Avie J. Rainwater, III, Ph.D., ABPP

There is a huge difference between being clinically depressed, and having the blues or an occasional “bad day.”  In reality there are five ways to be depressed:

Normal
It is completely normal to have an occasional “bad day” or to be “in a funk” from time to time.  This can be associated with poor sleep, upsetting news, acute stress and since it goes away all by itself in a matter of a few hours or a day or so, there is nothing to be worried about.  If however, the days come more and more frequently, you may be struggling with an adjustment disorder.

Adjustment Disorder with Depressed Mood
When we experience something that is more than just upsetting, but something that is really and truly distressing, and you can’t seem to shake he blue feeling, then you are likely suffering with an adjustment level of depression.  This simply means you’ve experienced some stressor and can’t quite shake it.  This level of depression can last up to six months, so it is wise to seek psychological so you don’t suffer needlessly.

Dysthymic Depression
Thymos is a term used to describe that part of us that is spirited and noble and also our need for connectedness with others.  The prefix “dys” means not.  So, Dysthymia describes that state where we feel hopeless, alienated from others and negative about ourselves.  This type of depression yields a low-level but happiness-crippling blue mood.  It isn’t a depression so severe that we can’t get out of bed or take care of ourselves, but it is strong enough to lick all the red off our lollipop and sends us trudging through day after discouraging day, after frustrating day, after unfulfilling day.  It robs the joy and meaning of life.  This type of depression lasts several years in duration and absolutely must be treated with psychotherapy. In my opinion, Dysthymia is the most serious type of depression as it has the greatest potential to ruin a person’s life.  They live day after week after month with no joy and are simply existing.

Major Depression
While the severity of major depression is more intense than any other form of depression, it is usually a time limited struggle.  These episodes are characterized by loss of interest in most things, change of appetite and sleep, and great difficulty in making oneself do the routine tasks of the day.  Thankfully, most major depressive episodes last a few weeks and then begin to remit on their own.  The limited nature of the episode doesn’t mean someone suffering with major depression doesn’t need to be in psychotherapy.  They do.  There is a reason they have become majorly depressed and that needs to be explored and remedied through the process of psychotherapy.

It is important to note that bipolar disorder, a type of major depression commonly called manic depression, is greatly misdiagnosed.  I find the majority of people who have been diagnosed by a counselor or primary care physician or psychiatrist, are, in fact, not bipolar.  Rather, these individuals typically have other psychological problems associated with complex personality dysfunctions and thus the diagnosis is missed.  In general, unless you have undergone evaluation and testing by a psychologist, the diagnosis of bipolar is – in my opinion – suspect at best.

Psychotic Depression
This is the most frightening form of depression since it involves the patient not being able to correctly perceive reality.  In that the patient has suffered a psychotic break from reality the presentation is typically very dramatic but, usually, it is rather short lived as it typically responds very well to anti-psychotic medication.  This depression can “stand alone” or be associated with a schizophrenic process. 

About medications…
While medications can help in relieving poor mood, they do nothing to cure depression.  No medications cure anything in the body.  If you have a sinus infection, your family physician may give you an antibiotic that will beat down the excess germs so your body’s immune system can take over and heal you.  Antidepressant medications simply “level the playing field” so you can better address the challenges and stresses of life that have actually caused the depression.  In psychotherapy, you will actually learn how to handle your life more effectively and thereby relieve the stresses that have caused your depression.