Why the type matters
Most depression shares the same core features: a persistent low mood, loss of interest or enjoyment, and changes to sleep, energy and thinking. The symptoms page covers these in detail.
But depression can also follow particular patterns. It may be linked to having a baby, to the seasons, to the menstrual cycle, or to another condition such as bipolar disorder. Some patterns need a different kind of treatment, so it is worth describing yours as fully as you can when you speak to a GP or specialist.
The types below are not all separate illnesses. Some describe severity, some describe timing and some describe extra features.
Less severe and more severe depression
The NICE guideline on depression in adults (NG222), published in 2022, uses two broad groups to guide treatment:
- Less severe depression covers what used to be called subthreshold symptoms and mild depression.
- More severe depression covers moderate and severe depression.
NICE used a score on the PHQ-9 questionnaire as one indicator: under 16 for less severe, 16 or more for more severe. Your clinician will also consider how long you have had symptoms and how much they affect your life.
The split matters because NICE recommends different first treatments for each. For less severe depression, NICE says antidepressants should not routinely be offered first unless that is the person’s preference. Treatment for depression sets out the options.
Persistent depressive disorder
Persistent depressive disorder (PDD) is continuous depression that lasts for 2 years or more. You may hear it called dysthymia or chronic depression.
Symptoms may be less intense than in a severe episode, but living with them for so long can wear people down. Some people have had PDD for so long that they think low mood is simply their personality.
NICE has specific recommendations for chronic depressive symptoms. These include cognitive behavioural therapy (CBT) that focuses on the long-standing nature of the symptoms, such as avoidance, rumination and difficulties in relationships, and medication. If treatment has not helped and symptoms are having a big effect on daily life, NICE recommends offering a referral to specialist mental health services for advice and further treatment.
Antenatal and postnatal depression
Depression can happen during pregnancy (antenatal depression) or after having a baby (postnatal depression). Together these are often called perinatal depression.
It is very common to feel down, tearful or anxious for a few days after giving birth. This is often called the “baby blues” and usually goes away within 2 weeks. Postnatal depression is different: it lasts longer and can start any time in the first year after birth.
Signs can include low mood, feeling unable to enjoy anything, feeling guilty or like a bad parent, trouble sleeping even when the baby sleeps, and anxious or frightening thoughts. The NHS notes that fathers and partners can also have depression after a baby is born.
Postnatal depression is treatable, often with talking therapy and sometimes antidepressants. The NHS says many antidepressants can be taken while breastfeeding. Speak to your GP, midwife or health visitor. In England you can also refer yourself to NHS Talking Therapies.
Seasonal affective disorder
Seasonal affective disorder (SAD) is a type of depression that follows a seasonal pattern, usually starting in autumn or winter and easing in spring or summer. Less commonly, some people have symptoms in summer instead.
Symptoms often include low mood, losing interest in everyday activities, feeling more tired and sleeping more than usual, and difficulty concentrating. The NHS says SAD may be diagnosed if you have had depression at a particular time of year for 2 years or longer.
NHS treatment options include light therapy using a special lamp, talking therapies such as CBT, and antidepressants. Getting outside in daylight and staying active can also help.
Depression in bipolar disorder
Bipolar disorder is a condition in which people have episodes of depression and also episodes of very high mood, called mania, or milder high mood, called hypomania. During a high, people may feel very happy or excited, have racing thoughts, need much less sleep and act impulsively.
The NHS notes that bipolar disorder can take time to diagnose, because it affects everyone differently and its symptoms overlap with other conditions. If high periods are brief or feel pleasant, they can be missed, and a person may be treated for depression alone.
Getting this right matters because the treatment is different. People with bipolar disorder are usually offered medicines to stabilise mood, alongside talking therapy. NICE recommends that, when assessing depression, clinicians ask about any past periods of elevated mood for exactly this reason.
If you recognise high periods in your own history, mention them to your GP. The NHS says a GP will usually refer you to a psychiatrist for assessment. See seeing a psychiatrist for more.
Psychotic depression
Some people with severe depression also develop symptoms of psychosis. The NHS calls this psychotic depression. Psychosis can include:
- delusions – beliefs that are very unlikely to be true, such as being convinced you have done something terrible
- hallucinations – hearing, and sometimes seeing, feeling, smelling or tasting, things that are not there
People may also become very restless, or very slowed down.
Psychotic depression needs specialist care. NICE recommends a referral to specialist mental health services. Treatment usually combines an antidepressant with an antipsychotic medicine, plus psychological and practical support. If someone’s safety is at risk, call 999 or go to A&E.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome. Mind explains that symptoms appear in the part of the cycle between ovulation and the start of a period.
The NHS describes PMDD symptoms as similar to PMS but much more intense, with a much greater effect on daily life. They can include feeling very anxious, angry or depressed, having suicidal thoughts, problems sleeping, overeating, and aches and pains.
The cause is not fully understood, but it has been linked to being very sensitive to normal hormone changes. Keeping a diary of symptoms alongside your cycle can help a GP see the pattern. People with severe symptoms may be referred to a specialist, such as a gynaecologist or psychiatrist.
Depression with other conditions
Depression often happens alongside other conditions, including anxiety, long-term physical illness, problems with alcohol or drugs, and neurodevelopmental conditions such as ADHD. When symptoms overlap, it can be hard to tell what is driving what. Causes of depression looks at some of these links.