Major Depressive Disorder (MDD)
A significant period of persistent depressed mood or loss of interest/pleasure in activities, accompanied by changes in sleep, appetite, energy, concentration, and self-worth. Major episodes significantly impair functioning.
- Persistent depressed mood most of the day, nearly every day
- Loss of interest or pleasure in previously enjoyed activities
- Significant changes in appetite or sleep
- Noticeable decrease in energy or fatigue
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
- Episodes last 2+ weeks and significantly impair functioning
Major depressive episodes are serious but highly treatable. Evidence-based therapy combined with behavioral activation, cognitive restructuring, and skill development produces significant improvement in most people. Treatment duration varies based on episode severity and history.
Persistent Depressive Disorder (Dysthymia)
A chronic pattern of depressed mood lasting 2+ years (1+ year in children/adolescents), with less severe but more persistent symptoms than major depression. Often described as "feeling down" most of the time.
- Chronic low mood present most days for 2+ years
- Reduced energy and motivation
- Difficulty concentrating and making decisions
- Low self-esteem and negative self-perception
- Hopelessness about the future
- Sleep and appetite changes
- Periods of more severe depression ("double depression")
- Significant impairment in work, school, or relationships
Persistent depression often goes unrecognized because symptoms are "lower level" than major depression—people adapt to chronic low mood. Treatment addresses the pervasive nature of the condition, helps identify depression-maintaining patterns, and builds lasting recovery.
Double Depression
A pattern of persistent depressive disorder with superimposed episodes of major depression—meaning chronic baseline depression punctuated by more severe depressive episodes. More serious and debilitating than either condition alone.
- Baseline persistent low mood and symptoms
- Periodic severe depressive episodes
- Return to chronic low mood after severe episodes
- Ongoing significant functional impairment
- Difficulty identifying when mood improves (new baseline too low)
- Greater suicidality risk during severe episodes
- More treatment-resistant than single episode depression
Double depression requires specialized, sustained treatment addressing both the chronic baseline depression and the acute episodes. Comprehensive behavioral and cognitive approaches help interrupt depression-maintaining cycles and establish healthier mood baseline.
Situational/Reactive Depression
Depression triggered by specific life circumstances—loss, trauma, major life change, medical diagnosis, or significant stress. While situationally understandable, it still requires treatment to prevent chronicity.
- Depression follows identifiable life stressor or loss
- Depressive symptoms emerge within months of stressor
- Depressive symptoms exceed what would be expected for the situation
- Significant functional impairment
- Symptoms don't naturally resolve with time
- Hopelessness about future related to life circumstances
- Loss of engagement despite continued opportunity
While situational depression is understandable, it still requires treatment. Processing the triggering circumstances, rebuilding engagement despite the stressor, and developing coping strategies helps prevent progression to chronic depression.
Treatment-Resistant Depression
Depression that persists despite adequate treatment with medication and/or prior therapy attempts. Often more severe, chronic, and associated with multiple failed treatment attempts.
- Continued depressive symptoms despite medication trials
- Prior therapy that did not produce lasting improvement
- Multiple treatment attempts without adequate response
- Severe functional impairment
- High suicidality or hopelessness
- Ongoing symptoms across work, relationships, and self-care
- Sense of hopelessness about treatment effectiveness
Treatment-resistant depression is challenging but still responsive to specialized, intensive therapy. Comprehensive assessment may identify factors maintaining depression (behavioral patterns, trauma, life circumstances), and targeted intervention addresses these underlying causes.
Depression with Suicidal Thoughts
Depression accompanied by thoughts of suicide, self-harm, or hopelessness about living. Requires immediate, expert assessment and comprehensive support. Suicidality is treatable.
- Thoughts of suicide or wanting to die
- Thoughts of harming yourself
- Feelings that others would be better off without you
- Persistent hopelessness or sense of burden
- Planning or preparing for suicide
- Previous suicide attempts
- Feeling trapped or like there's no way out
Suicidal thoughts are symptoms of depression that respond to treatment. Dr. Pratt provides immediate safety assessment, crisis planning, and evidence-based treatment to reduce suicidality and restore your desire to live. If you're in immediate danger, please call 911 or go to emergency.
