HOPE - Life without Depression
There are several forms of depressive disorders.

• Major depression: Characterized by the presence of severe symptoms that interfere with the individual's ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a lifetime, but more often, a person has several episodes separated by varying lengths of time. 

 • Persistent depressive disorder: Also known as Major Depressive Disorder (MDD) it is a depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but in general the depressive mood lasts for a minimum of 2 years. In both cases, patients present with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, abnormal patterns of sleep or appetite, gruesome nightmares, and poor concentration.

Some forms of depression are slightly different, or they may develop under unique circumstances. They include:

• Psychotic depression: Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

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• Postpartum depression: This is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth. There is a rare variant of this disorder, the prepartum depression, which as the name implies happens in the final stages of pregnancy. In both these cases the problem is that the patient cannot be treated with drugs as they may affect the fetus, or the patient cannot breast-feed the newborn eliminating an important stage in the mother-child bonding process. A depressed mother with drug therapy and concurrent side-effects may not able to care for her baby.

• Seasonal affective disorder (SAD): Is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. In some patients the onset of SAD can be the trigger for MDD.

• Bipolar disorder: Also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes that range from extreme highs (e.g., mania) to extreme lows (e.g., depression).

1. Altshuler LL, Hendrich V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry, 1998; 59:29.
2. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy and their combination in treating seasonal affective disorder. Journal of Affective Disorders, 2004; 80:273–283.

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