5 Unofficial Varieties of Depression

Depression is like a salad. Salads come in a staggering variety. A hearty kale and quinoa salad, a creamy potato salad, even a Jell-O and fruit cocktail salad—they’re all salads.

How do you group together such different things? In two ways: first, a salad is made with a variety of components (you can’t have one ingredient and call it a salad). And second, a salad is bound together with a common dressing.

Depression is similar. With nine separate official symptoms, of which you need five or more for a proper diagnosis, there are hundreds of possible combinations.

Across those combinations are some commonalities—the dressing, as it were. No matter what constellation of depression symptoms you have, it probably includes three things:

• Changes in mood: According to a study of almost 1,200 depressed individuals in the super-prestigious journal Nature Medicine, 97 percent of people with depression struggle with their mood. They feel chronically unhappy, hopeless, or helpless.
• Anhedonia: A tad more than 96 percent have what’s called anhedonia, which is when pleasure and satisfaction get crushed like a cigarette butt under a stiletto heel. You don’t look forward to or enjoy things.
• Fatigue: Ninety-four percent feel wiped out—call it tired, fatigued, or exhausted. Whatever you call it, it’s feeling about as energetic as a turtle on sleeping pills.

But after those three? There’s a huge range of symptoms and hundreds of possible profiles—the equivalent of tomato-avocado versus ambrosia. And to make things more complicated, some of the symptoms are opposites. For example, both losing your appetite and overeating are symptoms. The same goes for the contradictory symptoms of feeling agitated versus feeling like you’ve been fitted with some cement shoes, or worst of all, both at the same time.

No matter the combination, depression is serious. The World Health Organization ranks depression as the third most common burden of disease worldwide and projects that by the year 2030, it will be number one.

With so many possibilities, you’d think depression would be hard to treat. And so it is. But there is hope on the horizon. The study in Nature Medicine found that fMRI scans can sort people into distinct neurophysiological subtypes of depression, which in turn can help predict what treatments might benefit them. But until fMRI scans or other biological measures become a part of diagnosis, we have to rely on the OG method of symptom detection: self-report.

Therefore, when we listen to the experiences of people with depression, what do we discover? Some distinct profiles, such as these five:

1. Morning melancholy

Officially called the melancholic subtype, some researchers argue this profile should actually be its own diagnosis.

This type of depression is bleak and profound. Nothing feels good. Life’s pleasures evaporate. Even with a nice surprise or some good news, cheering up dissipates after a few minutes.

Therefore, it makes sense that folks with this type have no desire to socialize or do their favorite things because what’s the point? It makes no difference.

To top it off, in addition to feeling despondent or empty, another common emotion is guilt—guilt about being ill, guilt about being unmotivated, guilt about even existing.

The melancholic type is worst in the morning. Folks often report an improvement in mood and energy as the day goes on. But to add insult to injury, waking up hours before the alarm is common, which prolongs the worst of the misery.

2. “Anxious distress”

A study in the appropriately named journal Anxiety & Depression assessed 260 individuals with depression and found that a whopping 75 percent of them met the criteria for what’s called the anxious distress specifier.

Anxiety is part of why depression often goes undetected. We usually think of depression as feeling sad or not being able to get out of bed. We don’t think of it as feeling fidgety, tense, and exhausted, or being unable to get anything done because we’re distracted by worries and our attention span has shrunk to that of a fruit fly. Neither do we think of depression as a creeping dread that something terrible is about to happen, nor the idea that we’re suddenly going to snap and totally lose it. But it is.

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According to an article in The Lancet, anxiety is the tadpole to the frog of depression—it comes first, usually one or two years before—and then morphs into a different form. In other words, if we worry ourselves into a depression, anxiety can be both a precursor to and a symptom of that depression.

Furthermore, as we age, our depressive episodes become more anxiety-filled. Is Great Uncle Milton calling every few hours and freaking out over nothing again? It’s not just aging or eccentricity—it’s a reason to see the doctor.

3. Lingering trauma

A meta-analysis of 57 different studies totaling nearly 7,000 participants with PTSD found that more than half also had depression.

Interestingly, there was a hierarchy among traumas—survivors of military trauma and other person-to-person assaults like rape or sexual abuse were more likely to have depression than those who had survived non-interpersonal traumas like natural disasters.

This makes sense. Person-to-person traumas can change your beliefs about the world: I can’t trust anyone; people can betray you at any moment; if I let my guard down, people will exploit my weakness. And that is profoundly depressing.

In addition, it’s possible that trauma and depression are a two-way street. Let’s take the trauma of bullying. Of course, getting bullied can link directly to depression, but it’s also probable that kids who already grapple with depression—kids who already feel helpless and self-critical—are easier targets for the bullies of the world.

4. Healing from loss, interrupted

The death of a loved one. The end of a romantic relationship. Although the circumstances are very different, they both represent a loss. There’s no one “right” way to heal from a loss and no deadline to feel good again, but sometimes the natural healing process gets stuck.

A fascinating study in The American Journal of Psychiatry looked at almost 5,000 people with depression to see if whatever prompted their depression was associated with particular symptoms.

An interesting profile emerged for depression caused by a breakup or death: sadness for sure, not being able to find pleasure in anything. Those made sense. But interestingly, eating and sleeping also fell by the wayside. In some kinds of depression, people will stuff their feelings with food or sleep as a way to escape, but with loss and grief, both sleep and appetite evaporated. It’s as if the body goes on strike.

5. Impact of failures and setbacks

Losing a job, getting kicked out of school, or otherwise failing in spectacular or public fashion can sometimes be a catalyst for depression. The same American Journal of Psychiatry study found this particular kind of depression goes along with extreme fatigue, sleeping too much, and a pervasive pessimism, none of which is particularly conducive to job hunting or making up that incomplete in English Literature. It’s as if “I just can’t” were a syndrome.

Guilt and rumination can also be two additional symptoms of failure-related depression. Following a failure, it makes sense that individuals ruminate on what went wrong and what they could have done differently—spinning those thoughts around and around like a car’s wheels spinning on ice, all of which lead to the emotion of guilt.

To sum it up, depression isn’t exactly known for being clear-cut and easily categorized. Just as panzanella, egg salad, and tuna nicoise are all legit salads, exceptions to all five of these unofficial types of depression, as well as lots of other profiles, are all legit depression.

But regardless of the specific symptoms, depression is treatable. There’s no need for you or anyone you love to suffer. And while treatment can sometimes feel like more of an art than a science, there is hope. And then? You can start enjoying the ambrosia of life again.

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