The Black Dog Institute’s Clinical Model recognises four broadly different types of depression each with their own features and causes.
Recently I broke up with my partner and became really down. I just didn’t know how to cope. Feelings of hopelessness and despair stopped me from socialising for a while and I had trouble functioning at work. I got help and have learned new ways to manage these feelings.
Non-melancholic depression literally means that the depression is not primarily biological. Instead, it has to do with psychological causes, and is very often linked to stressful events in a person’s life, alone, or in conjunction with the individual’s personality style.
Non-melancholic depression is the most common of the four types of depression. It affects one in four women and one in six men in the Western world over their lifetime.
People with non-melancholic depression experience -
- a depressed mood for more than two weeks.
- social impairment (for example, difficulty in dealing with work or relationships).
In contrast to the other types of depression, non-melancholic depression has a high rate of spontaneous remission. This is because it is often linked to stressful events in a person’s life, which, when resolved, tend to see the depression also lifting.
Non-melancholic depression responds well to different sorts of treatments (such as psychotherapies, antidepressants and counselling), but the treatment selected should respect the cause (e.g. stress, personality style).
Looking back on things now, I never thought that I would get my life back. With the right treatment, I did.
Melancholic depression is the classic form of biological depression. Its defining features are -
- a more severe depression than is the case with non-melancholic depression.
- psychomotor disturbance: cognitive processing difficulties, with slowed thoughts and impaired capacity to work or study and an observable motor disorder (slowing and/or agitation of physical movements).
What it feels like
My speech, emulating my way of walking, had slowed to the vocal equivalent of a shuffle … I’d feel the horror, like some poisonous fogbank, roll in upon my mind, forcing me into bed. There I would lie for as long as 6 hours, stuporous and virtually paralysed – William Styron (American Novelist).
He is markedly lacking in spontaneity, sitting quietly, responding to questions but initiating little conversation. There is a noticeable lack of facial expression and little extraneous movement – A description of Spike Milligan (Irish Comedian).
Melancholic depression is a relatively uncommon type of depression. It affects only 1-2 % of Western populations. The numbers affected are roughly the same for men and women. Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example medications) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy.
This is a place where no one wants to be. It was terrifying. I am very fortunate that there are treatments that can stabilise this condition.
Psychotic depression is a less common type of depression than either melancholic or non-melancholic depression.
The defining features of psychotic depression are -
- an even more severely depressed mood than is the case with either melancholic or non-melancholic depression.
- more severe psychomotor disturbance than is the case with melancholic depression.
- psychotic symptoms (either delusions or hallucinations, with delusions being more common) and over-valued guilt ruminations.
The tiniest sounds can make you start. Music is deafening… Taste is repugnant. Mildly offensive smells work your gut into a frenzy. Everything appears to have hideously sharp edges… you can smell colour, savour sound, feel invincible objects – Helen Razer (Australian radio presenter and writer)
Psychotic depression has a very low spontaneous remission rate. It responds only to physical treatments.
A Typical Depression
My appetite has increased and I feel like sleeping all the time. Its true also that I have a tendency to worry about being rejected.
There is possibly a fourth type of depression known as Atypical Depression. Atypical depression is a name that has been given to expressions of depression that contrast with the usual characteristics of non-melancholic depression.
For example, rather than experiencing appetite loss the person instead experiences appetite increase; and sleepiness rather than insomnia. Someone with atypical depression is also likely to have a personality style of interpersonal hypersensitivity (that is, expecting that others will not like or approve of them).
The features of atypical depression include -
- The individual can be cheered up by pleasant events.
- Significant weight gain or increase in appetite (especially to comfort foods).
- Excessive sleeping (hypersomnia).
- Arms and legs feeling heavy and leaden.
- A long-standing sensitivity to interpersonal rejection – the individual is quick to feel that others are rejecting of them.