Sub-types of depression - Black Dog Institute

SUB-TYPES Of DEPRESSIONFact SheetWhat this fact sheet covers:• Sub-types of depression• Key points to remember• Where to get more informationThe reasons for developing depression are varied and complex. More often than not, severalevents rather than a single significant event or cause may trigger a depressive episode.Many of these events can interact with one another, making it even more difficult todetermine an obvious cause. Recent research has overthrown the notion that depression isone illness simply divided by levels of severity and that one treatment type is effective for allpeople. The Institute’s model of depression sub-types asserts that several factors, includingtemperament and personality styles, may contribute either to ‘vulnerability’ or alternatively,to ‘resilience’ to depression. People with depression experience:• a depressed mood for two weeks or more• social impairment (for example, difficulty in dealing with work or close relationships)Sub-types of depressionAt the Institute we believe that there are three broadly different sub-types of depression,each with their own features and causes:• Psychotic depression• Melancholic depression• Non-melancholic depressionEach sub-type also responds to different treatments (see our Fact Sheet Treatments forDepression). Depression can be further divided into ‘unipolar’ and ‘bipolar’ depression.• Unipolar depression is the name given when only depressive episodes are everexperienced• Bipolar depression refers to the depressive episodes that occur in the context of bipolardisorder (see our Fact Sheets on bipolar disorder); in the case of bipolar disorder,depression is usually melancholic or psychotic in nature1. Psychotic depressionPsychotic depression is caused by biological factors and is relatively rare, affecting 1-2per cent of diagnosed cases in Western populations. The defining features of psychoticdepression are:• Severely depressed mood• More severe psychomotor disturbance than is the case with melancholic depression.• Psychotic symptoms (delusions and/or hallucinations, with delusions being morecommon) and strong feelings of guiltPsychotic depression has a very low spontaneous remission rate. It responds only tophysical treatments (such as antipsychotics and antidepressant drugs) as a first step.This document may be freely downloaded and distributed on condition no change is made to the content.The information in this document is not intended as a substitute for professional medical advice, diagnosisor treatment. Not to be used for commercial purposes and not to be hosted electronically outside of theBlack Dog Institute website. Updated October 2012.1

SUB-TYPES Of DEPRESSIONFact Sheet2. Melancholic depressionMelancholic depression is also a biological depression. Its defining features are:• A more severe depressed mood than is the case with non-melancholic depression• Psychomotor disturbance such as slowed or agitated physical movements and slowedcognitive processing abilitiesMelancholic depression is a relatively uncommon type of depression. It affects only2-10 per cent of diagnosed cases in Western populations. The percentage of affected menand women is roughly the same.Melancholic depression has a low rate of spontaneous remission, meaning it very rarelygoes away of its own accord. It responds best to physical treatments (e.g. antidepressantdrugs) and only minimally (at best) to non-physical treatments such as counselling orpsychotherapy as a first step. However, psychological interventions can be helpful oncethe symptoms have subsided and during the recovery period.3. Non-melancholic depressionNon-melancholic depressions have to do with psychological causes, personalitycharacteristics and are often linked to stressful events in a person’s life. Non-melancholicdepression is the most common of the three types of depression but it can be hardto accurately diagnose because it lacks the defining characteristics of the other twodepressive types (namely psychomotor disturbance or psychotic features). In contrast tothe other types of depression, non-melancholic depression has a high rate of spontaneousremission which means that the depression resolves over time by itself. This is becausenon-melancholic depression is often linked to stressful life events which, when resolved,tend to result in the depression also lifting. Non-melancholic depression responds well toa range of treatment options including psychological interventions, antidepressants andcounselling.Key points to remember• There are three different sub-types of depression, each with their own features andcauses• Knowing what sub-type of depression a person has is important in being able to selectthe best treatment options• Psychotic and melancholic depression are a more biological sub-type of depression,resulting in more severely depressed mood and psychomotor disturbance• Non-melancholic depression is the most common form of depression and is oftenlinked to stressful life events, personality and coping styles.www.blackdoginstitute.org.auThis document may be freely downloaded and distributed on condition no change is made to the content.The information in this document is not intended as a substitute for professional medical advice, diagnosisor treatment. Not to be used for commercial purposes and not to be hosted electronically outside of theBlack Dog Institute website. Updated October 2012.2