Mental health articles

OF mental health care and mentally ill

Forms of depression

Most depressions have triggering life events, especially in a fi rst episode. Many patients present initially with physical symptoms (somatisation), and some may show multiple symptoms of depression in the apparent absence of low mood (‘masked’ depression). Less severe depression has been awarded many labels, including neurotic depression, minor depression and reactive depression (not depression as a reaction to circumstances but when reactivity to events in the surroundings is preserved).

It is now termed dysthymia, a persistent low grade condition. This may be complicated by episodes of more severe depression, resulting in ‘double’ depression in which resolution of the more severe syndrome is difficult to judge. Many patients do not fi t neatly into categories of either anxiety or depression, and the concept of mixed anxiety and depression is now recognised. The presence of physical symptoms indicates a somatic syndrome (so-called melancholic or endogenous depression). The value of these features in predicting response to treatment is not clear. The presence of psychotic features has major implications for treatment. Brief episodes of more severe depression are also recognised (brief recurrent depression).

More prolonged recurrence is now termed ‘recurrent depressive disorder’ (formerly depressive illness). Atypical depression is characterised by increased sleep and appetite, and weight gain. Agitated depression, more common in the elderly, may present with psychomotor agitation that is not accompanied by subjective anxiety.

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