Depression: forms and course

by Abdullah Arif · June 16, 2024

The word depression comes from Latin and means “to press down” or “to pull down”. These diseases are manifested, among other things, by changes in mood (affectiveness), lack of interest, apathy and reduced performance. Depression can appear at any age and is one of the most common mental illnesses .

According to statistics, depression affects women more often than men. In Europe, depression is reported to be the third most common cause of disease burden on society. On a pan-European scale , depressive illnesses occupy the sad first place in the number of “lost years of life”, which statisticians evaluate in connection with the limitations caused by the disease (e.g. length of work incapacity). In addition, mental illness continues to be burdened with many prejudices, which are often perceived as very burdensome by the sufferers themselves.

What form and course are depressive disorders?

Depression is a disease that manifests itself, among other things, in despondency . Other symptoms may also appear, such as feelings of hopelessness or social withdrawal . There are different forms of depression, which differ from each other mainly in terms of the duration of the disease and the severity of its manifestations. Depression in the clinical sense is a serious illness: it cannot be confused with the condition that the lay public refers to as temporary sadness or disgust that each of us will encounter during our lives.

Depression can occur once or appear repeatedly (in so-called episodes). It can also occur depending on the season: a typical example is the so-called winter depression , which appears in the winter months. However, depression is not like depression: this disease can have varying degrees of severity and we distinguish between several categories. A particularly serious risk factor is the increased risk of suicide . Therefore, it is important to recognize warning signs in time and seek professional help.

Depression usually has a so-called episodic course, where the disease phase alternates with phases that are almost or completely symptom-free. If residual symptoms persist after the acute phase, we speak of so-called residual symptoms of a depressive disorder. These residual symptoms increase the risk of relapse (return of the disease). The various forms of depression differ from each other mainly in the severity of the symptoms of the disease and the duration of its duration.

Depressive episode

A depressive episode is mainly manifested by despondency, loss of interest, sadness and listlessness. Depressive episodes are divided into mild, moderate and severe. In moderate and severe depressive episodes, psychotic symptoms may also appear , which are usually associated with a temporary and extensive loss of contact with reality (delusions, hallucinations , etc.).

Recurrent depressive disorder

If two or more depressive episodes occur, we speak of recurrent depressive disorder (sometimes referred to as recurrent depressive disorder ). In this case too, we distinguish between mild, moderate and severe course (with or without psychotic symptoms).

Recurrent brief depressive disorder

The term recurrent brief depressive disorder refers to a depressive episode that lasts only a few days (typically 2-3 days), occurs at least once a month and occurs repeatedly, for a period of at least one year.

Seasonal Affective Disorder (Winter Depression)

This form of depression appears in late autumn or winter. It is mainly characterized by a lack of energy, an increased need for sleep, weight gain and a depressed mood after dark.

Persistent affective disorders ( persistent mood disorders )

This category includes cyclothymia and dysthymia . Dysthymia is a chronic depressive mood lasting at least two years, the symptoms of which are not as strong as those of the above-described forms of depression. The term cyclothymia is understood as mood instability lasting at least two years with mild manic and depressive phases. There may (or may not) be periods of “normal” mood in between.

If dysthymia develops into a “real” depressive episode or disorder, we speak of so-called “double depression” (the term double depression is used in English ). Dysthymia most often develops in young adulthood. If dysthymia occurs at an older age, it is usually after a depressive episode or after a significant psychological burden, e.g. after the death of a loved one.

Bipolar disorder

In this disorder, depressive and manic episodes alternate. Sufferers go through phases of high spirits (mania) and low spirits (depression). However, it can also happen that manic and depressive symptoms occur at the same time (e.g. the patient has a clearly increased psychomotor pace, but at the same time is pessimistic and lacks the will to live): this condition is referred to as a mixed episode . Delusions and/or hallucinations may also occur in bipolar disorder. For more information, see the article Bipolar Disorder: Symptoms and Diagnosis .

Atypical depression

In addition to the above-mentioned forms of depression, there is also the so-called atypical depression . It is characterized by the fact that a person’s depressed mood persists, but happy events can lift it up temporarily. Atypical depression is often characterized by weight gain, an increased need for sleep and increased sensitivity (e.g. a person gets sick easily).

A depressive episode that persists for more than two years without improvement is referred to as chronic depression .

Depression can also be divided according to the mechanism of their occurrence. Primary depression occurs “on its own”, while secondary depression develops as a result of some other physical or mental illness. An example of such a physical disease can be epilepsy , an example of a mental problem, e.g. burnout syndrome .

What role does psychological stress and experienced trauma play?

Acute mental stress or mental trauma often have a significant impact on a person’s psyche. As a result, one of the following mental disorders or diseases can occur , in which depressive episodes play a significant role: