last updated 4/28/2025
There are 4 main kinds of depression. Figuring out which kind you have doesn’t make a huge difference if you’re choosing self-change or a psychotherapy, which can be helpful for all 4 kinds of depression.
But if you’re considering an antidepressant or other direct antidepressant treatments like a light box or ketamine, then you need to know if your depressions is episodic or mixed, because antidepressants can make those worse.
Here are those 4 kinds in more detail. You can also go straight to a questionnaire to help you figure out your risk of an antidepressant making things worse.
Lifelong depression
  | “When was the last time you felt well?”, People with this kind of depression tend to laugh gently and roll their eyes. “Like, never”. Or “I can’t remember such a time.” |
This kind of depression has been called “dysthymia” (literally “bad feelings” or “bad mind”). Just “down” all the time, compared to where others seem to live.
Dysthymia can be mild or severe. It is common in people who have had awful lives, either in childhood or as adults. Self-change efforts can help, but are probably more difficult for people with this kind of depression: they are working against a history, or long-standing life situation.
Psychotherapy might be the best approach, worth trying several kinds. Because antidepressant pills can easily become lifelong. And once you start down that road, if the first doesn’t work, it would make sense to try another, and then another, right? How many before you give up on that approach? The farther you go, the less ideal the antidepressant: less likely to work, side effects more likely.
However, if you say “I’m going to try two, two different kinds, and if that doesn’t work, I’ll stop”, antidepressant pills might be worth trying.
Single episode depression
With this kind of depression, you know what life was like when things were better. That serves as a clear target for what you’re trying to get out of treatment. So treatment should not go on forever: it should get you back to where you were and then you should be able to stop.
Unlike Episodic and Mixed depressions, antidepressants are unlikely to make a Fine/not Fine depression worse. They have their side effects and risks, but they don’t complicate the mood problem itself. With two important exceptions. First, maybe this is the first episode of depression that will go on to become episodic? There’s no way to tell. So if you do take an antidepressant and things get weird, it’s time to rethink what kind of depression you have.
Second exception: some people are genetically vulnerable to having antidepressants cause a Mixed depression. There’s no blood test for this (yet). But there is a test — the questionnaire below. If you have a high score, you’ll want to be careful when deciding whether to use an antidepressant or an alternative that doesn’t carry this same risk.
Repeated episodes of depression
  | Depressions that come and go could be life circumstances, just hitting barrier after barrier. But if you fall into a depression for no clear reason, that’s a clue there’s something else going on. However: bad things happen often, for most people. So is it event-caused, or is it … you? |
Here’s a clue: if you suddenly come out of an episode, for no clear reason, that’s very significant. (Obviously this is easier to figure out if you’ve had a lot of episodes). Here’s why recognizing repeated-episodes depression matters: antidepressants can it make worse. They can cause it to cycle faster (more episodes), cause episodes to become more extreme or mixed (more on Mixed States, next); or more rarely, cause a manic episode.
Sometimes it’s not obvious: are you really having “episodes”? Maybe things have just gone bad in really strange ways. Maybe you wonder: “am I having, like, little manic phases?” The MoodCheck questionnaire was designed to help you figure that out.
Mixed depression
  | Think of this as “Depression Plus”: depression plus some high-energy symptoms like anxiety, anger, agitation, and attention problems (the 4 A’s). |
Other high-energy symptoms in Mixed depressions include extreme insomnia: can’t fall asleep, can’t stay asleep (and often, then can’t wake up and get going, after finally getting 2 hours of sleep). Difficulty thinking can be profound: a math major who suddenly can’t do calculus; a mother who spends 10 minutes trying to decide which peanut butter to buy, or who can’t do laundry because folding and putting away the clothes requires too much concentration.
This is not mania. It’s not even “bipolar”, exactly. But Mixed depression is “a little bipolar” because those overenergized symptoms are a like manic symptoms. It’s having depressed and manic symptoms at the same time. Yes, that happens. Often.
However… you can get the same mixture of symptoms by combining depression with extreme anxiety; or with traumatic experiences (PTSD); or with relationship struggles (“borderline”); or with attention problems (ADD). So if someone has depression with anxiety, or anger, or agitation, or attention problems — is that a Mixed State or one of these other diagnoses plus depression? Figuring out this out can be very difficult. I think it’s basically impossible sometimes, because the symptoms of all these mood/energy problems overlap so much.
Here’s why you have to try to figure out what you’ve got. Antidepressants, which are treatment options for PTSD and anxiety and relationship struggles and even attention-problems-with-depression, can cause a Mixed State, and they can make it worse. And it can be difficult to get out of a Mixed State if you’re on an antidepressant, unless you lay on a pretty heavy layer of antimanic medication. Here’s a page with more about Mixed States, and one about their treatment.
In any case, be aware: this is very tricky territory, where doctors and psychiatric nurse practitioners and therapists frequently disagree with one another, because the diagnostic overlap is so broad.
A Questionnaire to help
The MoodCheck questionnaire will help you decide where you are on the spectrum of depressions. If your score is really low, it’s likely you have a lifelong or first episode depression. If your score is high, that suggests your depressions are more complicated, likely either episodic or mixed (or maybe just a first episode and you haven’t gotten complicated yet!).
Take the MoodCheck questionnaire. Then go to the Scoring and Interpreting page. Or see more about Diagnosis or Treatment using the pull-down menus above.