Depressive Disorders

Depressive disorders should not be confused with “the blues” nor are they sad moods that one can easily dismiss or “get over”.  The hallmark of a depressive disorder is the persistent feeling of sadness, worthlessness, with a loss of interest in things that used to bring you pleasure.  A depressive disorder is a mental illness that effects the individual physically, emotionally, and cognitively.  Left untreated, the symptoms can last for long periods and cause varying degrees of impairment in daily functioning.  The good news is that research shows that most people with depressive disorders respond well to medication, therapy, or both.

Signs & Symptoms

  • Persistent depressed mood as evidenced by feelings of sadness, hopelessness, or purposelessness;
  • Misplaced guilt or excessive worthlessness nearly every day;
  • Loss of pleasure or interest in activities or hobbies that used to be enjoyable;
  • Disproportionate reactions to minor concerns with irritability, frustration, or angry outbursts;
  • Feelings of fatigue or low energy almost every day;
  • Significant changes in weight;
  • Notable changes in appetite;
  • Psychomotor retardation (i.e. moving or talking slowly) as observed by others, or;
  • Psychomotor agitation (i.e. feeling restless or difficulty sitting still);
  • Diminished ability to think, focus, recall, or make decisions;
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Thoughts of death or suicide, or suicide attempts
  • Somatic complaints (i.e. aches or pains, headaches, cramps, or digestive problems) without obvious origins and/or do not respond to treatment.

Major Depressive Disorder

Major depression is when five or more of these symptoms are present for at least 2 consecutive weeks.  Either depressed mood or loss of pleasure must be included in the symptoms and they must cause notable impairment in functioning.  In other words, the symptoms interfere with your ability to work, sleep, eat, and enjoy once pleasurable activities.  Episode of depression cannot be caused by other medical conditions or substance use. 

Persistent Depressive Disorder (Dysthymia)

Otherwise known as dysthymia, persistent depressive disorder symptoms and intensity tend to ebb and flow over time.  The symptoms must present for a period of two years for this diagnosis and they do not usually disappear for more than 2 consecutive months.  Individuals with persistent depressive disorders may experience both episodes of major depression along with less severe bouts of depressive symptoms.

Peripartum Depression 

Peripartum depression is a major depressive episode that is experienced around the time of childbirth. Typically, the timeframe is a few weeks before or following delivery (postpartum depression).  It is more severe than the somewhat mild depressive and anxiety symptoms that women tend to experience within a few weeks of delivery.  This type of extreme dysphoria, anxiety, and exhaustion experienced concurrently with peripartum depression interferes with the new mother’s ability to care for their babies and/or themselves.

Psychotic Depression 

The distinct feature psychotic depression (major depressive disorder with psychotic features) is the presence of symptoms of psychosis in addition to acute depressive symptoms.  Psychosis may be in the form of delusions and/or hallucinations.  Delusions are unwavering, false beliefs that the individual clutches despite proof of the contrary.  Hallucinations are perceptions of hearing sounds or seeing objects in the absence of the actual sounds or objects.  In the instance of psychotic depression, the psychotic features may be consistent with depression (e.g. guilt, inadequacy, and worthlessness) or the they can indicate that hallucinations and/or delusions conflict with the depressed mood (e.g. laughing when sad). 

Seasonal Affective Disorder 

Seasonal affective disorder is type of depression that is influenced by the change in seasons.  Normally, it has an onset at the same time every year and coincides with a specific season (winter or summer months).  Typically, these depressive episodes correspond with winter months, but some people experience it in reverse and the depressive symptoms are activated during the summer months.  Individuals experiencing “winter depression” have symptoms that include low energy, hypersomnia, overeating, weight gain, social withdrawal, and cravings for carbohydrates.  Symptoms more specific to summer depression include loss of appetite, sleep disturbance, weight loss, and anxiety.


Psychotherapy and medication are the typical treatment modalities.  Psychotherapy provides the platform to talk about your condition and any related issues.  Psychotherapy can help you adjust to a crisis or current struggle.  CBT (cognitive behavioral therapy) will help you identify and replace negative beliefs and behaviors.  Your psychotherapist can help you: 

  • Examine interpersonal relations and repair relationships through improved interactions.
  • Identify precipitants to depression and teach adaptive coping skills to change responses and perceptions to those triggers that make depression worse.
  • Recognize areas you have control over and regain sense of personal power over depression rather than being driven by it.
  • Utilizes DBT strategies of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to assist you in managing your behaviors, emotions and thoughts.
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