Depression or depressions?

Llanto en la depresión

Depression or depressions?

¿What is the most frequent symptom in depression?


But diverse mental disorders with similar characteristics, namely different types of depression, which sometimes respond to different treatments, according to their nature, and which we group as Depressive Disorders.


The common feature is the presence of three characteristics

(DSM-5, 2014)

The mood is the pervasive and sustained emotional and feeling tone that is experienced internally and that influences a person’s behavior and perception of reality (Kaplan & Sadock, 2013). One could also say that it is the sustained emotion that colors the way we view life (Morrison, 2015).

The most frequent symptom of depression is a sadness, without forgetting that periods of sad mood are inherent to human experience (Roca, 2015). But depressive sadness is often described as a very different feeling from that sadness originated by a vital event such as a death or an affective separation. This feeling gets increasingly deep. At the beginning, it leads often to crying, but there comes a point in which the patient no longer cries and claims that “he wants to cry, but he can no longer do it” (Álvarez, 2013).

Feeling of emptiness –lack, scarcity or absence of a thing or person that is missed- (RAE, 2014)

Somatic changes, such as weight, appetite, energy and sleep alterations, fatigue, pains…

Cognitive changes: such as memory, concentration or attention loss. Distractions.

The symptoms produce significant discomfort or impairment in the social, and work areas, or other important areas of functioning.

Disruptive mood dysregulation disorder.

Major depressive disorder (includes the major depressive episode).

Persistent depressive disorder (Dysthymia).

Premenstrual dysphoric disorder.

Substance/medication induced depressive disorder.

Depressive disorder due to another medical condition.

Other specified depressive disorder.

Unspecified depressive disorder.disorder.

What differs among them

Are issues of duration, timing, or presumed etiology, the most frequent being stress (Roca, 2015).

James Morrison (2015) provides a summarized definition:

Mayor depressive disorder. People who hadn’t maniac or hypomanic episodes, but showed one major depressive episode or more. The major depressive disorder can be recurrent or a single episode.

Persistent depressive disorder (dysthymia). There are no exaltation phase, and it lasts much longer than the typical major depressive disorder. This type of depression isn’t usually serious enough to be considered a major depressive episode (however, the chronic major depression is now included in this group).

Disruptive mood dysregulation disorder. A child’s mood is negative between frequent and intense “temper outbursts”.

Premenstrual dysphoric disorder. Some days before her period, a woman experiences symptoms of depression and anxiety.

Depressive disorder due to another medical condition. Diverse medical and neurological conditions can cause depressive symptoms; they don’t necessarily meet the criteria of any of the above mentioned disorders.

Substance/medication induced depressive disorder. Alcohol and other substances (by intoxication or withdrawal) can lead to depressive symptoms; they don’t necessarily meet the criteria of any of the above mentioned disorders.

Other specified or unspecified depressive disorder. These categories must be used when a patient displays depressive symptoms that don’t meet the criteria for the previous depressive diagnosis or another diagnosis of which depression is a component.

The classification of endogenous and reactive depressions

It’s been phased out and obsolete for a while, but some people still use it.

Other different types of depression, according to the criteria applied

It would be a long list. I will only mention some of the most used terms of depression types, both at a popular level and amongst many physicians.

  1. Acute depression.
  2. Anaclitic depression.
  3. Anancastic depression.
  4. Anxious depression.
  5. Bipolar depression.
  6. Catatonic depression.
  7. Chemical depression.
  8. Childhood depression.
  9. Christmas depression.
  10. Chronic depression.
  11. Endogenous depression.
  12. Fall depression.
  1. Gestational depression.
  2. Hereditary depression.
  3. Hormonal depression.
  4. Hypothyroid depression.
  5. Inhibited depression.
  6. Juvenile depression.
  7. Melancholic depression
  8. Minor depression.
  9. Neurotic depression.
  10. Obsessive depression.
  11. Postpartum depression.
  12. Postvacation depression
  1. Psychotic depression.
  2. Reactive depression.
  3. Seasonal depression.
  4. Senile depression.
  5. Spring depression.
  6. subsyndromal depression.
  7. Teen depression.
  8. Unipolar depression.
  9. Work depression.

Adding the final touch, you cannot compare childhood depressions, detected in children as small as three, which will alter brain’s anatomy because of their great vulnerability of being in development (Luby, 2015).

Depression in the elderly is the most frequent psychiatric pathology of this age range. It’s a relevant source of impairment, and significant deterioration of quality of life, increasing morbidity and mortality (Alaba, 2015).

A colleague explained that the depression was better understood when it was compared with cancer.

Just talking about the fact that a person has depression could be the first step; but you must categorize it, since each type has different symptoms, prognosis, treatment...

When you tell a patient that he has cancer, you have to tell him which type of cancer is it, because it’s not the same if it’s cutaneous, pancreatic, breast or intracranial cancer. With depression it occurs much the same: let’s categorize it.

It’s is very different the treatment of a cancer in its very beginning than in the advanced stages. The same occurs with depression. It responds more rapidly and easily at the beginning and the possibility of eradicating it is bigger.

Each type of cancer and each patient requires a different dosage and a specific duration of chemotherapy or radiotherapy (weeks, months…). All patients with cancer are usually treated, but the same is not true with depression, even if a 50% of the untreated patients become chronic (Urretavizcaya, 2008). It is known that only 70% of patients with depression get better with the first treatment. The others require an increasing of the dosage to its maximum or an anti-depressive of a different type or substances different from anti-depressives (antipsychotics, anti-epileptics, mood regulators…). In fact, the main cause of depressions becoming chronic is treatment with lower dosages than required. Depression must be treated for months, years or for life, according to the case. I won’t delve into these subjects since they will be the focus of future posts.

Cancer patients receive treatment in the schechuled dates, and rarely decide to abandon it. However, in depression, the most frequent cause of treatment withdrawal is the fact that the patient “looks well”. Of course many of them wouldn’t withdraw should they ask themselves if they are as well as before getting depressed, if they enjoy as much as before, if they have the same interest in their job. It’s the so-called residual symptoms, remaining after depression treatment. They appear in up to 74% of patients and favor relapse or recurrency-three quarters during the first six months- (Lozano, 2009).

On a regular basis they visit their oncologist, following a schedule, to prevent a cancer relapse or avoid metastasis. This is not the same with depression, neither for the patient nor for the family. However, I have been told by patients with both cancer and depression that they suffer more from the depression than the cancer itself. How many relapses and recurrences would be avoided if the patients should come back on time to their appointments! Particularly when they think they “are doing well”. Furthermore, besides the great suffering this pathology causes, it’s the first cause of suicide among humans (Kaplan & Sadock, 2013). Let us not forget that each year one million succeed at taking their lives, but 100 million try to do it.

Some patient could say: “But doctor,you can see cancer, but not depression!": It is true that cancer lesions can be detected with echography, CT, MNR and this has been so for quite a while now…But it is also true that lesions resulting from depression and affecting their target, the BRAIN, can also be seen (Lozano, 2009), specially at certain locations (hippocampus, amygdala, cingulate cortex…) that, when damaged, cause the different symptoms of depression. They can be assessed with functional MNR, PET…I like to share these data with my patients in Google images, make them note that what they suffer is not something ethereal and spiritual, even though it of course affects the spirit and vice versa. These are the wonders of Neurobiology of depression, to which I will devote more than a post.

Neurobiología de la depresión

Some of the damaged areas in depression: Hippocampus, amygdala, prefrontal ventromedial cortex, latero-orbital, dorsolateral, anterior cingulate cortex and striatum.

I don’t want to end these paragraphs about cancer and depression without apologizing to whoever may feel upset. That isn’t at all my intention. Cancer still frequently ends lives, but before that depression has ended the will to live, the will to fight for life.

OMS VIDEO: "I had a black dog"

Source "I had a black dog" psych-educational video of the WHO on Depression.


(DSM-5, 2014) Manual diagnóstico y estadístico de los trastornos mentales (DSM-5) (5ª ed.). Arlington, VA, USA: Asociación Americana de Psiquiatría. 2014.
(Kaplan & Sadock, 2013)Sadock B. & Sadock V. “Manual de bolsillo de Psiquiatría Clínica” Quinta edición. Edición en español. Wolters Kluwer Health España, S.A., Lippincott Williams. Barcelona 2011.
(Morrison, 2015)Morrison, J.: “DSM-5 Guía para el diagnóstico clínico” D.R. Editorial El Manual Moderno, S.A. de C.V. México, 2015
(Roca, 2015)Roca, M: Conferencia “La depresión, una enfermedad de hoy” VIII Congreso Nacional de Psiquiatría de Santiago, 2015.
(Álvarez, 2013)E. Álvarez Martínez, J. Pérez Blanco, V. Pérez Solá: “Trastornos del humor (afectivos)” Capítulo nº 18 del Tratado de Psiquiatría de Psiquiatrí INTERSALUD - Palma de Mallorca - Illes Balears, 2013.
(RAE, 2014) Real Academia Española: “Diccionario de la lengua española” 23ª edición, octubre 2014.
(Luby, 2015) Luby JL, Belden AC, Jackson JJ, Lessov-Schlaggar CN, Harms MP, Tillman R, Botteron K, Whalen D, Barch DM :Early Childhood Depression and Alterations in the Trajectory of Gray Matter Maturation in Middle Childhood and Early Adolescence” JAMA Psychiatry del 16 de diciembre de 2015.
(Alaba, 2015) Alaba, J.:Depresión” en la Persona Mayor en el Blog de Matia Fundazioa, post publicado el 22 de ene. de 2015
(Urretavizcaya, 2008) Urretavizcaya M, Baca Baldomero E, Álvarez E, Bousoño M, Eguiluz I, Martín M, et al. Conceptos prácticos para la clasificación y el manejo de la depresión largo plazo. Actas Españolas de Psiquiatría 2008; 36: 1-68.
(Lozano, 2009) Lozano JA. Síntomas residuales y tratamiento de la Depresión. De próxima aparición en: “PERDIENDO EL MIEDO A LA DEPRESION. Situaciones frecuentes y complejas en el paciente con depresión en atención primaria”. SEMERGEN 2009; 32 Supl. 2: 2-5 Editorial Elsevier.
(Lozano, 2009) Lozano, JA y Manzanera R.: “Neurobiología de la depresión: Consecuencias físicas y tratamiento farmacológico”. Seminario impartido en el XXXI Congreso Nacional de la Sociedad Española de Médicos de Atención Primaria. Zaragoza, 23 de octubre de 2009.


  • Ana Mangili

    Excelent review

    • Dr. Jose Antonio Lozano

      Thank you very much for your comment. And I’m glad the review of depression seems excellent. His congratulations encourages me to continue in that line. Thank you.

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    Llanto en la depresión
    Depression or depressions?


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