Those who suffer from clinical depression describe their feelings as a heaviness or fog. Any psychiatrist will tell you that not all depression is the same and symptoms should not all be treated the same way.

Common treatments like traditional talk therapy, Transcranial Magnetic Stimulation (TMS) for treatment-resistant depression, and the myriad medications that are available today don’t work for everyone. Or they work for a short time before side effects crop up, and patients must endure withdrawal from the medication.

Some psychiatrists, when working with patients who have not found an effective treatment for their depression, will collect information from close family members. Their descriptions of a patient’s behavior provide a window into a world the psychiatrist would never see otherwise. But those clues can help with a diagnosis that differs from what previous providers missed.

For example, hypomania, a mild to moderate state of high energy, elevated or irritable mood, and increased activity that lasts for at least four days in a row can occur intermittently between depressive episodes and typically signals a bipolar disorder. If a psychiatrist treats only the depression part of the patient’s symptoms, medications commonly used can actually make their moods more unstable.

Depression

Depression is arguably the most common mental health disorder in the world. It sometimes leads to suicidal ideation. Yet for many patients it can be difficult to get an accurate diagnosis and treatment that works effectively. Maybe that’s because there are many different types of depression, each with variations on symptoms and mood changes.

If you recognize some of the symptoms listed below in yourself or someone you care about,  it might be time to seek a medical diagnosis from a provider in your community. If behavioral health clinicians or psychiatrists are difficult to access, call or text the suicide and crisis lifeline at 988 for advice.

Common treatments include talk therapy, medication, and lifestyle changes that focus on nutrition, exercise, and healthy sleep patterns. Some patients may require more acute psychiatric care.

Major Depressive Disorder

Clinical depression is different than a feeling of sadness that everyone experiences from time to time. Common symptoms include feeling sad most of the time for weeks at a time, changes in appetite, sleeping too much or too little, fatigue, struggling with concentration, and feeling like the world would be better off without you. Some patients report feeling numb, foggy, or out of touch with themselves.

Postpartum Depression

All mothers can expect to feel exhausted when caring for a new baby. But postpartum depression is a deeper and more persistent condition. Patients report feeling intense sadness, crying, numbness, anxiety, guilt, and trouble bonding with the baby. Because new mothers feel like they must live up to the expectation that they are happy to have a new baby, they often hide their symptoms in an effort to appear normal.

Seasonal Affective Disorder

Some people view a seasonal affective disorder, S.A.D., as an unserious disorder. That is not the reality of those who suffer from it. Typically occurring in the winter months, patients report feeling low moods and low energy, sleeping and eating too much,  and withdrawing socially.

Bipolar Depression

Common symptoms of a bipolar disorder include swinging between high and low periods. On the high side, patients report feeling elation, high energy, impulsive behavior, and even talking faster. Most report needing less sleep, impulsive spending, and a strong sense of confidence. The low periods typically range from deep sadness, low energy, exhaustion, changes in sleep patterns, and other symptoms typical of depression.

PMDD - Premenstrual Dysphoric Disorder

This is a severe mood disorder driven by a woman’s menstrual cycle. Symptoms usually follow a pattern and occur a few days before a menstrual period. What we recognize as typical of most women who experience PMS, like irritability, mood swings, depression, crying spells and food cravings, may signal a more serious mood disorder.  Patients can benefit from medical intervention , stress management, and lifestyle changes.

Persistent Depressive Disorder

Sometimes called dysthymia, also known as persistent depressive disorder or PDD, patients experience a chronic, low-grade form of depression defined by symptoms like low energy, hopelessness, trouble sleeping, and low self-esteem lasting for at least two years and often much longer. Because it persists for so long, patients tend to accept the feelings as normal and don’t recognize them as a mental health disorder.

Anxious Depression

We often think of an anxiety disorder as a comorbid component of  depression. In reality, they are two separate conditions. Patients may feel tense, restless, and constantly nervous about things that can go wrong. That’s the anxiety part. They also feel the typical symptoms of depression, like persistent sadness, sleep problems, exhaustion, and trouble concentrating. Treatment should address both conditions simultaneously. 

Atypical Depression

A person with atypical depression experiences cycles when they feel like their mood has improved temporarily, especially after experiencing a positive event, making them think they are no longer depressed. But they also report sleep disruption, weight gain, heavy feelings in their arms or legs, and feeling heightened sensitivity to criticism or rejection.

Melancholic Depression

Just as the name implies, people with a diagnosis of melancholic depression typically suffer from a more intense form of depression. They do not experience positive feelings at all. Common symptoms include feeling deep depression when they wake up every morning, extreme weight loss, feelings of guilt, slowed movement and speech. Many report a deep sense of emptiness.

Depression With Psychotic Features

Considered to be one of the most severe forms of depression, psychosis intensifies the patient’s feelings of disfunction. They may experience delusions or hallucinations that seem real even though they are not.  People with this condition may feel they are being punished for some terrible sin they have committed. While it may resemble schizophrenia, it is a unique and serious condition that requires urgent psychiatric treatment.

In Conclusion

Depression can affect anyone. Whether they are young, old, black, white, brown, rich or poor, it doesn’t matter. Depression does not inherently lead to suicidal ideation, but it often does. That’s why it’s important to take it seriously and seek help. If you or someone you are about has symptoms, please take action.

If you or someone you know is struggling, call or text 988 or chat online with the 988 Suicide & Crisis Lifeline for free, caring, confidential support. You can also text HOME to 741741 for free, confidential, nonjudgmental support from Crisis Text Line.

A Culture of Caring: A Suicide Prevention Guide for Schools (K-12) was created as a resource for educators who want to know how to get started and what steps to take to create a suicide prevention plan that will work for their schools and districts. It is written from my perspective as a school principal and survivor of suicide loss, not an expert in psychology or counseling. I hope that any teacher, school counselor, psychologist, principal, or district administrator can pick up this book, flip to a chapter, and easily find helpful answers to the questions they are likely to have about what schools can do to prevent suicide.