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Depression: Is There More Than One Type? - Dr. Emmons

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Dr. Emmons shares how he classifies depression into three major types.

Dr. Emmons:
I think of depression as not being just one thing. What we call depression comes in many different shapes and sizes.

I categorize it in three ways – I think of there being an anxious depression, which I believe is the most common by far, probably 80 percent of people with depression have what I call an anxious depression.

The second category, much less common, is an agitated depression.

And then the third category, which is increasingly common, is a sluggish or lethargic depression.

I believe those represent different problems within the brain. The anxious depression, most common one, is very likely an imbalance in serotonin. Generally that’s a deficiency or the serotonin system is not working properly.

I think the most common reasons for that, probably the most common reason is stress, chronic, unrelenting stress where people do not get a break from it.

But also diet and lack of movement, lack of exercise have a very big role in the onset and perpetuation of that.

The second category, the agitated depression, I believe involves an imbalance between serotonin and dopamine.

Serotonin generally is calming. Dopamine generally is stimulating or activating.

And if you have an imbalance where there’s not enough serotonin to keep one calm and there’s too much excess dopamine causing inner agitation, hostility, anger, irritability – that’s a very uncomfortable state.

The third category, the sluggish, lethargic depression, I believe, involves too little dopamine. There’s a deficiency.

Dopamine and norepinephrine are very closely related brain chemicals. Then there’s not enough to keep on energized, focused, motivated so that people become just tired, run out.

And that can be an effect of long-term depression, also very commonly a seasonal depression.

If someone has had high levels of stress chronically, over many months or years even, eventually the body becomes depleted so that the chemicals like serotonin, dopamine, norepinephrine, they just aren’t there in sufficient amounts.

Then it becomes very, very hard to get out of it because you don’t even have the initiative left to get going. There are ways, though, of getting that moving again, both nutritionally and in terms of lifestyle changes and choices that I think can really be helpful in getting a person started.

And then the real key, with all types of depression and anxiety, the real key concept is to find the few practices or lifestyle changes that really fit with you and your body and stick with them.

Stick with them for a year and you will feel dramatically different and then if you can hold on to some of them over the course of your life you can prevent this from coming back again.

Very often people do shift from one to another. It will start off with a single pattern, for example the anxious depression.

Most people who get depressed or anxious it begins under times of great stress or just after a time of great stress.

That’s the most common starting point but if it’s not dealt with successfully, if people don’t fully recover from that initial episode it will very often divert into one or the other types of depression over time.

Probably the most common is to go from the anxious state to eventually to that sluggish, depleted sort of state.

But some people will go to that more irritable or agitated state. In particular, some people have that reaction to antidepressants.

It’s a very common thing to go on an antidepressant and maybe feel better at first but then over time, over a period of weeks or even months, to become either more irritable or agitated or more sluggish or lethargic.

And I think that that is often a side effect of the medication that goes unrecognized.

About Dr. Henry Emmons, M.D.:
Dr. Henry Emmons, M.D., is a psychiatrist who integrates mind-body and natural therapies, mindfulness and allied Buddhist therapeutics, and psychotherapeutic caring and insight in his clinical work. Dr. Emmons obtained his medical degree from the University of Iowa College of Medicine and did his residency in psychiatry at the University of Rochester Medical Center, where he was Chief Resident. He practices general and holistic psychiatry and consults with several colleges and organizations nationally. Dr. Emmons is the author of “The Chemistry of Joy: A Three Step Program for Overcoming Depression Through Western Science and Eastern Wisdom.”

Visit Dr. Emmons at his website

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