Digging Deeper into Depression
Once you have a solid grasp of these primary depressive disorders, you can begin digging deeper to understand the role of specifiers.
When someone obtains a diagnosis from an expert mental health professional, they rarely receive something as general as MDD. Because depression is so intricate and multifaceted, they are various ways to provide additional information about the person’s specific situation.
As mentioned, some terms are used to measure the intensity of symptoms like:
- Mild
- Moderate
- Severe
- Severe with psychotic features
Other terms – single episode or recurrent – are used to describe if this is a new or returning period of depression.
Depression specifiers represent a way to build a more detailed image of the condition and how it is affecting a person’s life and ability to function. Since one person’s depression can appear much differently from the depression of another, specifiers are helpful ways to guide treatment and achieve lasting recovery.
Depressive disorders have many possible specifiers that can be added to the diagnosis. Depressive disorder specifiers include:
Peripartum Onset
Though postpartum depression is a term used in popular culture, the official diagnosis is a depressive disorder with peripartum onset. The distinction between postpartum and peripartum is made because about half of pregnancy/ delivery depression actually begins before the child is born.
As many as six percent of women will develop the symptoms of a major depressive disorder during or soon after pregnancy. Women who have a period of peripartum depression after one birth are much more likely to experience symptoms with subsequent pregnancies.
Depression with peripartum onset can present a very serious risk to the mother as well as the child. Not only will the mother report depression, but anxiety, panic, delusional thinking, and hallucinations are common with this condition, which may result in the mother harming herself or someone else, including the child.
In women, depression with peripartum onset is due to a number of environmental and physiological factors. There is some evidence to support that male postpartum/ peripartum depression occurs regularly despite a lack of noticeable physiological changes connected to birth.
During pregnancy and in the days and weeks that follow, men will experience a change in structure, diet, activity level, sleep, and social interaction. Men also experience a decline of testosterone throughout the pregnancy.
At this point, paternal postpartum depression is not an officially recognized condition, but it may be in the future. As the understanding of peripartum depression expands, better diagnosis and treatments will emerge.
Seasonal Pattern and Depression
Just like depression with peripartum onset – postpartum depression, depression with seasonal pattern is not always comprehended fully in the mainstream. Sometimes called seasonal affective disorder (SAD), depression with seasonal pattern is a specific form of depression that is influenced by daylight, weather, and time of year.
Depression with seasonal pattern is a recurrent form of depression that usually worsens during the fall and winter and improves during the spring and summer. In some situations, rather than achieving a period of stability during the warmer months, a manic or hypomanic episode associated with bipolar disorder will occur.
Depression with seasonal pattern is only the actual diagnosis if there are no better explanations for the mood and activity level changes. For example, if the person has seasonal employment and has less work and less money during the winter months, the mood changes are expected and not linked to depression.
Seasonal pattern depression must present consistently for a two-year period to be accurately diagnosed. The condition is more common in younger people and people who live at farther from the equator.
Atypical Features With Depression
Depression with atypical features is a good example of depression creating a unique set of symptoms in certain people. Someone with this form of depression will experience:
- Mood reactivity where their outlook drastically improves briefly with life events.
- Increase in appetite and significant weight gain.
- Sleeping for extended amounts of time.
- Feeling heaviness, especially in the arms and legs.
- A pattern of being oversensitive to rejection in work or personal relationships.
The chief difference in depression with atypical features is that the individual can reports periods of happiness during the depressive episode when they receive a compliment or a visit from a loved one. The mood will quickly deteriorate when the positive influence leaves.
Anxious Distress and Depression
Many times, someone will receive a diagnosis of an anxiety disorder in addition to their depressive diagnosis. This system might not always be appropriate.
Does the depression exist on its own? Does the anxiety exist on its own, or does one only present with the other?
If your anxiety is inseparable from your depression, chances are good that you don’t have two separate disorders. You only have depression with anxious distress.
Depression with anxious distress will trigger symptoms like:
- Feeling on edge
- Feeling restless
- Trouble concentrating
- Extreme fear of negative events
- Feeling like you may lose control of your thoughts or behaviors
Depression with anxious distress is an important distinction to make since this condition is known to complicate helpful treatment. It is also linked to a longer duration of symptoms and an increased risk of suicide.
Other Depression Specifiers
Though less common than some other others, these depression specifiers can dramatically influence symptoms and treatment.
- With Mixed Features. Depression with mixed features or a mixed episode will have symptoms of mania/ hypomanic mixed in with symptoms of depression. So, someone may have a low mood but lots of energy or a great mood but no energy or motivation.
- With Melancholic Features. Most common during a period of severe depression, someone with melancholic features will feel empty without the capacity to identify or experience pleasure. They will eat little, wake early, and feel worse in the morning hours.
- With Catatonia. If someone has depression with catatonia, they will spend long periods being still and silent with few, if any, thoughts and feelings. Others with catatonia will engage in odd behaviors or periods of agitation.
Though it is possible to have several specifiers, a mental health professional will likely only diagnosis the most prevalent concern as a specifier.
Conclusion
By being an informed patient, you are more likely and better able to advocate for yourself. Review the information above and present your findings to your mental health professional.
Keep an open mind, though. There is a great deal of overlap with depressive disorders and you may be misperceiving one of your symptoms.
Understanding your depression symptoms helps you understand yourself. That is always a good thing.
