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Levels of Depression, Types of Depression

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?

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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.

Relapsing-Remitting Depression

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).

Woman looking into distance whilst thinking

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

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.)

Treatment-Resistant Depression

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.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

18 thoughts on “Levels of Depression, Types of Depression”

  1. Hi Lynn

    Perhaps the word you’re looking for is

    Anhedonia – literally translated as the inability to feel pleasure

  2. Natasha –

    Interesting comments. Thank you for the venue. Here is my question:

    What is the name of my type depression? A pschyatrist gave it to me years ago, and he has since died. I tried participating ed in depression studies and have never qualified. On two occaisions, I was told that I was “too depressed” and the drug they were testing would not help. I found that humorous. “Too depressed”.

    Anyway, I have felt “unhappy” all my life. “Happy” people are not “normal” and who is to say that “happy” is “normal”. I attempted suicide at 19 (I/m 60 now), but a friend interviened and obviously the attempt was just that – an attempt. I don’t have a death wish, but I’m certainly not afraid to die. I have never cared emotionally about anything or anybody. I tell my girlfriend (and 2 ex-wives) that I “love” them because that’s what I’m supposed to do and that’s what they expect, but truthfully “love” is an abstract emotion. Daily questions such as “what do you want to eat, where would you like to go, what movie would you like to see, etc. promt the same response “I don’t care” – because I don’t. And I guess that’s the overriding symptom: I don’t care. Never have.

    There’s a name for this type depressionit, but I have lost it. Can you assist?

    Thank you

  3. my name is michael i have experienced depress most of my life. i am having now ishave been in full blown chronic well over a year…go to my therapist once week see my phys once a month to keep posted as how well i am doing on my meds i aint doing good and tell them i dont i am getting better some days are worse….i have no desire to change any of my behavior i should be looking a job but i dont want too..was going to church and enjoy it immensely but i dont any more whatt is wrong with me

  4. I agree there are a lot of different levels of depression

    Somedays when I am pushed beyond my ability to cope I feel like an animal backed into a corner with someone poking at me with a stick Its at times like this that depression rears it’s ugly head as extreme irritability

    The other day I was stressed out and irritable due to the pressures of work. My computer wouldn’t allow me to use it until I changed a password. I was so pissed off that I changed it to an expletive. Then at lunch I was sitting in a quiet area of McDonalds having a salad and water when a homeless person came by begging for money. I was so angry because I was on a break trying to de-stress myself. It reminded me of how I could end up if I don’t learn to manage my illness better. Then on the way home from work I rested a moment on a bench to use my cell phone and someone came by trying to get my attention and I scretched out NO, waved them away and got up ubruptly ready to leave only to realize it was a coworker who lives in my area just trying to say hi. I was embarrassed and apologized profusely

    When I got home I went straight to bed. When I got up the next morning as I was getting ready for work I found myself crying as I was washing my hair and wretching as I was brushing my teeth. Not the best way to start the day…

  5. Thank you, THANK YOU, for saying this.

    I understand that for a lot of people, depression can just resolve itself. I know this sounds mean and hurtful, but sometimes I believe that these people didn’t really “cure themselves” or “worked their way out of it” — it just resolved itself much little a mental flu. These people are riding along a self deluded high where they thought they fought the beast and won… but maybe the beast just got bored and walked away.

    For people to then assume that everyone’s experience with anything is the same as theirs is just wrong.

  6. Hi Natasha,
    Great blog! vitamin D3, and a B complex vitamin tablet-recomended each by a physicians-and then I added an Omega3 fatty acid tablet, was found very effective by me for mild depression with a lot of rest over the last 6mo. It’s my own belief that the ill brain will require more nutrition to heal, I believe that it will try to heal on its own, and that the brain’s need for increased nutrition contributes to individual weight fluxuation and symptoms that are saying, ‘Please attend to our matter of becoming ill.’ If my brain is saying, ‘I feel like dieing’, It’s an ‘I don’t feel so good right now.’ This theory suggests that some symptomes are not connected to the sorce of the illness and suplimenting the need may lighten other issues that are agrivated by an issue of nutrition; it may inhibbit ones abillity to heal, and on an unconscious level, a deprivation translates into neglect if that was an issue. Once your brain is sick its not the same as a healthy brain. My respons to the suppliments is very hopefull which tends to decrease alot of issues and make me more resillint and “bounce back” from stressers. The helpless victem is passing from my thinking. I’m going to add a multi vitamin because I seem to like salad so much. Thankyou, what a wonderful support blog!

  7. Hi Wayne,

    It’s hard to find a place and a perspective that speaks to you, I’m glad you’ve found one here.

    You are not alone.

    Whatever suffering you are feeling right now, I guarantee to you, others have felt and are feeling the same way.

    Regarding treatment, I don’t know what your situation is, but one of these numbers may help you: http://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-referral-resources/menu-id-200/

    I know you’ve said you feel you can’t call, but at least you can have the numbers for a day when you do feel up to it.

    Drop by any time.

    – Natasha

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