Depression is like salad. Hear me out on this one.
Salads come in a staggering variety. A leafy green house salad, a creamy macaroni salad, even a Jell-O salad—they’re all salads. How do you group together such disparate examples? Two things: first, a salad is a variety of foods (you can’t have one ingredient and call it a salad). And second, a salad is bound together with a common dressing.
So it is with depression. With nine hallmark symptoms, of which you need five or more for an official depression diagnosis, there are hundreds of possible combinations.
But across those combinations are some commonalities—think of those as the dressing that pulls a salad together. No matter what constellation of depression symptoms you have, it probably includes three things. According to a study of almost 1,200 depressed individuals in the super-prestigious journal Nature Medicine
- 97% of depressed people struggle with their mood: feeling chronically unhappy, hopeless, or helpless.
- A tad more than 96% have what’s called anhedonia, which is when pleasure and satisfaction get crushed like a cigarette butt under a stiletto heel.
- And 94% feel fatigued. Whatever you call it—tired, exhausted or wiped out—it means you feel about as energetic as a sloth in slo-mo.
Those are the symptoms common to most depressed people. But beyond those three? There’s a huge range of symptoms and hundreds of possible profiles—the equivalent of ambrosia versus tabbouleh. And to make things more complicated, some of the symptoms are opposites. For example, losing your appetite or eating everything that’s not nailed down are both symptoms, as is feeling agitated and restless, feeling like you’ve been fitted with some cement shoes, or worse, both.
No matter the combination, depression is serious. The World Health Organization ranks depression as the third most common burden of disease worldwide and projects that by 2030 it’ll be number one.
With so many possibilities, you’d think depression would be hard to treat. And so it is. But there is hope on the horizon. The study in Nature Medicine found that fMRI scans can sort people into four distinct neurophysiological subtypes of depression, which in turn can help predict what treatments might benefit them. But until fMRI scans or other biological measures become a part of diagnosis, we have to rely on the OG method of symptom detection: self-report.
So, when we listen to the experiences of people with depression, what do we hear? Some distinct profiles. And this week, from a by-no-means comprehensive list, here are five types of depression.