Subtypes of depression

Depression subtype	Symptoms or timing
Anxious distress
	Feeling tense Feeling restless Worrying that interferes with concentration Fear of losing control or that something awful may happen
Atypical
	Mood improves in response to positive experiences Increased appetite or weight gain Hypersomnia (≥10 hours/day or ≥2 hours more than when not depressed) Feelings of heaviness in limbs Sensitivity to interpersonal rejection that is longstanding and impairs personal and work relationships
Catatonia^*
	Psychomotor activity that is profoundly decreased (eg, stupor) or increased (eg, agitation) Nonpurposeful resistance to instructions or external stimuli Minimal resistance to positioning by examiner Distorted facial expression Profound lack of verbal response Odd, repetitive movements that can include posturing; caricatures; or repetitive, non-goal-directed movements Mimicking another's speech or movement
Melancholic
	Profound loss of pleasure and/or does not feel better with positive events or pleasurable experiences Depression is worse in the morning Early morning awakening (ie, 2 hours before usual time of waking up) Pronounced psychomotor agitation or slowing Anorexia or weight loss Excessive guilt
Mixed^¶
	Elevated or expansive mood Inflated self-esteem or grandiosity Pressured speech or more talkative than usual Racing thoughts or flight of ideas Increased energy or goal-directed activity Decreased need for sleep Engages excessively in pleasurable activities with high potential for painful consequences (eg, excessive spending or irresponsible sexual activity)
Peripartum
	Symptoms begin during pregnancy or within 4 weeks of childbirth^Δ
Psychotic^¶◊
	Delusions (false, fixed beliefs) Hallucinations (false sensory perceptions)
Seasonal^§
	Regularly begin at a particular time of year (eg, winter) Regularly remit at a particular time of year (eg, summer) Seasonal episodes are recurrent and largely outnumber nonseasonal episodes

This table summarizes specific subtypes of depressive episodes and their characteristic symptoms or features. For additional information and diagnostic criteria, refer to UpToDate topics on clinical features and diagnosis of depression in adults.

* Refer to UpToDate topics on catatonia for detailed discussion.

¶ Depressive episodes meet criteria for either major depressive disorder or persistent depressive disorder.

Δ Some professional organizations define perinatal depression as any depressive episode up to 12 months after childbirth.

◊ Refer to UpToDate topics on major depression with psychotic features for detailed discussion.

§ Seasonal pattern is a subtype of major depressive disorder but can also occur in bipolar I or II depression.

Reference:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR), American Psychiatric Association 2022.

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Subtypes of depression