There is more than one type of depression, according to the diagnostic manual that therapists and psychologists in Brooklyn use to diagnose depression. As we review your symptoms and try to gain a better understanding of your struggles, we’re often looking at both subtle and clearer differences between these disorders in order to determine how to effectively treat them.
Major depressive disorder (MDD) is a more urgent, more powerful form of depression with symptoms considered to be severe. Persistent depressive disorder (PDD) is a “milder” but no less problematic form of depression. It was previously referred to as “Chronic Depression” or “Dysthymia.” These conditions have many similarities, and it is possible to cycle in between the conditions – showing symptoms of major depression at times, and persistent depression at others – but they are distinctive conditions.
Diagnostic Differences
Before we get into the symptomatic differences between the two conditions, let’s talk about the diagnostic ones. Persistent depressive disorder can only be diagnosed if the patient has struggled with it for over one to two years depending on the patient’s age. It is the term for a low level of chronic depression that is essentially constant throughout the day and night.
Though the symptoms are considered less severe compared to MDD, their long term presence puts patients at higher risk for self-harm the longer they struggle with it. Major depression, on the other hand, can be diagnosed in as little as two weeks and “episodes” are often severe in nature, which makes treating it more urgent.
Symptomatic Differences Between MDD and PDD
It’s easy to say “less severe than major depression” or “low level of depression.” But because depression is always a struggle, it important to identify what “less severe depression” means.
Both PDD and MDD will have feelings of helplessness, negative self-talk, loss of interest in pleasurable activities, and depressed mood. But what makes them different is the following:
Function – Patients with PDD are typically able to function in some form with most of their daily tasks. They may not be able to give activities their full energy, or enjoy those activities, or focus as easily as those without depression. But they can typically go to work, address some of their family’s needs, and take care of a pet. Their ability to function may be compromised, but they are capable of it. Patients with Major Depressive Disorder often find depression so debilitating, it dramatically interferes with their ability to function.
Intensity – Patients with persistent depression will describe a low mood and feeling “down.” They may show changes in appetite, sleep, energy, and concentration, but they are more capable of pushing through it with a bit of effort. Patients with major depressive disorder typically are *extremely* sad or down to the point of being overwhelmed by it. Engaging in daily tasks feels nearly impossible, and in some cases may not be possible. They feel impaired by their condition with more persistent thoughts of self-harm.
While someone with PDD may feel “low” and unhappy or passionless and tired throughout the day, a patient with MDD could, depending on the severity of their symptoms, be unable to even leave their bed. Despite MDD being more severe, however, it should be noted that chronic depression can both cycle into MDD at times, and also lead to significant life alterations that cause people to consider self-harm in the future, especially as they no longer experience joy for such a long period of time.
Patients with PDD also may experience what is sometimes called “Double Depression.” These are more severe forms of depression that resemble MDD that come at different times or after different triggers. These periods of “Double Depression” can increase the risk of self-harm considerably. But they may not qualify as MDD because they may not last the requisite two weeks or display all of the same symptoms.
How Does Recognizing These Two Different Conditions Affect Treatment
Therapy for depression – both MDD and PDD – can be very similar. Both benefit from many of the same therapeutic techniques, such as CBT. Both benefit from treatment from an experienced therapist. Both respond well to professional intervention. Many of the same techniques are used as well, such as cognitive restructuring and behavioral activation.
However, there are differences as well. First, duration and frequency of therapy may change. MDD may require more immediate and frequent meetings to help address the episode in the moment and reduce the risk of worsening symptoms. PDD may benefit from ongoing treatment that helps continue to address its symptoms over time.
In addition, In MDD, CBT often focuses on identifying and challenging negative automatic thoughts and cognitive distortions that contribute to the development and maintenance of depressive symptoms. The emphasis is on modifying maladaptive thinking patterns during acute episodes and targeting specific negative thoughts related to the current episode. In PDD, cognitive restructuring may also be utilized, but the focus is broader and may involve addressing deeply ingrained negative beliefs and schemas that contribute to the chronic nature of depressive symptoms.
Similarly, in MDD, CBT may include specific techniques to recognize early warning signs of relapse and develop coping strategies to prevent future depressive episodes. In PDD, since the condition is chronic, relapse prevention may involve ongoing monitoring and management of symptoms to minimize their impact and prevent exacerbations.
While the therapy techniques are similar, the way that they are approached is different.
An important part of treating our mental health is understanding how our behaviors and experiences contribute to worse mental health symptoms.
For example, if you have a fear of spiders, and you purposefully avoid situations that might cause you to see spiders, your fear of spiders gets worse. This is the psychology of avoidance, which we mentioned in a past article. Or, if you have panic attacks, the way you breathe when you have panic disorder can actually trigger future panic attacks.
Our brains are complicated structures that work in equally complicated, often cyclical ways.
We also see this with depression, and one of the most common ways that this manifests is with the relationship between depression and sleep. Depression can cause sleeping issues and, to make matters worse, sleeping issues can cause depression. Understanding this relationship can help you make better decisions in order to help address your depression and also understand why you may feel the way you feel.
How Depression Causes Sleep Issues and Disturbances
Depression itself causes issues with sleep, both quality and frequency. Depression can cause both insomnia (inability to sleep) and hypersomnia (excessive sleep). Some of the scientific findings that relate to depression’s affect on sleep include:
Depression reduces REM sleep and affects how the body goes in and out of sleep stages.
Depression dysregulates melatonin, which his the hormone that regulates sleep/wake cycles.
Depression increases the likelihood of waking up in short bursts during sleep.
Depression reduces deep sleep time.
Depressed people tend to take longer to fall asleep at night.
These are all findings that implicate depression as a cause for possible sleep related problems.
How Sleep Issues Can Contribute to Depression
So, we know that depression can cause sleep issues. But where challenges arise is that science has shown that sleep issues can cause depression. Examples of these findings include:
Sleep deprivation studies have shown that even one night of poor sleep can cause depression-related symptoms, or exacerbate symptoms in those that already have depression.
Sleep disturbances cause abnormalities in regions of the brain that are linked to mood regulation and negative bias, increasing the frequency of negative thinking.
Sleep quality issues can alter the portions of the brain that are responsible for good decision making and stress coping.
Numerous studies have linked poor sleep, chronic insomnia, and a host of sleep issues with the development and maintenance of depression, although exactly how they are linked is not always clear. Nevertheless, it is clear that sleep issues can both cause depression and increase depression related symptoms.
Breaking the Poor Sleep/Depression Cycle
Sleep is not the only cause of depression, nor is depression the only cause of poor sleep. But the cyclical nature of the two – where poor sleep leads to depression and depression leads to poor sleep – is still very important for those with depression to recognize and understand, as they can help explain symptoms and experiences, and also help improve decision making about when to rest.
This is one of many examples of the ways that our mental health is more complicated than many of us believe. It is also why, by treating depression, we can improve our sleep quality which may also improve or depression. If you feel like you’ve been down or sad, reach out to a therapist and start receiving the support you need to improve your mental health.
Human beings are social animals. Research quite literally shows that we need interaction with other human beings in order to survive. Our life, our health, and our happiness are all directly connected to our ability to communicate and socialize with others.
Still, many of us also struggle with social anxieties. While not everyone may have social anxiety that qualifies as a mental health diagnosis, we can still have fears, anxiousness, and shyness in social situations.
Motivation for Feeling Social Anxiety and Fear
Social phobia can have many different causes and symptoms, and has been linked to issues like trauma, bullying, and other past experiences. One of the most common symptoms of social anxiety is a fear of being judged, and a fear of making a mistake in a way that hurts their social standing.
In psychotherapy treatments for social anxiety, like CBT, one way that we try to help address social phobia is to reframe the way you see and approach different situations. The fear of being judged is a perfect example of this. We often feel like, when we stumble within a conversation, that the person on the other end is making fun of us or thinking about how much we made a mistake.
But, when you leave a conversation, how much time do you spend thinking about all the mistakes *someone else* made? How much time do you spend thinking about and judging other people for their fumbles?
Most likely, you don’t think about other people’s mistakes at all.
The truth is that most people do not spend time thinking about you. Most people do not spend much time thinking about anyone but themselves. We all live very busy lives with our own stresses and distractions. We have our own family to worry about. We have dozens of conversations throughout the day. Most people simply do not have the time and energy to spend thinking about every little mistake you made.
And that’s a good thing.
Part of our social anxieties come from feeling like other people care about us enough to talk about us and think about us all throughout the day. But other people are not thinking about us at all. Even in situations where we do truly and objectively do or say something embarrassing, most people have too much going on in their lives and their own needs/desires to focus on anyone but themselves.
Other People Care About You – But Not That Way
Other people do care about you. They care that you’re happy. They care that you have your needs met. They care if you tell them that you got a new job and they care if you tell them you lost a family member.
But very few people have the time or energy to care about small conversational mistakes or inappropriate verbal responses. They don’t care about your facial tics or your bad jokes. There’s very little that any person can do that can cause someone else to focus and think about them all throughout the day.
So the next time that you find yourself worried about being judged, remember how little energy other people have to spend thinking about your mistakes. We all have our own stresses to worry about.
Major depression and bipolar disorder – two of the most common types of depression – can often be lifelong and ongoing without help. While both are treatable, both typically result in thoughts and behaviors that feed into a cycle of depression that keeps the symptoms constant or, in some cases, making them worse. Psychotherapy and related support are often required to overcome these conditions. Postpartum depression is a bit different. While it is unfortunately true that some women do experience ongoing symptoms of postpartum depression (PPD) if it is left untreated, many others overcome PPD almost spontaneously – weeks or months down the road, when the transition to parenthood has settled, hormones have balanced, and both partners have been able to figure out their co-parenting roles. It is because PPD can go away on its own (even though that is not a guarantee) that many women do not seek treatment. But the problem is that, even in situations where PPD has faded away, the effects and experience of that post-partum depression can be long-lasting.
Ways that Post-partum Depression is Traumatic
PPD is, in many ways, traumatic. Most people expect having a baby to be this joyful, exhilarating event. But a large percentage of women end up experiencing at minimum a mild form of post-partum depression (known as the “baby blues”) and many others experience more profound and heavy emotions with symptoms such as emptiness, loneliness, sadness, and depressed mood.
Those negative emotions can have many long-term consequences, even after the PPD has gone away. Many women experience:
Fear over having another child. There are many women that experience anxiety over having PPD again, and some women that will avoid future pregnancies specifically because they do not want to experience postpartum depression.
Guilt and shame over not fully appreciating the baby’s first few months. PPD can make it difficult for new mothers to bond with their baby. After the PPD goes away, many women feel guilt about the experience and feel sadness that they did not fully enjoy those days.
Reliving the experience. Many women remember vividly what it was like to live with PPD. They may have flashbacks or extreme levels of empathy for other moms. They may also still have issues with their partner that resulted from their PPD experiences.
These are only a few of the ways that postpartum depression is traumatic for the moms that experience it. Many women that have postpartum depression struggle with the effects of it long after the PPD has gone away.
Trauma Needs Support
Not everyone will overcome postpartum depression on their own. But even those that do can still live with the effects of having it long after the postpartum depression has gone away. Those emotions benefit from ongoing support by counselors and therapists that understand how to work with both PPD, trauma, anxiety, and more.
Postpartum depression may be common. But we have therapies now that can help address not only the PPD itself, but the months and years after. Seeking help is beneficial for anyone that feels they are struggling, and no one should feel like they need to “wait it out” alone.
All of us have this tendency to focus on the negative. Living in this busy world, we often find that our thoughts are on worries, the things we need to do, where we made mistakes, and on and on. It’s one of the reasons why positive affirmations are considered a part of many depression treatments. By telling ourselves every day things like “I deserve to be happy,” we can restructure our minds to believe it.
Affirmations can seem silly to those that have not done them before, but the research into them – although limited – is largely positive. It’s a key component of cognitive restructuring. We, as therapists, often have people with anxiety and depression repeat these affirmations to themselves every day to essentially rewire their minds so that they learn to see the world in a more positive and hopeful way.
Starting Affirmations Early – Before They Are Needed
What some researchers are doing is looking to see if components of psychological treatments, like affirmations, can help not only treat different mental health conditions, but actually prevent them. To study this, researchers looked at one of the most at-risk populations for depression: college age women.
They had half of the group learn behavioral interventions that included positive affirmations, while another group acted as the control. They then followed up with his group at various intervals over the next 18 months. The group of college-aged women that utilized treatment tools like affirmations had lower depression scores and higher self-esteem across the board when compared to women in the control group, indicating that treatments like positive affirmations were powerful enough to potentially prevent depression and depression-like symptoms.
Are Affirmations Preventative?
Research into affirmations is limited. Even in the above study, affirmations were given with a variety of other behavioral interventions, so it’s unclear if affirmations alone would have had much benefit. Similarly, usually when performing a research study, it is better for the control group to have some type of inert treatment to compare it to. Since the control group had no treatment at all, it’s difficult to say if the existence of any treatment would have provided similar results, no matter what it would be.
But there is plenty of research to suggest that affirmations can actually be quite powerful, especially with our tendency to think negatively. Those that are looking to give themselves a positive mental health boost in their lives should consider seeing if daily affirmations can provide them with some help in boosting their confidence, happiness, and self-esteem.
In today’s world, there is often a societal focus on the effect of menopause on women’s mental health. But what is not often talked about is perimenopause, and the effects of perimenopause on mental health.
Menopause – the end of a woman’s natural fertile period – is typically between the ages of 45 and 55. It is marked by often drastic changes in hormonal levels that, at least during the transition period, affect how a woman feels both physically and emotionally.
But perimenopause begins much earlier. Perimenopause is when the body begins to have hormonal shifts related to menopause but are still often many years away from menopausal onset. Some women experience perimenopause as young as their late 30s, and most women will experience it by the age of 40 to 44.
During this stage, women are still able to have children and still having periods, but their bodies are experiencing hormonal shifts and changes behind the scenes as it prepares for menopause later in life.
Perimenopause Effects on Mental Health
Because perimenopause begins at a younger age – sometimes as much as 12+ years before menopause begins – many women have no idea that they’re experiencing it, and many doctors do not talk to women about their changing bodies. Perimenopause remains an often silent part of the culture.
So it can be surprising to women in their mid 30s to mid-40s when they begin to have mental health symptoms they did not have before:
Anxiety
Depression
Trouble Sleeping
Mood Swings
The degree and severity of these symptoms differ from person to person, and lifestyle and experiences still play a role. But if a young woman in her late 30s/early 40s starts to notice that they’re feeling more anxious, or they’re having hot flashes, or they simply do not feel as emotionally healthy as they did before, it is possible that perimenopause may be to blame.
Other Factors to Consider
Now, during this same phase, women may be undergoing changes in their lives that may also have an effect on mental health. Many women have children by about 40 which adds stress to one’s life, and that is an age when there could be stresses with marriage or career that might be affecting a person’s mental health. Similarly, changing bodies can come with their own stresses, as reminders of aging and decreased fertility can affect health and wellness as well.
The Perimenopause Age and Mental Health
It is not always clear if anxiety, depression, or other mental health issues are the result of perimenopause, affected by perimenopause, or developed entirely independently. But what is clear is that it can be a stressful time, and those same mental health issues can affect someone’s ability to feel comfortable and confident within themselves.
Even mental health issues that are caused directly by hormonal changes can be addressed using psychotherapy, which is why it is so important for anyone that feels like they’re struggling to control their emotions, no matter their age, consider working with a trained psychologist or counselor. No mental health issues need to be permanent, and while it is useful to be aware of what perimenopause can do, it is also useful to treat it.
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