Depression affects millions of people every year, but it doesn’t look the same for everyone. While many people use the word “depression” broadly, clinicians recognize several different subtypes of major depressive disorder, each with unique patterns and symptom presentations.

Understanding these subtypes can help patients make sense of their experiences, recognize when symptoms may be changing, and know when it might be time to seek additional support. It also helps highlight when a person may be experiencing treatment-resistant depression (TRD) — the category for which Spravato® (esketamine) is FDA-approved.

This guide explains the main depression subtypes, what sets them apart, and how individuals can know when it may be appropriate to consider advanced treatment options.

What Is Treatment-Resistant Depression?

Before reviewing subtypes, it is important to define treatment-resistant depression (TRD).

TRD is generally defined as:

✔ Major depressive disorder
✔ That has not improved despite trying at least two antidepressant medications at adequate doses and durations

Spravato is FDA-approved for adults with treatment-resistant depression.

Common Depression Subtypes

Depression can manifest in different ways. Below are several subtypes recognized in clinical practice. This list is for educational purposes — only a licensed clinician can diagnose depression or determine its subtype.

1. Major Depressive Disorder (MDD), Unspecified

Symptoms may include:

• Persistent low mood

• Loss of interest

• Fatigue

• Feelings of guilt or worthlessness

• Sleep or appetite changes

• Difficulty concentrating

This is the general category under which all additional subtypes fall.

2. Melancholic Features

Symptoms may include:

• Marked loss of pleasure

• Lack of reactivity to positive events

• Early morning awakening

• Significant changes in appetite

• Psychomotor slowing or agitation

  
  

3. Atypical Features

Symptoms may include:

• Mood reactivity

• Increased sleep

• Increased appetite

• Feeling “heaviness” in limbs

• Sensitivity to rejection

4. Anxious Distress

Symptoms may include:

• Tension

• Excessive worry

• Restlessness

• Fear of losing control

This is a very common specifier, especially in individuals who experience both depression and anxiety.

5. Seasonal Pattern (Seasonal Affective Disorder)

Symptoms may occur:

• In the fall and winter months

• With predictable yearly patterns

6. Peripartum Onset

Symptoms may appear:

• During pregnancy or after childbirth

7. Psychotic Features

Symptoms may include:

• Delusions

• Hallucinations

• Severe depressive symptoms

This subtype requires careful, specialized treatment.

How Depression Subtypes Relate to Treatment Choices

Different depression subtypes may respond better to certain therapeutic approaches, lifestyle changes, or medication strategies. However:

When to Consider Advanced Treatments Like Spravato®

While many people experience relief from traditional antidepressants, therapy, or lifestyle changes, others continue to struggle despite multiple attempts.

You may want to speak with a psychiatrist about advanced treatment options if:

✔ You have tried two or more antidepressants without meaningful improvement
✔ Symptoms significantly interfere with daily functioning
✔ You feel “stuck” despite therapy or medication adjustments
✔ Your provider has discussed the possibility of treatment-resistant depression

A comprehensive psychiatric evaluation can help determine whether Spravato is an appropriate option.

Why Understanding Your Subtype Still Matters

Identifying the correct depression pattern can help your provider:

• Tailor your overall treatment plan

• Select appropriate medication strategies

• Integrate therapy approaches each subtype responds well to

• Monitor for changes or worsening symptoms

• Determine when TRD criteria may be met

Depression is complex, and personalized care leads to the best outcomes.

If You Suspect You May Have Treatment-Resistant Depression

If you’ve tried multiple treatments and continue to struggle with significant depressive symptoms, you may benefit from an evaluation to discuss advanced options such as Spravato®.

At Aurora Wellness, our psychiatrists in White Plains and Brooklyn provide comprehensive assessments to determine whether Spravato is an appropriate and safe option as part of your treatment plan.

If you’re considering Spravato or want to explore whether it may be right for you, book an appointment/consultation with Aurora Wellness to get started.

Final Thoughts

Depression has many forms, and understanding its subtypes can help make sense of your personal experience. While these subtypes do not determine whether Spravato is effective or appropriate, they can guide your overall treatment plan and help you recognize when it may be time to explore additional options.

If you are struggling despite multiple treatments, you may meet criteria for treatment-resistant depression, the condition for which Spravato is FDA-approved.

Aurora Wellness provides comprehensive evaluations for patients considering Spravato® treatment at our clinics in:

📍 White Plains, NY
📍 Brooklyn, NY

If you're wondering whether you may qualify, our clinical team can walk you through every step.