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. 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

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Depression

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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?

Sad Doll

Sad Doll
Photo courtesy of Flickr (Elena Gatti)

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 the 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.

You partner will be going thorough 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 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

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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 a depression. Some women will become much more irritable or anxious than before the 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

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Or peripartum or