Types of Depression

“Good morning, Eeyore,” said Pooh.
“Good morning, Pooh Bear,” said Eeyore gloomily.
“If it is a good morning,” he said,
“Which I doubt,” said he.”
A.A. Milne, The House at Pooh Corner

The information that follows on dysthymia and the other mental health disorders on this page is for general information purposes only and is not meant to replace an evaluation from a qualified mental health processional.

In addition to major depression, there exists another type of depressive illness-dysthymia-that is far less severe, though crippling in its own way. Dysthymia consists of long-term chronic symptoms that do not disable, but keep one from feeling really good or from functioning at full steam. Physically, it is akin to having a chronic low-grade infection-you never develop a full-blown illness, but always feel a little run down.

Although dysthymia implies having an inborn tendency to experience a depressed mood, it may also be caused by childhood trauma, adjustment problems during adolescence, difficult life transitions, the trauma of personal losses, unresolved life problems, and chronic stress. Any combination of these factors can lead to a enduring case of the blues.

A dysthymic disorder is characterized not by episodes of illness but by the steady presence of symptoms (see diagram on next page). Because dysthymia does not incapacitate like major depression, as a rule, dysthymic people do well in psychotherapy (medication can also be used). During stressful times, a person with dysthymia may be catapulted into a major depressive episode, called “double depression.”

Dysthymic disorder is a common ailment, affecting about 3-5 percent of the general population. Unfortunately, because dysthymia is not as severe as clinical depression, the condition is often undiagnosed or dismissed as a case of psychosomatic illness. (“Your symptoms are all in your head,” is the all-too-common response from doctors.) Perhaps the most famous dysthymic is Eeyore, the despondent and downcast donkey in A.A. Milne’s Winnie the Pooh. If you identify with Eeyore (or feel down in the dumps most of the time), it is important that you consult a qualified mental health professional who can make a correct diagnosis. In addition, you can use the wellness strategies described in the “Staying Well” link on this web site.

Having a dysthymic temperament also brings with it positive traits. Dysthymic individuals can be serious, profound, deep, prudent, dependable, industrious, patient and responsible.

“Terror drove me from place to place. My breath failed me as I pictured my brain paralyzed. Ah, Clara, no one knows the suffering, the sickness, the despair of this illness, except those so crushed.”
Composer Robert Schumann, speaking of his manic depression

The information that follows on manic depression, currently known as bipolar disorder, is for general information purposes and is not meant to replace an evaluation from a qualified mental health processional. Although manic-depressive illness (which affects two to three million people) is less common than major depression, it maintains a high profile because of the many creative artists who have suffered from it. Examples include Edgar Allen Poe, Tennessee Williams, Ezra Pound, Virginia Woolfe, Vincent Van Gogh, Alfred Tennyson, Cole Porter and Robert Schumann. In recent times, celebrities such as Abbie Hoffman, columnist Art Buchwald, actress Patty Duke, actress Margot Kidder, and CNN’s Ted Turner have been similarly afflicted.

As Kay Redfield Jamison, a psychologist who is diagnosed with manic depression, writes in her memoir An Unquiet Mind:

When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars and you follow them until you find better and brighter ones. Shyness goes. The right words and gestures are suddenly there, the power to captivate others is a felt certainty. Feelings of ease, intensity, power, well-being, financial omnipotence and euphoria pervade one’s marrow.

Upon hearing this description of mania, people often respond, “If this is a disease, where do I sign up for it?” The problem with mania, however, is that due to the impulsivity and poor judgment that it brings, an episode can wreak havoc on family, friends, the community and the law. Moreover, when the high inevitably wears off, the individual comes crashing down into a state of total darkness and despair. As Jamison describes:

A floridly psychotic mania was followed, inevitably, by a long and lacerating black, suicidal depression. Everything -every thought, word and movement-was an effort. Everything that once was sparkling now was flat. I seemed to myself to be dull, boring, inadequate, thick brained, unlit, unresponsive, chill skinned, bloodless, and sparrow drab. I doubted, completely, my ability to do anything well. It seemed as though my mind had slowed down and burned out to the point of being totally useless.

A well-known myth that perfectly describes the manic depressive’s fall from grace is the myth of Icarus. Icarus, son of the Greek inventor Daedalus (who built the labyrinth), was given wings of wax by his father. Enamored of his new found ability to fly to great heights, Icarus ignored his father’s warning and in a moment of ecstasy flew too close to the sun. The heat of the sun melted the wax which held his wings together, and Icarus crashed into the sea.

The alternation of mania and depression illuminates a second aspect of manic depression-its cyclic nature. Periods of creativity, productivity and high energy alternate with times of fatigue and apparent indifference. Mania leads to depression, which leads to mania which becomes depression, etc. This extreme flip-flop of mood between peaks and valleys is extremely dangerous, as shown by the fact that 20 to 25 percent of untreated manic depressives (including many of the artists listed earlier) commit suicide.

In the period that follows giving birth to a child, many women experience some type of emotional disturbance or mental dysfunction. A large percentage of these “baby blues” are characterized by grief, tearfulness, irritability and clinging dependence. These feelings, which may last several days, have been ascribed to the woman’s rapid change in hormonal levels, the stress of childbirth, and her awareness of the increased responsibility that motherhood brings.

In some cases, however, the baby blues may take on a life of their own, lasting weeks, months and even years. When this occurs, the woman suffers from postpartum depression-a syndrome very much like a major depressive disorder. This depression may also be accompanied by anxiety and panic. In extreme cases, symptoms may include psychotic features and delusions, especially concerning the newborn infant. There may be suicidal ideation and obsessive thoughts of violence to the child.

A good introduction to this often undiagnosed disorder is contained in the book This Isn’t What I Expected by Karen Kleiman, M.S.W. and Valerie Raskin, M.D., mentioned earlier. You might also want to visit About Stretch Marks for more information about postpartum depression.

Many people do not realize that a number of common prescription drugs have side effects that can induce depression. Thirty years ago, my mother went into a long-term depression as a result of a reaction to the drug Resperine, a high blood pressure medication. Similarly, my own depression was accelerated by my reaction to large doses of antibiotics given for a leg infection.

It may be worthwhile to consult the Physician’s Desk Reference (PDR) or books such as Worst Pills, Best Pills (by Wolfe, Sasich, and Hope) to learn if depression is a potential side effect of a medication you are taking. In addition, taking recreational drugs or being exposed to toxic chemicals in the environment may also have an adverse effect on mood.

Usually, stopping the intake of the offending substance will eliminate the symptoms (as happened in my mother’s episode). If depressive symptoms caused by the substance linger, then psychological treatment may be necessary.