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depression

Depression Types, Causes, and Risk Factors

When you’re depressed, understanding the different types and causes of this mood disorder can help you find the most effective treatment—even if you’re dealing with clinical, atypical, or treatment-resistant depression.

Big Autumn leaves floating on water

What are the different types of depression?

Depression is a mood disorder that affects your ability to function normally in daily life and can come in many different shapes and forms. Defining the causes, symptoms, and severity—whether it’s mild, moderate, or major (clinical) depression—can be complicated, but getting an accurate diagnosis may help you better manage your depression and get the most effective treatment.

Some types of depression may be caused by life events, stressful experiences such as a bereavement, trauma, divorce, or financial worries. Other types can be caused by seasonal changes, menstruation, or pregnancy and childbirth. Your personality type can also play a role in depression, as can genetics, certain medications, and alcohol and drug abuse.

Why understanding the types, causes, and risk factors is important

Knowing the type of depression you have can help you best manage your symptoms and get the most effective treatment. For example, studies have shown that mild depression can be just as effectively treated by exercise as antidepressants—but without the risk of any unpleasant side effects. Major depression, on the other hand, may also require more extensive intervention, whether it’s therapy, medication, or an alternative treatment.

Similarly, understanding the cause of your depression can also help determine the best ways to boost your mood and improve how you feel. If you are feeling depressed because of a dead-end job, for example, the best treatment might be to find a more satisfying career rather than simply taking medication. If you’re new to an area and feeling lonely and sad, finding new friends will probably give you more of a mood boost than going to therapy. In these cases of “situational” depression, the depression may be remedied by changing your circumstances.

Additionally, recognizing your personal risk factors and triggers for depression can help you prevent your symptoms from returning.

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Mild and moderate depression

These are the most common types of depression. More than simply feeling blue, the symptoms of mild depression can interfere with your daily life, robbing you of joy and motivation.

Those symptoms become amplified in moderate depression and can lead to a decline in confidence and self-esteem.

Persistent depressive disorder (dysthymia)

Dysthymia, otherwise known as persistent depressive disorder (PDD), is a type of recurrent mild or “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood.

  • The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years).
  • Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.”
  • If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.”

What is high-functioning depression?

“High-functioning depression” is a term that you may have heard on social media or in the news, but it is not a recognized medical term or clinical diagnosis. Rather, it seems to be used to describe how some people are able to function in their daily activities despite their ongoing depression.

In many cases, it is confused with persistent depressive disorder, where you have a continuous low mood but may still be able to hide it from other people and carry on with daily activities such as going to work or school.

Regardless of labels, the important thing to remember about depression is that the symptoms affect people differently. Even someone who outwardly seems “fine” may be suffering inwardly and in need of help.

Major or clinical depression

Clinical or major depression, otherwise known as major depressive disorder (MDD), is much less common than mild or moderate depression. It is characterized by severe, relentless symptoms.

  • Left untreated, major depressive disorder typically lasts for about six months.
  • Some people experience just a single depressive episode in their lifetime, but major depression can also be a recurring disorder.

Atypical depression

Atypical depression is a common subtype of major depressive disorder with a specific symptom pattern. It responds better to some therapies and medications than others, so identifying it can be helpful in ensuring you receive the most effective treatment.

  • People with atypical depression experience a temporary mood lift in response to positive events, such as after receiving good news or while out with friends.
  • Other symptoms include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.

Psychotic depression

Sometimes, major depression can be accompanied by symptoms of psychosis, such as hallucinations, delusions, or stupor. Major depression with psychotic features can be extremely frightening. During a depressive episode, you may believe things that aren’t based in reality, feel paranoid, angry, and irrational, or see, hear, or feel things that aren’t actually there. These can be especially distressing if they involve thoughts of hurting yourself or others.

With psychotic depression, your psychomotor skills may also be impaired, slowing your movement and thoughts. Or you could even experience a state of stupor, where you’re unable to move, talk, or respond to your surroundings.

Experiencing psychotic features during a depressive episode can increase the likelihood of a bipolar disorder diagnosis, so it’s important to speak to your doctor right away.

If you are feeling suicidal…

When you feel suicidal, your problems don’t seem temporary, they seem overwhelming and permanent. But with time, you will feel better, especially if you get help. There are many people who want to support you during this difficult time, so please reach out!

Read Are You Feeling Suicidal?, call 988 in the U.S., or visit IASP or Suicide.org to find a helpline in your country.

Treatment-resistant depression

Depression treatment can involve therapy, medication, lifestyle changes, and other options—but they can all take time to work. It may take a while to find the right therapist, for example, settle on an antidepressant that works for you, or for a new exercise routine to start delivering improvements. Or it may take trying a different combination of treatments to help ease your depression.

While there’s no exact definition of treatment-resistant depression, medical professionals often use the label when the first several treatments are unsuccessful. If you feel depression treatment isn’t working for you:

Ensure you have the correct diagnosis. Having the wrong diagnosis can make finding the right treatment even more difficult. If you’re being treated for depression but actually have bipolar disorder, for example, taking antidepressants could make your symptoms even worse.

Make healthy lifestyle changes. Staying socially active, managing stress and anxiety, exercising regularly, and getting enough sleep can have a profound effect on your mood. Even when you’re also in therapy and taking antidepressants, self-help steps can make these treatments more effective.

Try to avoid alcohol and recreational drugs. Substance abuse can simultaneously make depression symptoms worse and make it harder to treat. Even other prescription medications may adversely interact with antidepressants.

Consider alternative treatments. If you have treatment-resistant depression, your doctor may recommend therapies such as transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT).

Seasonal affective disorder (SAD)

For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 0.5% to 3% of the population, particularly women and young people.

SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.

Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe and often disabling form of premenstrual syndrome (PMS). In addition to physical symptoms such as bloating, cramps, headaches, and body pain, PDD can also cause depression symptoms including:

  • Irritability
  • Tension or anxiety
  • Low energy
  • Sleep difficulties
  • Despondent mood
  • Frequent crying
  • Mood swings
  • Trouble concentrating
  • Food cravings

[Read: Depression in Women]

Caused by hormonal fluctuations, PMDD often starts in the 10-14 days before your menstrual period and improves within a few days of its start.

Postpartum depression

Following childbirth, it’s common for women to experience some symptoms of the “baby blues.” Hormonal fluctuations combined with exhaustion, sleep deprivation, and stress can leave you feeling fragile, tearful, and emotionally overwhelmed. These symptoms usually go away after a few weeks.

However, in some cases, symptoms persist, resulting severe, lasting depression known as postpartum depression. While postpartum depression shares many of the same symptoms of the baby blues—sadness, insomnia, mood swings—they are more severe, can interfere with your ability to care for your baby, and may even include suicidal thoughts.

[Read: Postpartum Depression and the Baby Blues]

In some rare cases, postpartum depression may also include postpartum psychosis, characterized by delusions, hallucinations, and extreme anxiety and confusion.

Causes of depression

While some illnesses have a specific medical cause, making treatment straightforward, depression is far more complicated. Despite what you may have seen in TV ads, read in newspaper articles, or maybe even heard from a doctor, depression is not just the result of a chemical imbalance in the brain, having too much or too little of any brain chemical.

Rather, depression is often caused by a combination of factors—biological, psychological, and social—that can vary wildly from one person to another. For example, if you’re going through a divorce, have been diagnosed with a serious medical condition, or recently lost your job, the stress could prompt you to start drinking more, which in turn could cause you to withdraw from family and friends. Those factors combined could then trigger depression.

Other causes of depression include:

Medications, such as barbiturates, corticosteroids, benzodiazepines, opioid painkillers, hormonal birth control, and specific blood pressure medicine can trigger symptoms in some people—as can hypothyroidism (an underactive thyroid gland).

Biological factors, including inflammation, hormonal changes, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells.

Recent stressful life experiences. Major life changes, such as a bereavement, divorce, unemployment, trauma, or financial problems can often bring overwhelming levels of stress and trigger depression.

Marital or relationship problems. While a network of strong and supportive relationships can be crucial to good mental health, troubled, unhappy, or abusive relationships can have the opposite effect and contribute to depression.

Anxiety. Depression and anxiety disorders often go hand-in-hand. Since more than 40 percent of people with major depression also suffer from anxiety, it’s important to seek treatment for both conditions.

[Read: Anxiety Disorders and Anxiety Attacks]

Chronic illness or pain. Unmanaged pain or being diagnosed with a serious illness, such as cancer, heart disease, or diabetes, can trigger feelings of hopelessness and helplessness.

Alcohol or drug abuse. Substance abuse can often co-occur with depression. Many people use alcohol or drugs as a means of self-medicating their moods or cope with stress or difficult emotions.

Not sure of the cause of your depression?

Whether you’re able to isolate the causes or not, the most important thing is to recognize that you have a problem, reach out for support, and pursue the coping strategies that can help you to feel better.

Risk factors

The following risk factors can make you more vulnerable to developing depression:

Loneliness and isolation. There’s a strong relationship between loneliness and depression. Not only can lack of social support heighten your risk, but having depression can cause you to withdraw from others, exacerbating feelings of isolation. Having close friends or family to talk to can help you maintain perspective on your issues and avoid having to deal with problems alone.

Family history of depression. Since it can run in families, it’s likely some people have a genetic susceptibility to the problem. However, there is no single “depression” gene. And just because a close relative suffers from depression, it doesn’t mean you will, too. Your lifestyle choices, relationships, and coping skills matter just as much as genetics.

Personality. Whether your personality traits are inherited from your parents or the result of life experiences, they can impact your risk of depression. For example, you may be at a greater risk if you tend to worry excessively, have a negative outlook on life, are highly self-critical, or suffer from low self-esteem.

Early childhood trauma or abuse. Early life stresses such as childhood trauma, abuse, or bullying can make you more susceptible to a number of future health conditions, including depression.

History of mental health problems. If you’ve previously struggled with anxiety, an eating disorder, or post-traumatic stress disorder (PTSD), for example, your risk of depression increases.

Substance abuse. If you are already at risk of depression, abusing alcohol or drugs may push you over the edge. There is also evidence that those who abuse opioid painkillers are at greater risk for depression.

Age and gender. In your senior years, your risk of developing depression increases, perhaps because of risk factors such as social isolation or chronic illness. Similarly, women are about twice as likely as men to develop depression. While the reasons are unclear, it may be because of hormonal changes.

What you can do to feel better

When you’re depressed, it can feel like there’s no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.

[Read: Coping with Depression]

Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. They just need to be a good listener—someone who’ll listen attentively without being distracted or judging you.

Get moving. When you’re depressed, just getting out of bed can seem daunting, let alone exercising. But regular exercise can be as effective as antidepressant medication in countering the symptoms of depression. Take a short walk or put some music on and dance around. Start with small activities and build up from there.

Eat a mood boosting diet. Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar and refined carbs. And increase mood-enhancing nutrients such as Omega-3 fatty acids.

Find ways to engage again with the world. Spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one). You won’t feel like it at first, but as you participate in the world again, you will start to feel better.

When to seek professional help

If support from family and friends and positive lifestyle changes aren’t enough, it may be time to seek help from a mental health professional. There are many effective treatments for depression, including:

Therapy. Consulting a therapist can provide you tools to treat depression from a variety of angles and motivate you to take the action necessary. Therapy can also offer you the skills and insight to prevent the problem from coming back.

[Read: Depression Treatment]

Medication may be imperative if you’re feeling suicidal or violent. But while it can help relieve symptoms of depression in some people, it isn’t a cure and is not usually a long-term solution. It also comes with side effects and other drawbacks so it’s important to learn all the facts to make an informed decision.

Transcranial magnetic stimulation (TMS) therapy. This noninvasive treatment directs recurring magnetic energy pulses at the regions of the brain that are involved in mood and may be used for treatment-resistant depression.

Electroconvulsive Therapy (ECT). This is another option for depression that’s proven resistant to medication, therapy, and self-help. ECT uses electrodes to induce a quick seizure by delivering a mild electrical pulse to the brain. While the practice can be effective, you’ll likely want to learn more about how ECT works to decide if it’s right for you.

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D.

Get more help

What Causes Depression? – Including genes, temperament, stressful life events, and medical issues. (Harvard Health Publishing)

Co-occurring Disorders and Depression – How medical disorders can affect depression and vice versa. (Mental Health America)

Atypical Depression: What’s in a Name? – Article on the symptoms, diagnosis, and treatment of atypical depression. (American Psychiatric Association)

Depression and Other Illnesses – An overview of the mental and physical illnesses that often co-exist with depression, and how this impacts treatment. (Depression and Bipolar Support Alliance)

Depression support & suicide prevention help

Depression support

In the U.S.: Find DBSA Chapters/Support Groups or call the NAMI Helpline for support and referrals at 1-800-950-6264

UK: Find Depression support groups in-person and online or call the Mind Infoline at 0300 123 3393

Australia: Call the SANE Help Centre at 1800 18 7263

Canada: Call Mood Disorders Society of Canada at 613-921-5565

India: Call the Vandrevala Foundation Helpline (India) at 1860 2662 345 or 1800 2333 330

Suicide prevention help

In the U.S.: Call 988 Suicide and Crisis Lifeline at 988

UK and Ireland: Call Samaritans UK at 116 123

Australia: Call Lifeline Australia at 13 11 14

Other countries: Visit IASP or Suicide.org to find a helpline near you

Last updated: September 15, 2022