Depression is classified into different subclasses based on the symptomatic and chronological characteristics and age of onset. Among these subtypes, the classic clinical depressive disorder will not be described (for further details see this link).
Masked depression : manifested through somatic symptoms such as gastrointestinal disorders (abdominal cramps, diarrhea), cardiac (palpitations) or respiratory (wheezing). Some of the non-affective aspects of depression are then amplified.
Anxious depression : includes symptoms that more often recall anxiety disorder, such as panic attacks or agitation. In the hypochondriac variant the subject is tormented by the fear of having a disease; in the most serious cases the subject has the certainty of having a disease, with a removable delirium and a high risk of suicide.
Atypical depression : the clinical manifestations of this form of depression have to do with panic attacks, continuous hypersomnia and sleepiness during the day, hyperphagia and weight gain, evening worsening of symptoms, irritability and high sensitivity to the judgment of others and high sensitivity to loss or detachment from a family member.
Histeroid dysphoria : this subclass of depression also belongs to the so-called atypical form and affects mainly the female sex. In particular, it manifests itself in those women who have character traits in which an intense preoccupation prevails for the judgment of others, a marked sensitivity to frustrations, the tendency to dramatize an experience of rejection (especially in the sentimental field) and difficulties in tolerating interpersonal conflicts. These subjects have an excessive emotional response to environmental stimuli. In the case of events that are not particularly negative, they present reactions such as mood depression, suicidal ideation, severe asthenia, alcohol abuse, tendency to stay in bed in a state of numbness. On the contrary, in case of particularly positive events, they show a reaction of joy, contentment and even euphoria, they feel particularly energetic, active and dynamic and sometimes they can manifest impulsiveness. Individuals suffering from this type of depression show an alteration at the level of the pleasure system, in fact they are not able to actively search for it. But if they are dragged by other people, they can enjoy pleasant situations.
Agitated depression : the clinical picture of this subtype of depression is characterized by a marked psychomotor agitation, with irritability, agitation, inability to relax, motor restlessness but also suicide attempts. The patient is tense, restless, speaks excitedly, writhes, moves his limbs and trunk continuously, sometimes he is unable to remain seated, often there are vegetative symptoms such as insomnia and hyporexia. Not rarely the mood presents dysphoric tints (= moodiness, anger, irritability). Agitated depression is sometimes the consequence of a sudden suspension of benzodiazepine treatment.
Depression with psychotic manifestations (depressive episode with psychotic symptoms) : represents about 10% of all types of depression. Typical features are the presence of delusions and hallucinations in association with classic depressive symptoms. Generally this severe form of depression requires hospitalization of the patient and carries a higher risk of suicide. Due to the presence of delusions and hallucinations, very often these forms are misdiagnosed as schizophrenia ..
Amatory depression : occurs when depression is also accompanied by organic disorders that affect, for example, the brain, the heart or have to do with infections. This combination can lead to a slowing down of the psychomotor activity to the point of causing its arrest. The individual with an amational depression remains in bed in a state of immobility, does not eat, presents mental confusion, hallucinations, changes in the sleep-wake rhythm. It is important to remember that in the absence of adequate medical support and therapy, the persistence of this form of depression leads to serious somatic problems that can develop into death.
Cotard syndrome : is a rare form of depression that generally occurs in elderly individuals with organic brain problems and with previous manic-depressive attacks. Initially it is characterized by anxiety and affective depersonalization. Also appear nihilistic delusions, that is the sick person is convinced that he no longer possesses some internal organs (such as heart and liver). Sometimes he can even deny his own existence but also that of his family or that of the world. In addition, these subjects have ideas of physical enormity and immortality.
Endogenous depression (depressive episode with melancholia): not attributable to conscious or semi-conscious triggering events or to other environmental factors; rather, it is triggered by genetic-biological or unconscious causes present in the patient's personality. Familiarity with mood disorders is common: there is probably no inheritance of the disease but of a certain vulnerability or depressive character. It is characterized by: loss of the ability to feel pleasure, active mood, slowing down or psycho-motor agitation, sleep alterations, there may be a loss of weight with loss of appetite (this may lead to states of starvation) or the weight may increase . The patient is fully functional on a socio-working level. Often he is a very precise person, scrupulous, methodical, very tied to duty. Usually all this symptomatology is worse in the early hours of the day and improves in the evening.
Reactive depression : occurs following painful events, such as mourning, separation or failure. From the point of view of symptoms, there is a prevalence of emotional weakness, insomnia and lasting sadness; the reaction is disproportionate and excessive compared to the real extent of the sad event. Pure reactive depression does not exist and the traumatic event can only trigger it in the presence of an endogenous vulnerability.
Secondary depression : it is a type of depression that manifests itself following organic diseases or after some pharmacological treatments (eg corticosteroids, oral contraceptives, androgens, etc.). For example, the diseases that most favor the onset of secondary depression are multiple sclerosis, Parkinson's disease, Alzheimer's disease, epilepsy and brain trauma. Furthermore, diseases affecting the endocrine system, such as hypothyroidism, Addison's disease, Cushing's disease, some infectious diseases, such as HIV or syphilis, and many neoplasms have also been shown to be factors favoring the arising from this type of depression.
Childhood depression : affects children under the age of ten. In addition to the classic symptoms of depression, these children show a tendency to isolation or crying for no reason, they have low self-esteem, thoughts of death and loss of interest. Along with these disorders, somatic symptoms may also arise characterized by vomiting, abdominal pain, dizziness, anxiety and fear. Sometimes the child suffering from childhood depression can also hear voices, known as auditory hallucinations.
Adolescent depression : in the adolescent age the depression disorder occurs due to the easy humoral irritability. It is well known that the adolescent always has the feeling of not being understood, or of not being heard. Generally you can go through periods when there is a decline in academic performance and you can also interrupt social activities. It often happens that in these periods the adolescent uses narcotic substances alone or in association with large quantities of alcohol, making the pathological picture more serious.
Senile depression : it affects elderly people between 60 and 70 years and is accompanied by anxiety, agitation, irritability, hypochondria and frequent auditory hallucinations. At this age, the disorder lasts longer and tends to become chronic. The clinical picture becomes more complicated because, in addition to senile depression, there are concomitant factors that can occur, such as memory and learning disorders, a physiological motor slowing down, mental confusion and space-time disorientation.
Postpartum depression : it is the form of depression to which women are most exposed during the period following the birth. In post-natal depression (for more information, see this link), the most obvious episodes generally occur after one month of the child's birth. The woman experiences emotional lability, disorientation, agitation and delusions for not being able to look after her child. Sometimes it comes to much more serious episodes (postpartum psychosis) in which infanticide phenomena occur.
Bipolar disorder or manic-depressive syndrome : this form of depression is characterized by rapid and exaggerated mood swings, which may include irritability, sadness or euphoria, accompanied by insomnia, a state of agitation or psychoses with a tendency to suicide. The onset is usually a result of particular physical conditions due for example to illness, childbirth, the use of substances or drugs. It is a situation that tends to last, if it is not treated, and can become chronic (for more details, see this link).
In addition to these forms of depression, there are others that, although included among mood disorders, do not constitute real depressive phenomena. However, they are accompanied by depression because there is the appearance of a lowering of the mood accompanied by sadness or melancholy. These disorders include Dysthymia, Cyclothymia and the seasonal emotional disorder which will be briefly explained below.
Seasonal emotional disorder : it is a type of mood disorder that varies with the course of the seasons. Generally it appears between 30 and 40 years old, it mainly affects women and represents about 4-6% of mood disorders. The syndrome is characterized by a seasonal recurrence of depressive phenomena in autumn and winter, alternating with manic or hypomanic disturbances that occur in spring and summer. As for the symptoms, they are mostly represented by depressed mood, fatigue, difficulties in the workplace and in social relationships, lethargy, hyperphagia and reduced libido. On the contrary, the arrival of the spring season causes in some individuals a change in the symptoms opposite to those manifested during the winter season. For example, these individuals experience an increase in energy, less need for sleep and a reduction in appetite.
The correlation that exists between the seasonal emotional disorder and the trend of the seasons has been demonstrated. In fact, if an individual in a depressive phase is transferred to an area close to the equator, the episode is quickly resolved, even if the opposite symptoms can occur, ie those related to the summer phase. It has therefore been hypothesized that the symptoms of depression regress following the daily exposure of the sick subject to an artificial light source that has the same characteristics as the solar one. Furthermore, this type of treatment is effective if the individual keeps his eyes turned towards the light source.
