What is the difference between Melancholy and Atypical Depression?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

How are Melancholy depression, atypical depression, and major depressive disorder related?

When you read around on the internet, and in some books on the subject also, you will find a lot of different names for depression. Some of these are understood as separate disorders because in doing research or in the way these disorders affect clients they look like different but related conditions. Some of these terms are primarily descriptors, technically descriptors, for the most significant feature of the depression. Some of the terms you will read about elsewhere are more descriptions of the thing that may have caused or may be causing the depression.

Someday we may be able to run a precise test, brain scan, or blood test and identify specific forms of depression. There has been a lot of promising research in this field and some huge claims about the ability to diagnose mental disorders by this or that test, but as of now most diagnosing is done by asking the patient questions, counting up symptoms, and then if you have enough symptoms you get a disorder with a particular name.

Melancholy depression or atypical depression.

Melancholy depression and atypical depression are two “Specifiers” used to group cases of Major Depressive Disorder with similar features together for ease of reference. In the newer diagnostic book (DSM-5) there are 9 specifiers. These specifiers are somewhat changed from the older DSM-4 system. What follows is my oversimplified explanation, for the full text of the description you would need to look at the APA book DSM-5.

What is Melancholy Depression?

Almost total loss of pleasure. Stuff that used to make you happy now just does not interest you. If you are too depressed to think about sex or a hobby you used to love, chances are you have melancholic depression.

With Melancholic depression, nothing is likely to snap you out of it. You see a show that others say is funny but you can’t enjoy it and laughter is just too much work. If something good happens, it does not make you feel good even for a little while.

People with Melancholic depression have a noticeable down mood. They are despondent, hopeless, or in despair. People with this form of major depression wake up way early and their depression is worse in the morning. They have changes in appetite and feel guilty.

This is the kind of depression that made its way into novels in the last century and may still be seen on soap operas. These literary efforts make this look like it is someone being dramatic or overacting. In the clinic, this is a real enough disorder and people with this condition are not faking it for attention.

Depression with atypical features specifier.

With atypical features, the depressed person can snap out of it a little for a while if something really good happens. They laugh at a joke, some of the time. The trouble is that the happy feeling is fleeting and disappears before they realize they just smiled.

With atypical features, the person has significant weight gain and or increased appetite. They are always tired and drag around. With this type of major depression, the image that should come to mind is a bear hibernating for the winter. They eat everything in sight and then sleep for hours. Upon waking they are too tired to walk around and after eating they return to sleep.

People with atypical features to their depression customarily have had a long-term pattern of feeling rejected. They are very sensitive to any hint of rejection, judgment, or criticism and this often interferes with personal relationships, job, school, or any other activity that involves getting along with others.

With Seasonal pattern depression specifiers.

Another specifier would be added if this person had the depression only at one particular time of year or at a transition between seasons. This requires the change of weather or seasons to be the trigger for the depression. If you work a summer or winter job and get laid off each year that is not seasonal depression. We know what caused it and the weather need not get blamed.

This type of depression is often called winter blues or it used to be called seasonal affective disorder before we split bipolar and depression into two very different groups of disorders.

Peripartum onset specific for depression.

The name of this specifier was changed and I think for good reason. This is the “thing” that used to get called postpartum depression. Turns out that lots of times this started out in the middle of the pregnancy. Starting before the birth of the baby is a bad sign as often this results in a more severe depressive episode.

Women who had postpartum depression now called Major depressive disorder with Peripartum onset found that with each succeeding pregnancy the depression gets worse.

With psychotic features turns into two specifiers.

What used to be major depressive disorder with psychotic features has been subdivided into two specifiers. One is Mood congruent psychotic features and the other is mood-incongruent psychotic features.

Catatonia.

This is that condition where a person stands frozen like a statue. It can be diagnosed separately without any depression but occasionally it appears as a specific type or specific form of major depressive disorder.

This is a quick, abbreviated, run down on some features of Major Depressive Disorder. If you or anyone you know has these symptoms seek professional help. Getting help is not giving in to your illness. Getting help early can keep depression from getting far worse and ruining your relationships, job, or your happy life.

For more posts on depression:

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Are you at risk for Postpartum or Peripartum Depression?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Mother with child

Postpartum depression.
Photo courtesy of pixabay.

7 risk factors for Postpartum Depression.

What factors might put you at risk of Peripartum Depression?

When it comes to mental health, why one person gets a disorder and another person does not, is just not all that clear. A life event, something we call a stressor, could push one person into depression and a similar event could leave another person unscathed. Risk factors do not equal getting the disorder. But if you have these factors in your life then you are at more risk of Peripartum Depression than most.

For those not familiar with the term Peripartum depression, it is like Postpartum Depression only it allows for depression that starts in pregnancy rather than restricting the concept to those who become depressed after the birth of a child.

Here are 7 factors that put you at risk.

1. Past Episodes of Depression.

Women who have had episodes of depression in the past are at increased risk to develop Peripartum Depression. The more times someone has been depressed and the longer those episodes, presumably the higher that risk.

If you have had depression and received treatment, think back to what was helpful to you in reducing or controlling that episode of depression and do more of that. If you did not get help for those past episodes of depression or sadness, now is the time.

2. Stress in your life adds risk.

The more stress the woman is under the more the risk. What is stressful to one woman may not be to another. It is far more complicated than just financial stress.

Look for ways to reduce stress. Learn stress reduction and stress management techniques. Also, work on relaxing and being patient. Give your life the time to develop rather than pushing to have everything be done right now.

3. Poor relationship with your partner.

New couples need some time to adjust to each other. Some couples were never meant to be despite getting together and making that baby. Many other couples get off to a rocky start but with work, they develop a good long-term relationship.

Having a second person to share the duties, joys, and trials of child-rearing can be a beneficial thing for all involved. If there are problems in the relationship the sooner you work through those problems the better.

4. Having little social support increases your risks.

One person, your partner, no matter how supportive that person is, will probably not be enough support for the tasks of creating a family and raising children. Being a parent is hard work. Some people make parenting and relationships look easy but for most of us, it takes work.

Your partner will be going through things also. Sometimes you feel and think things your partner is not up to hearing. Work on strengthening your support system to reduce this risk of Peripartum Depression.

There are posts elsewhere on this blog about support systems and how to develop one. Some of those posts can be found here:

How supportive is your support system?

Can one person be a support system?

How do you develop a support system?

5. Your mother’s depression puts you at risk.

A family history of depression, any depression, increases the risk of you developing Depression. Having a mother had Peripartum or postpartum depression adds to the risk that a woman will have an episode of depression during pregnancy and the first year after the delivery of the child.

As with so many other “risk factors,great-grand-mother” a risk factor does not mean that absolutely positively this woman will be depressed, it just means it is one other thing to think about.

We have also seen research that suggests that the life experiences of your great-grandmother and beyond may be affecting your emotions. See the post – Pick your grandmas wisely – their life affects your feelings. 

6. Being poor – low SES.

Along with all the other burdens that come with being poor, living in bad neighborhoods, or being of low socioeconomic status there is the extra risk of developing postpartum depression.

Absolutely there are poor families that are happy and where there is little or no depression. Having money does not deter depression. But all things being equal having some money, at least enough to get by on sure relieves a lot of the stress of being a new parent.

Couples who are able to delay that first child until they have a job or career path do better. It helps if you have stable housing and something saved up. Many young parents have to rely on family, friends, or government programs to make ends meet.

Not having the money to get by on can strip the joy of a new child right out of your grasp.

7. Having a difficult infant.

There are those babies who from day one just are crankier than others. That child may have an illness or just an irritating disposition. Hard to care for children make their parent’s life more difficult. This is an extra burden on young or inexperienced parents.

These are the most commonly recognized risk factors for Postpartum or Peripartum Depression. I suspect there are other factors that up this risk, especially personal life experience factors. When you have come through difficult times or are still going through them, life’s challenges can be more difficult to manage.

If you or someone you know has a lot of these risk factors, look for ways to manage the stress of going through the pregnancy or being a new parent. Support systems can help so can professionals. And if you are feeling overwhelmed just now consider a help hot-line or reaching out for professional help.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

.

What is Postpartum or Peripartum Depression?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Is this postpartum depression or just the baby blues?

Postpartum depression.
Photo courtesy of Pixabay.

The idea that a woman can get sad, blue, even depressed as a result of giving birth has been around for a long time. Professionals have struggled with what this is and how to be helpful and we continue to struggle with those issues.

We knew that depression around the time of delivery causes a lot of suffering for the mother. Sometimes it becomes a problem for the father and other family members. And yes, we now know that having a depressed mother, immediately after birth, or later in childhood, can affect the child, possible for the rest of that child’s life.

There has been a reluctance to keep creating new disorders for each and every cause of depression. One way out of this dilemma has been to keep the same set of symptoms for depression regardless of what has caused the depression.

For depression, there is a list of specifiers for types. Most of those specifiers have to do with the way the symptoms present. Some people eat more and some eat less and so on.

Only two causes have gotten their own specifiers, seasonal pattern as in seasonal affective disorder and Postpartum Depression. Postpartum Depression is now called Peripartum Depression to also include depression that sets in before the birth of the child.

Symptoms of Peripartum Depression.

Symptoms of Peripartum depression are very similar to the symptoms of other forms of depression. Sleep disturbance, if it is over and above that caused by having a newborn who cries when it has needs, is one symptom. Changes in appetite and loss of interest in things that used to make you happy are other common signs this is depression and not just the normal getting used to being a parent.

Feeling hopeless or like a bad mother are serious symptoms of depression. Some women will become much more irritable or anxious than before pregnancy. You may also feel numbed out or disconnected from life and from those around you. Worrying, excessively about the child’s safety can also be a symptom of a mental health issue.

The new DSM (DSM-5) reports the frequency of Peripartum Depression at 3% to 6% of all women. The sheer fact that it gets its own separate specifiers suggests to me that the rate of women with depression during and after the birth of a child is higher than any 6%.

Some studies have followed women for the first year after the birth of the first child and they find significant stress and higher rates of depression over that year time period.

Research studies have reported that rates of “Baby Blues” those brief episodes of sadness that occur during and after pregnancy can run as high as 80% in some populations.

One reason for the discrepancy in the numbers is that we used to talk about mood disorders and treat Depression and Bipolar as part of the same mood disorder family. These two conditions have gotten a divorce and are now living in separate chapters in the new DSM-5. While Postpartum or Peripartum depression may only get 6% the new Peripartum Bipolar Disorder should also have some numbers. So far I have not seen any statistics on the number of women who develop Peripartum Bipolar Disorder but the new DSM-5 clearly allows for this possibility.

Some of these cases in which a woman develops symptoms during and after pregnancy also reach the point of having delusional or psychotic features. In these cases, the mother may believe there is something wrong with the child, that the child is evil or a similar delusion. Women who develop psychosis after the birth of one child have a risk (from 30% to 50%) of having psychotic symptoms during each pregnancy thereafter.

Another reason the rates of Peripartum Depression may be understated is that some women do not develop symptoms quickly enough to get the diagnoses in the first 4 to 6 weeks. After that, the diagnoses will probably be Major Depression and the Peripartum specific will get left off.

Those milder cases of sadness that happen during pregnancy and after delivery, the things that are popularly called baby blues, they most likely will not get a diagnosis at all. For a while there was a study of something called Minor Depression, there was even a set of proposed symptoms for minor depression in the older DSM-4. That has now been dropped.

While some cases of baby blues may not get the official nod of a diagnosis of “with Peripartum onset,” they need treatment. If you have been sad or depressed during pregnancy or afterward, consider getting professional help. Let the professional worry about what the correct diagnosis code should be.

If you have ever thought that your child was cursed or evil, get help fast before you harm that child and yourself.

What causes a woman to be at high risk for Peripartum or Postpartum Depression? There are at least 7 factors that put you at risk for postpartum depression. More on those factors in a coming blog post.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel