically speaking.
I would suggest there are mild, moderate or severe, relapsing/remitting or chronic depressions. Doing the basic math, that’s six types right there and we haven’t even taken into account treatment-resistant depression, or the depression subtypes noted in the DSM.
Depression is not a disease; it’s a cluster of diseases.
Levels of Depression – How Depressed are You?
Dealing with straight major depression with no subtype consideration, there is still the question of depression severity. There are many classification and severity evaluation scales used in psychiatry These are generally used for diagnosis and in drug trials. A drug is thought to “work” when it changes the score on a specific rating scale a specific amount.
There is much debate over rating scales and their use, but one thing is clear, depression isn’t a single thing; it is many things combined.
Also clear to me is there’s a big difference between someone who identifies as being suicidal everyday for a month and one that identifies being extremely sad most days without suicidal ideation. They may both be depressed, but one is perhaps suffering significantly more, and is at more risk, than the other.
The hope when someone gets treatment is it is their very first depression, that it hasn’t been going on for too long (say, not a year) and the person had a high level of functioning pre-depression. This person has a pretty darn good chance of getting well with treatment, or possibly even without (see note below).
Some people, on the other hand, have consistent relapsing and remitting depression. For example, they find themselves depressed for two months, then fine for six months, then depressed for another month and so on. This type of person may or may not seek treatment depending on how long their depressions tend to last. If someone knows their depression only lasts a month they could be quite willing to wait it out without treatment (although, I would say get some counseling and maybe you could even shorten the month, but that’s me).
Unfortunately, many people find their relapsing-remitting depression getting worse over time: more severe depressions, lasting longer, with less time in between. From all the data I’ve read, this is pretty typical. Hopefully, at the sign of worsening depression, the person seeks treatment so they aren’t in the situation of facing a chronic depression.
Chronic depression is another kettle of fish. You get depressed and you stay that way. For a very long time. These people sometimes spend years without treatment having slowly accepted their depression as “normal.” This is really too bad because the longer you wait, the worse your predicted outcome. (Not that you won’t get better, simply statistically, it’s harder.)
Here’s the important note I mentioned:
Previous depression and previous depression severity are the best predictors of future depressions. It’s really important to write that down somewhere. It’s key in understanding why treatment matters. (There’s lots of research on this, this study just popped up first.)
Oh yes, treatment-resistant depression. This, technically, means having failed two adequate trials of antidepressants. (Adequate trials are the right dosage for the right amount of time.)
Most psychiatrists I know would say that’s a dumb definition. That pretty well describes half the depressed population – it’s hard to hit the right antidepressant on the head. In practice, the only people really considered treatment-resistant have tried a lot more than two antidepressants.
So Depressions are Different, so what?
My point, dear friends is this: Don’t assume you understand depression just because you’ve had it.
Just because you got better with CBT, doesn’t mean someone else will. Just because you got better on a six-month treatment of a drug doesn’t mean someone else will. Just because you were still able to work through depression doesn’t mean someone else can.
And so on and so forth.
And I’m absolutely convinced to the very bottom of my soul that severe, chronic depression is a different beastie than what most people experience. Which is good. For all the people not experiencing severe, chronic depression.
But I do so wish people would stop judging the treatment someone chooses for their mental illness. The course of their illness is not the same course as yours; so leave them alone.