What are the different types of depressive disorders?

There are two main types of depressive disorders (see Table 8):

Major depressive disorder.
Persistent depressive disorder.

A case study example of how a person experiencing co-occurring depression and AOD use disorder may present is illustrated in Box 4.

Table 8: Types of depressive disorders

Disorder	Symptoms
Major depressive disorder	Major depressive disorder is characterised by one or more major depressive episodes in which five or more of the following symptoms are experienced nearly every day for at least two weeks: Depressed mood most of the day, nearly every day (e.g., feels sad, empty, hopeless; appears tearful). Loss of interest or enjoyment in activities. Reduced interest or pleasure in almost all activities. Change in weight or appetite. Difficulty concentrating or sleeping (e.g., sleeping too much or too little). Restlessness and agitation. Slowing down of activity. Fatigue or reduced energy levels. Feelings of worthlessness or excessive/inappropriate guilt. Recurrent thoughts of death, suicidal thoughts, attempts, or plans. A person may have a single episode or they may have recurrent episodes over their lifetime. The duration of depressive episodes may range from weeks to years.
Persistent depressive disorder	Persistent depressive disorder is a consolidation of the previous diagnoses of dysthymia and chronic major depressive disorder, and is characterised by at least two years of depressed mood more days than not, as well as other depressive symptoms such as appetite changes, sleeping problems, fatigue, feelings of worthlessness and hopelessness.

Box 4: Case study D: What does co-occurring depression and AOD use look like? Sheryl’s story

Case study D: Sheryl’s story

Sheryl, a 49-year-old who identified as female, was brought in to see her GP at the insistence of one of her adult daughters. On a routine visit home, her daughter became very concerned about her, insisted on making an appointment for Sheryl, and also accompanied Sheryl to her GP appointment.

Sheryl told her GP that since her twin daughters had moved out of home, which occurred several months earlier, she and her husband had separated. They had been together for 29 years. Since they all left, she has felt depressed and does not feel like she has any purpose. She was not able to leave her home much during the pandemic, but she was not bothered by this as she had no desire to leave the house and lost interest in things that she used to enjoy, such as gardening. She also hadn’t kept in touch with her friends and hadn’t even told them that her husband left. Sheryl also told the GP that she suspected that she’s peri-menopausal and thought these feelings were ‘normal’ for this stage of life.

The GP conducted a routine medical assessment, which included Sheryl’s weight, blood pressure, and ordered blood tests. The GP remarked that Sheryl had gained a significant amount of weight in the past two months which surprised Sheryl, as she hadn’t been eating and had almost no appetite. Sheryl’s daughter asked her mother why she hadn’t noticed that her clothes were tighter, and Sheryl said that she hadn’t been getting dressed – she had been wearing pyjamas or her nightgown around the house most of the time.

The GP asked Sheryl a little more about her sense of purposelessness, and Sheryl assured her that she had no plans to end her life. Sheryl said that she ‘just wants to sleep’. She told the GP that she had always had trouble sleeping and was very ‘high strung’ and anxious when she was younger, working in a high-pressure job. Sheryl and her husband’s family were very conservative, so when Sheryl became pregnant, she gave up her career to become a full-time mum, as was expected of her, but expressed that she was also happy to do so. Sheryl told the GP that over the past few months, she’d had more trouble sleeping and had been taking more of the sleeping tablets prescribed to her to help her get to sleep and stay asleep throughout the night. Sheryl also said that sometimes she had been taking sleeping pills during the day, as she had just wanted to sleep.

Key Points

What are the primary concerns for Sheryl?
Where to from here?

Case study D continues in Chapter B7.