Q: I was wondering if you could explain the different types of depression? — Kathy

A: Depression is a disease caused by a chemical imbalance in a person's brain. The symptoms are many, but sadness and lack of motivation, with inability to function, are the main ones. Symptoms must be present for most days over a period of two weeks or more.

We used to divide depression into two categories, exogenous and endogenous. The first was supposed to be a reaction to a stressful event (some call it "reactive" depression). The other happened without a "good" reason. These terms are not used much anymore because it is impossible to differentiate between them and the treatment is the same, anyway. It was also implied that one type was somehow better than the other.

One may come across the term "agitated depression." This describes a situation where the main presenting symptoms are anger and frustration. Studies show that men who are depressed present like this more often. Women tend to present with the symptoms of anxiety. Another commonly used term is "somatic depression." This describes presentation of a mood disorder mostly through unexplained multiple medical complaints. Some patients who suffer from chronic pain may indeed be describing a psychological pain when talking about pain with their doctors. This, of course, does not make this psychological pain any less real or less debilitating. As a matter of fact, the pain and other body-related symptoms of depression are

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very real and can completely shatter the ability to function in daily life. This is also why recognizing "somatic depression" and seeking help are so important. Two additional terms are "psychotic depression" and "bipolar depression." "Psychotic" means out of touch with reality. Psychotic symptoms are delusions and hallucinations. Those who suffer from psychotic depression may be certain that someone is after them, or that their spouse is unfaithful. These false beliefs are called delusions. Hallucinations are false, nonexisting sensory perceptions. People who see things that are not there, or feel or hear things that are not there all are experiencing hallucinations. Psychotic symptoms, if disturbing to the patient and/or family, require strong medications different from medications for depression.

Bipolar illness is a cyclic disorder characterized by symptoms of depression alternating with times of overactivity and heightened senses. The state of fast thinking and feeling deceivingly well is called mania. People with mania lose touch with reality. Bank debts, dangerous decisions, even aggression may all be a part of the mania presentation. Bipolar depression is common. Some estimates claim that one out of three people with depression may indeed have cyclic, bipolar disorder. Treatment of bipolar depression is again different than treatment of "regular" or "unipolar" depression (I had to sneak in yet another funky Latin word). Many patients with bipolar disorder do not like the medications necessary to control it, because they do not want to lose the elated feeling they sometimes get when in the manic phase. The cyclic nature of this disorder, however, will always bring the depressive symptoms back.

The last form of depression is called dysthymia. This is a chronic malady when symptoms of sadness and feeling low are present for months, even years. The affected person can usually function enough to carry on a "normal" life. All types of depression can be helped. Some may only be controlled, not cured, and symptoms/complaints may return. There are always options to make things better for depressed patients. Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.