Written by : HAKIZIMANA Maurice

What is depression? Depression, commonly known as a “nervous breakdown” does not refer to a simple bout of low mood or temporary sadness, but rather to a genuine mental illness. It is characterized by mood disturbances (sadness, loss of pleasure).

While the clinical presentation of a depressive episode is generally nonspecific, the symptoms it encompasses, the differences in intensity, progression, and underlying causes are heterogeneous. The term “depressive disorder” encompasses multiple realities that require different treatment approaches from one form to another.¹

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Quite arbitrarily, we can classify these different forms of depression according to five criteria: the intensity of the episode, its clinical presentation (i.e. the symptoms that make up this episode), the time of its appearance in the person’s life, the cause and finally according to its evolutionary mode.

(1)Depending on the intensity

• Dysthymia

Dysthymia could be defined as a mild depression that tends to recur chronically. The symptoms of dysthymia persist for at least two years, sometimes much longer, and during this entire period the sufferer feels depressed all day, every day, or almost.

• Major depressive episode

A major depressive episode is characterized by a very low mood or a noticeable loss of interests or joy in life. Symptoms must occur almost daily, over a period of at least two weeks, to be diagnosed. There are several levels of severity, but a major depressive episode, even a mild one, must be treated.

• Melancholy
  
  

Melancholia is an extreme form of major depressive episode, marked by a feeling of intense despair. One loses all self-esteem, feels guilty for being ill, convinced that one will never recover and even that one is unworthy of life. Above all, the risk of suicide is very high, making melancholy a medical emergency.³

(2)According to clinical presentation

• Atypical depression

Atypical depression refers to the presence of certain symptoms that are rather unusual or even the opposite of those of classic depression: increased appetite with weight gain, increased time spent in bed. There is also a subjective sensation of numbness in the limbs and, above all, an unusual reactivity of mood, particularly to positive events.

• Depression with psychotic symptoms
  
  

In this type of depression, in addition to the usual procession of depressive symptoms, delusions appear, such as sensory hallucinations or misinterpretations with a feeling of persecution and the conviction that someone wants to harm you. More common in chronic psychoses or bipolar disorder, psychotic symptoms can, however, be found in any type of depression.

 

(3) Depending on the time of appearance

• Childhood depression
  
  

Depression can affect children of all ages, from toddlers to teenagers.² Diagnosis is often more difficult because if you ask them, they may not be able to put words to their feelings. But the signs are there: low energy, loss of interest, sleep disturbances, appetite problems, irritability, and a tendency to isolate themselves from others.

• Depression in the elderly

It’s difficult to diagnose depression in older people. Sadness, loss of motivation, and fatigue are often simply attributed to signs of aging. This is unfortunate, as it’s a very common condition in geriatrics and a serious one, as it’s in this age group that suicide attempts most often turn into completed suicides!

• Peripartum depression

Peripartum depression is another serious mood disorder. It is usually associated with the hormonal changes of pregnancy and childbirth, although it is not clear why some women are more susceptible to it than others.

• Premenstrual dysphoric disorder

Most women experience mild mood swings just before their period. However, some may experience much more severe symptoms, collectively known as premenstrual dysphoric disorder, a severe form of premenstrual syndrome.

(4) Accordning to etiology

• Endogenous depression versus reactive depression

The origins of depression are the subject of multiple theories. Some experts believe it may be caused by an imbalance in brain chemistry, a condition closely linked to genetic factors. It is believed that there are “vulnerability genes” for depression that we could pass on to our children.⁴

Conversely, a reactive depression will have its origin in one or more adverse events which are the basis for this disorder (loss, bereavement, accident, etc.)

• Secondary depression

It appears that certain illnesses can cause a depressive episode by attacking the central nervous system. For example, vascular depression is described, a late-onset depression associated with vascular damage. Other illnesses that are involved include asthma, diabetes, Parkinson’s disease, multiple sclerosis, and HIV.

• Iatrogenic depression

Certain psychoactive substances and medications, both common and uncommon, appear to be responsible for depression. These include corticosteroids, certain migraine and blood pressure medications, immunosuppressants, and certain contraceptive pills. Unfortunately, this list is not exhaustive.

• Traumatic depression

Psychological trauma following a serious assault, a natural disaster or a war situation can lead the victim to develop post-traumatic stress disorder. However, the onset of a depressive episode is very frequently associated with this disorder.⁶ It is also possible to develop a depressive episode without post-traumatic stress disorder.

(5)According to the evolutionary mode

• Bipolar depression

Bipolar disorder is characterized by alternating manic or hypomanic episodes and depressive episodes, interspersed with periods of normal mood. People with bipolar disorder therefore experience phases of mild to severe depression. Going from one extreme to the other can be particularly distressing, which may explain why people with bipolar depression have a particularly high suicide rate.

• Unipolar depression

In contrast to bipolar disorder, unipolar disorder involves recurring episodes of depression only and is similar to recurrent depression.

• Seasonal depression

Some depressions follow the rhythm of the seasons, as regular as a Swiss clock. So-called seasonal depression, or seasonal affective disorder (SAD), has a typical seasonal course with the onset of the episode in autumn, as soon as the length of the day decreases, followed by a spontaneous improvement in spring with a recurring character of the disorders from one year to the next according to the same seasonality.⁵

All credits: Dr. Eric Charles, Psychiatrist

References :

1. Manuel diagnostique et statistique des troubles mentaux 5e éd. American Psychiatric Association Trad. fr. Issy-les- Moulineaux, Elsevier-Masson 2015, 1 114p.
2. Prevalence and development of psychiatric disorders in childhood and adolescence. Costello et coll. Arch Gen Psychiatry. 2003 Aug;60(8):837-44.
3. Pathologie dépressive. JP Clément et coll. Psychiatrie de la personne âgée. Seconde édition. 2019. Editions Lavoisier. 694p : 133-51.
4. Les maladies dépressives (seconde édition). Sous la direction de JP Olié, MF Poirier et H Lôo. Médecone-Sciences Flammarion. 2003. 637p.
5. La dépression pour les Nuls. E. Charles et coll. Collection Pour les Nuls. Ed First. 2013. 382 p.
6. A chacun son rythme. E. Charles. Collection l’optimiste. Ed First. 2015. 227 p.
7. Psychiatric Comorbidities. C. North et coll. In : Clinical Manuel for Management of PTSD. Sous la direction de DM Benedek et GH Wynn. American Psychiatric Publishing, inc. 2011. 468p.

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