There are many types of depression including:
- Major depression
- Seasonal affective disorder
- Post-partum depression
- Bipolar disorder
- Adjustment disorder
- Depression with psychosis
For the purposes of this website, we will look at the following as they relate to older adults.
Major Depressive Disorder – no psychosis
This is a significant form of depression. Major Depressive Disorder involves a depressed mood or lack of interest, lack of enjoyment in life. In addition, many of the other symptoms of depression including lack of energy, changes in appetite, sleep disruption, negative thoughts about oneself or the world, and thoughts of death that have gone on for several months. The ability to function properly or socially is significantly impacted and the person is withdrawn and feels very distressed.
Subsyndromal or Sub-Threshold – Minor Depression
This form of depression is characterized as having some symptoms of depression (the same qualities as in major depression) for more than two weeks, but not meeting the threshold to make the diagnosis of a Major Depressive Episode. People with this form of depression are at risk for developing Major Depressive Disorder.
Dysthymic Disorder or Persistent Depressive Disorder – Long-Term Depression
This form of depression is low-grade and less intense than major depressive disorder. Depressed mood is present most of the day or for more days than not. It impacts the person’s ability to function as they would like to and it affects the people around them, but the impact is to a lesser degree compared to more severe forms of depression.
Dysthymic disorder persists for a long period of time – at least two years – with many symptoms and no relief during the two-year period. Typically, the person is able to function, but they don’t feel well. They don’t feel happy or enjoy life and they will have other symptoms affecting sleep, appetite and thoughts.
Major Depressive Disorder with Psychosis
This is the most severe form of depression. It is major depressive disorder with psychotic features. In this form, the person has the symptoms of depression. They are distressed and cannot function properly, but they have added symptoms of psychosis.
What is psychosis?
Psychosis, in general, is defined as a break in reality. An example would be ‘delusion’ when a client believes things that are not true despite being shown facts that argue against their belief. A common delusion for geriatric depression is ‘poverty’ – that they have nothing left, they believe they’re poor or broke when the truth is they have enough means to sustain themselves. Another type of delusion includes paranoid or persecutory delusion where clients firmly believe they are being followed or bugged, their phone is wire-tapped or they’re being videotaped. Some individuals may experience somatic delusion: they feel physically sick and believe that there is something wrong medically, when there is no evidence of medical illness.
Another form of psychosis is hallucination: A client hears voices or talking when there is no one there. The voices may say very derogatory things – or tell the client what to do.
Major depression with psychosis is extremely distressing and is a very difficult and different form of depression. It is a very severe form of depression that requires different kinds of intervention. Anti-depressants alone will not be enough -an anti-psychotic medication will be required as well. Electroconvulsive therapy is a ‘first line’ treatment for this type of depression and can help.