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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.

This entry was posted in Depression, How Others See Bipolar, Understanding Mental Illness and tagged , , , . Bookmark the permalink.

14 Responses to Levels of Depression, Types of Depression

  1. jake says:

    There are I agree many subtle shades of depression which can be coloured by many other components, not limited to drug abuse, poverty, and sexual abuse. Depression permeates the soul.
    It is hard to explain to someone how you feel when you are buried in blankets or sitting in a dark closet. It is impossible to rationalize an overdose of psyche meds or impulsively quiting a job to someone when you cannnot rationalize it to yourself. I lost a brother to suicide a victim of an unrelenting illness, depression.
    I cannot determine anyone elses course of action for this dreaded disease. If someone asks for an opinion I have one, but otherwise I have nothing to say, I have no unsollicited advice to offer. What path you follow is the correct path because it is the one you have chosen. If it does not work, so be it, it is not for us to judge, it is for us to offer up our support if and when you need it.

  2. Natasha Tracy says:

    Hi Jake,

    I’m immensely sorry to read that you’ve been touched by suicide so personally. That’s a really tough thing to go through.

    “What path you follow is the correct path because it is the one you have chosen. If it does not work, so be it, it is not for us to judge, it is for us to offer up our support if and when you need it.”

    Honestly, that is one of the best things I’ve read in a while. Thanks so much for writing that; I know it offers support to all the people who read it, knowing that they are not being judged.

    - Natasha

  3. Amanda says:

    As with all of your writing, this is succint and utterly, utterly correct. This piece should be mandatory reading for everyone, especially people who think “occasionally being sad” is no different to severe chronic depression!

    I really love your blog, keep up the awesome work. :)

  4. Natasha Tracy says:

    Hi Amanda,

    “As with all of your writing, this is succint and utterly, utterly correct.”

    That is very kind, thank-you.

    If only I _could_ make a list of mandatory readings! It would really improve the life of everyone who is touched by mental illness (which is pretty much everyone).

    “I really love your blog, keep up the awesome work.”

    I’ll try. Thanks.

    - Natasha

  5. Kylie says:

    Again, thankyou. I am an avid reader and twitter follower these days. I attending a Mental Health First Aid Course last weekend, and had the opportunity to share a lot of my personal experiences in a very safe setting, it was empowering. I passed on your url’s as I feel that the more people that become enlightened the better. I love today’s post, as it really explains that we are all touched differently by depression, or any mental illness for that matter.

  6. Holly Gray says:

    Excellent to see this being addressed. I have two separate depressive disorders: Major Depression (Recurrent Type) and Dysthimia (they sound redundant but I’ve learned that they’re not.) One of my biggest pet peeves with layman depression advice is the automatic ‘get more exercise and eat right’ line. It bothers me not because a healthy diet and exercise aren’t positive habits – they unquestionably are – but because that advice assumes all depression is the same. It most definitely is not.

    In my personal experience, chronic, low grade depression like dysthimia responds well to healthy eating, exercise, plenty of water, and the proper amount of rest. When I’m in the grips of a major depressive episode, however, those things do nothing. They aren’t hurting me, obviously and must surely impact my overall health. But they have zero effect on my depression. It’s like taking aspirin for labor pains – labor pains that seem to last a minmum of 6 months.

    Thanks for addressing this topic, Natasha.

  7. Natasha Tracy says:

    Hi Kylie,

    Thanks for passing on my links. I’m honored that you think so highly of my work. It’s great you felt empowered through sharing.

    - Natasha

  8. Natasha Tracy says:

    Hi Holly,

    I have a similar opinion. Mild depression is different. Period. I have no doubt that different things work for people with mild depression, but they just don’t touch the sort of thing I generally experience.

    People don’t believe me when I say exercise doesn’t make me feel better. It just makes me feel tired. People don’t believe me when I say focusing on diet does nothing. (In truth, the only thing I’ve seen is actually a negative reaction on a low-carb diet, but that’s another thing.)

    If I could _list_ the number of things that are a good idea but do nothing for me it would take up an entire other blog post.

    (And I didn’t mention this, but as far as treatment goes, bipolar II depression is one of the hardest types of depression to treat. Just sayin’.)

    “It’s like taking aspirin for labor pains – labor pains that seem to last a minmum of 6 months.”

    That’s a good one. I may steal it.

    - Natasha

  9. Jake commented: “It is impossible to rationalize an overdose of psyche meds or impulsively quiting a job to someone when you cannnot rationalize it to yourself.”

    oh. my. goodness. I have been there. I’m so glad he shared this because I cannot stop beating myself up over impulsively, desperately deciding to quit my amazing job last year. I can’t help but think I’ve ruined my own life even more than it was already messed up.

    Maybe it’s weird, but I am so encouraged by this. Thank you, Jake.

  10. Wayne says:

    I googled mental illness in the hopes to find a really good supportive blog that speaks the truth and not just some repeated generic narrow view of people that assume all types of depressive illnesses are the same.

    I’m not sure what I suffer with, but I know I am suffering. I just can’t afford to pay for treatment, and phoning around for “free” treatment is something I just can’t do, I suffer with anxiety so that doesn’t help.

    @Beth – I can totally relate to this, I’m curently 21 years old (Just, 17th Feb) but a few years ago when I was 17 I impulsively quit college (one year before going to Uni aswell) because of the adopted views I had of society because of whatever it is I’m suffering with. I’ve regretted it ever since, because now I’m unemployed going from pointless placement to pointless placement, getting nowhere and unable to go back into education because of lack of money to live off.

    …Anyways, I’m rambling on now. Best post I’ve seen so far, good job Natasha, this made me feel like I could relate somehow.

    -Wayne

  11. Natasha Tracy says:

    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

  12. Lynette says:

    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!

  13. Hi Lynette,

    Certainly, you should continue what works for you, but for others, two things:

    1. Do not take any supplements without discussing it with your doctor
    2. Those supplements have no scientific backing: http://www.healthyplace.com/blogs/breakingbipolar/2011/03/diet-and-bipolar-disorder

    Thanks for contributing.

    - Natasha

  14. Stephanie says:

    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.

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