I am going to try to make this very simple.
Historically, there was thought to be two types of
depression. One type, called endogenous, was thought to be mostly biochemical
in nature and could happen to individuals even when there were no significant
stresses going on in their lives. This type of depression was thought to be a
true illness.
A second type of depression was called reactive. In
this case, depression was experienced by individuals who are undergoing serious
stresses or losses in their lives. This is the category of depression that
would best describe the symptoms experienced by many people who live every day
in pain, or suffer serious prolonged illness or injury. This type of depression
happens to people as a reaction to what is happening to them. Clear examples would
be, prolonged injury or illness, death in the family, divorce, job loss and prolonged
unemployment, or almost any type of serious loss.
Even though the causes of these two types of depression
were quite distinct, the symptoms are very similar. Treatment for both types of
depression is also similar, and involves, usually, a combination of medication
and counseling. Counseling involving cognitive behavioral therapy is the most
common and most effective. For these reasons, depression is thought of,
nowadays, as being of a single type. Depression is usually diagnosed with the
term, major depressive disorder, regardless of the cause.
Although these terms are not used for diagnosis
anymore, it is still often useful to explain the concept of reactive depression
to patients who suffer from depression caused by their chronic or long-term
pain. The idea of depression, as a reaction to the stresses and losses connected
to living every day in pain, makes more sense. Importantly, it also takes away
some of the fear and stigma associated with depression.
Yours with care - Michael
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