A Proposal For Depressive Subtypes: “Whatcha think?”

I always keep my eyes open for new developments – cutting edge information – I can share with chipur readers. Actually for my own benefit, as well. Found an interesting piece on Medical News Today I’d like to summarize.

Presented in the most recent edition of Psychotherapy and Psychosomatics is a proposal for a brand-spankin’-new classification of depressive subtypes. It’s based in the notion that the current diagnostic structure is too simple to accommodate the many variations of depression.

I couldn’t agree more, so let’s see what they have to say – in their words. More importantly – let’s see what you think…

  • Type A: Depression with Anxiety, characterized by an enduring tendency to experience anxiety and depression, and to show poor resilience under stress.
  • Type B: Acute Depression – This subtype has episodes that are relatively discreet and develop with no apparent precipitating stress, or the stress may be disproportionate to the intensity and duration of the depression. The severity of the depression can deteriorate into intense psychological pain and psychomotor retardation or agitation. Several authors have suggested that this subtype of depression should be termed ‘melancholia’.
  • Type C: Adult Depression after Childhood Trauma. This form of depression may be unique. Individuals suffering early trauma or loss may develop lasting neurobiological changes, which render them vulnerable to stress throughout their life. In particular, sensitization of the hypothalamic-pituitary-adrenal (HPA) axis may remain throughout life.
  • Type D: Depressive Reaction to Separation Stress. This can be precipitated by acute psychosocial trauma such as bereavement, divorce, job loss or forced emigration, and may sometimes be more severe than other forms of depression. For months, and sometimes years afterwards, some may experience sadness, apathy, insomnia and pessimism.
  • Type E: Postpartum Depression. This has a typical peak onset in the first 3 months following delivery. There are vast reductions in estradiol and progesterone levels postpartum, but their exact relevance to the development of depression remains unproven. Psychosocial factors, such as an unsupportive partner or an unwanted pregnancy, have also repeatedly been found to be relevant to the development of postpartum depression.
  • Type F: Late-Life Depression. This occurs in elderly people with no prior personal or family history of depression, but often with risk factors for cardiovascular disease, such as hypertension, diabetes mellitus, smoking or hypercholesterolemia. The patient describes a gradual loss of energy and interest, and a diminishing ability to cope. Cognitive testing may show impairment.
  • Type G: Psychotic Depression. This form features delusions and severe disturbances in work and social function. Hyperactivity of the HPA axis as measured by dexamethasone nonsuppression is present in at least half of the patients. Antipsychotic medication in addition to antidepressants is indicated.
  • Type H: Atypical Depression. This subtype characterizes patients who show hypersomnia and hyperphagia instead of the insomnia and weight loss typical of acute depression. They have more anxiety, including panic disorder and social phobia, and they are more likely to be a suicide risk and to abuse drugs.
  • Type I: Bipolar Depression. This occurs in patients with previous episodes of mania and should also be considered in depressed patients with a strong family history of bipolar disorder.
  • Type J: Depression Secondary to Substance Abuse or to a Medical Condition. This subtype, which is recognized by DSM-IV, is a diverse group of disorders that can be difficult to treat. It is a striking biological fact that substances and medical conditions as diverse as therapeutic corticosteroids, illicit cocaine use or pancreatic carcinoma can cause depression.

Is that one heck of a lot of information, or what? Well, absolutely; however, if you’re going to attempt to address as many depressive presentations as possible you’re going to be left with a huge roster.

So why even bother? If you ask me, this kind of work is absolutely vital in ensuring nothing falls between the cracks in terms of symptomatology. And that’s important, because it can only be a boost to the selection – and creation – of efficacious psychotherapeutic and medicinal interventions.

I mean, who really cares about diagnoses purely for the sake of diagnosing?

So what do you think, chipur readers? Would you venture a guess as to your subtype? What else do you have to offer all of us?