FOUR TYPES OF DEPRESSION: Situational, Existential, Psychological & Physiological (SEPP)

Virtually everyone has some experience with depression, however, the term “depression” has so many different meanings that when two people talk about it, it is likely they are referring to different phenomena. As such, I am hoping that the classification system defined below, which I refer to as the SEPP system, will be a step forward in distinguishing between four general categories of depression so that discussions on the topic can be more precise moving forward.

The classification of depression into the four categories below – Situational, Existential, Psychological, and Physiological (SEPP) – was born out of my professional training and experience (as a psychologist and researcher in psychology) and shaped by my own personal experiences with depression. I should note that this classification system does not represent a formal diagnostic schema recognized by the American Psychological Association, nor any edition of the Diagnostic and Statistical Manual (DSM). It is simply a schema I created from my observations and experiences. Despite this, I believe categorizing depression in this way can be helpful to clinicians, patients and lay persons as we all try to have more precise therapeutic conversations about depression.

Type 1: Situational (Sub-Clinical) Depression

Have you ever spent a few days feeling down in the dumps because your favorite football team lost a playoff game? Have you ever cried for a week and had difficulty concentrating after learning that your boyfriend cheated on you? Have you ever had brief thoughts of killing yourself after getting a rejection letter from your top ranked college or graduate school?

If you’ve ever experienced intense sadness in response to these or similar events, congratulations: you are a warm-blooded human being! You’ve also experienced what I call situational depression. As humans, it is completely normal for us to feel sadness, even for extended periods of time, in response to negative events and situations in our lives. There aren’t many people who, upon losing their jobs or suffering the death of a loved one, are able to feel unperturbed through the experience. In fact, not only do I believe there is nothing wrong with experiencing this type of depression, it is probably abnormal to NOT feel depressed in such cases. However, problems arise when these feelings do not abate after a few weeks and a person feels unable to perform their usual goal-oriented activities, or, develops persistent thoughts of suicide. When this occurs it is a sign that a person’s depression is better explained by one of the other categories below.

In my experience, situational depression is nearly universal in the human condition, which means that if this is something you are currently experiencing, you have company... and a lot of potential support around you. The problem, however, is that since this type of depression is so common, many people consider themselves an expert on the subject and believe that this type of depression is the only type of depression there is. As such, many people feel emboldened to give a lot of unsolicited advice to anyone whom they hear is struggling with “depression.” Much of the time, the advice given by those who have only known situational depression is vague and unhelpful, despite them having good intentions in giving the advice. But sometimes, the advice of those who have only known situational depression can actually make a person feel worse, especially if the person suffers from one of the other more serious forms of depression described below. When friends and family members say things like - “You just need to get out of the house,” or “Stop feeling sorry for yourself and just move on,” or “So many people in the world have it much worse than you!” - individuals with more serious forms of depression are likely to experience an exacerbation of their depressive symptoms and have an increase in suicidal thoughts.

In contrast to the statements above, if you want to help a friend or family member who is depressed, but you are unsure what type of depression they have, the best advice I can give you comes from a recommendation given in the 12-step tradition: "Don't just do something, sit there!" In my experience, situational depression will usually resolve on its own after a few days or weeks, without the need for therapy or medication. As such, just sitting with someone and validating their feelings gives the person with situational depression what they truly need in that moment: a clear indication that someone cares about them. Furthermore, if it turns out that the individual in question is suffering from one of the other more serious forms of depression, just sitting there prevents us from exacerbating their symptoms with unsolicited advice that is likely to invalidate their feelings. As noted above, situational depression usually abates within days or a couple of weeks, however, it doesn't abate, or gets worse, it could be an indication that the afflicted individual may be struggling with one of the more serious forms of depression described below.

Type 2: Existential Depression

While the trigger for situational depression is usually a negative event (e.g., the loss of job or death of a family member), the trigger for “existential depression” is often, ironically, a positive event: usually one that a person has been looking forward to for a long time.

How can a positive event trigger a depressive experience? For many of us, we decide at some point in adolescence to dedicate our lives to a particular goal that we believe will give our lives meaning and provide us with self-actualization. The goals to which we aspire may include lofty career achievements (e.g., becoming a doctor or writing a book); specific personal desires, like having a child or buying a sports car; or, they may include spiritual objectives, like attaining advancement on a chosen spiritual path. Regardless of the goal, when we organize our lives around these things we often create an unrealistic expectation that the attainment of these goals will remove all forms of unhappiness from our lives and yield an unending state of bliss. In some cases the attainment of these goals DOES give us the satisfaction we crave, but many times it doesn’t. To spend your entire life pursuing a single goal and then realize, after achieving it, that it didn’t bring the joy and meaning that you expected, is enough to send most people into an existential crisis.

“Was my entire life a waste of time?” “If achieving the goal I’ve been pursuing for so long didn’t give my life meaning, will my life ever have meaning?” “Does life NOT have a purpose?” “Where do I go from here?”

These are the questions asked by someone whom I would describe as having existential depression. The trigger for this depression is much more profound than the trigger for situational depression and the depressive experience is usually much deeper. This type of depression usually causes a person to question everything they once believed to be true. Without the meaning they hoped to achieve after the attainment of their goal, the things in life they once enjoyed – watching sports, eating a fine meal, or even having sex – no longer give them pleasure and they feel lost without a goal to pursue in the future.

For those of you who have seen The Shawshank Redemption, this type of depression is what I imagine the librarian experienced after winning his freedom and being released from prison: though he should have been happy after getting released from prison, leaving prison meant the loss of his job in the prison library, and thus the loss of his identity and purpose in life.

In my experience, existential depression can be the trickiest to address. Taking Prozac won’t give those afflicted a new identity or purpose, nor will it help them to discover the meaning of life. Similarly, psychotherapy approaches that focus on concrete symptom relief are not very effective either. The depressive symptoms that are caused by existential depression come from a deep, nebulous source and don’t respond much to techniques that simply address a person’s cognitive errors, irrational thoughts, diminished activity levels or lack of engagement in pleasurable activities.

In my experience, this type of depression generally requires a combination of strategies, integrated over a long period of time, and time is perhaps the most important part of the healing. First, I believe that ongoing psychotherapy with a therapist who is insight-oriented (usually from the psychodynamic or psychoanalytic style) is the best place to start. Therapy should not be pushed at a pace faster than what the patient is willing to go, and it may seem that progress is not being made, even after a couple of years in therapy. However, this type of therapy will provide patients with the safe space necessary to explore themselves and play with new possibilities and potential identities in an environment that is validating and devoid of judgment and expectations.

Second, I believe that exploration and participation in groups that are oriented towards big-picture goals (e.g., religious and spiritual groups; philosophy groups and book clubs, humanitarian organizations, etc.) can be an important adjunct to therapy, helping patients consider different life goals and purposes. Third, I think that experiencing foreign cultures and different ways of life for an extended period of time – as Elizabeth Gilbert described in Eat, Pray, Love – can be especially helpful as well. Finally, I believe that the simple passage of time is a necessity so that individuals can experiment with new potential identities and life goals and learn that they may have to try on a few different ones before they find what fits.

Type 3: Psychological Depression

The third type of depression in the SEPP system is called psychological depression because I see the cause as being linked to various psychological factors, such as: losing perspective; negative thinking patterns; negative self-talk; and dysfunctional responses to stress.

For most of us, having our hopes and dreams continually crushed by reality is one of the worst experiences we can endure. For some, the primary means of coping with such experiences is to deprive themselves of hopes and dreams in the future so as never to be disappointed again. This adaptation is often successful in protecting a person from being crushed by reality, and for this reason it is employed (usually unconsciously) with increasing frequency, to serve this purpose. However, the downside is that this adaptation leaves people with the byproduct of chronic depression, low self-esteem and hopelessness. Usually, this adaptation occurs unconsciously, and the job of the therapist is to illuminate this phenomenon. Unlike with existential depression, I believe that this type of depression can respond equally well to both cognitive-behavioral therapy and psychodynamic therapy, though each type of therapy would address the problem in different ways.

Sometimes, an episode of psychological depression that a person is experiencing is the result of unrealistic expectations, set either by oneself or others, and therapy involves the careful adjustment of expectations. In other cases, a person’s pattern of negative self-talk needs to be replaced with more empowering self-talk and reminders of past success.

In yet other cases of psychological depression, an individual’s symptoms are related to one’s participation in a dysfunctional relationship. Sometimes, the joint goals of a relationship can become incompatible with an individual’s personal goals, and ongoing participation in the relationship leads to sadness, grief, low self-esteem and unhealthy habits. Here, at best, the relationship needs to be adjusted (possibly with the help of joint therapy), but at worst, the relationship might need to be terminated.

In each of the cases of psychological depression described above, a well-trained therapist is needed to help individuals to identify the patterns in which they are entangled. Additionally, a well-trained therapist can be of the most assistance in identifying specific treatment interventions based on the particular assets, limitations, personality type and cognitive style of each individual patient.

Type 4: Physiological Depression

The final type of depression in the SEPP system is physiological depression. Here, an individual’s depressive symptoms starts with an imbalance among any of the neurotransmitters (e.g., serotonin, norepinephrine, dopamine, etc) or hormones (e.g., thyroid stimulating hormone, TSH; adrenaline, cortisol, estrogen, testosterone, etc.) that affect our mood and physiology.

In some cases, changes in neurotransmitters and hormones can lead to actual feelings of depression, irritation or mood lability. In other cases, changes in neurotransmitters and hormones simply create a physiological state that is incompatible with the achievement of one’s goals. Physical feelings of fatigue, low appetite, restlessness and insomnia, as well as cognitive difficulties and problems with concentration, can all impair an individual’s abilities to achieve her goals. But these physical and cognitive states alone are NOT depression: they simply make the attainment of one’s goals – academic, athletic, social, etc. – much more difficult. When these difficulties lead to an accumulation of failures, then negative thinking patterns, low self-esteem and relationship problems begin to mount. As these problems build, it becomes increasingly difficult to fight the physiological and cognitive challenges described above, and then a vicious cycle ensues.

At this point, something is needed to break the cycle, and this is where I believe medication can be the most helpful. As I tell my patients, medication alone will not solve your problems, but if the medication works as hoped, it will produce a physiological state (e.g., increased energy, stamina, concentration, etc.) that will enhance your ability to implement the strategies we discuss in psychotherapy.

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Though it should go without saying, I will nonetheless mention that in many cases people don’t simply suffer from just one of the depression types described above, but rather a combination of them. Once again, a well-trained therapist can be of great assistance in helping people to discern which combination of depression types they suffer from and devise a treatment plan specific to each individual according to their the assets, limitations, personality type and cognitive style. As such, it is my hope that, if you are experiencing one of the types of depression described above, you might feel empowered to pursue treatment with a well-trained therapist. In addition, I hope that the discussion of differences between the four types of depression outlined in this article was poignant enough to convince all those reading that no two people experience depression in the same way, and thus, we should all be careful when assuming that our own experiences with depression automatically apply to everyone we meet who describes themselves as feeling “depressed.”