Depression & Other Mood Disorders

What is Depression?

Everyone experiences sadness at times.  Sadness is a very normal emotion.  Depression is a mood disorder that can be much more debilitating than sadness.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.  According to the World Health Organization, depression is the leading cause of worldwide disability. Men and women may experience depression differently. Women are affected at twice the rate of men, while men with depression are more likely to die by suicide. There are also gender differences in the way symptoms are experienced.

Major Depressive Disorder:

Major Depressive Disorder, also known as clinical depression is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression.

Click the tab below to view the symptoms:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Dysthymia:

People with dysthymia generally experience little or no joy in their lives. Instead things are rather gloomy most of the time. If you have dysthymia you may be unable to remember a time when you felt happy, excited, or inspired. It may seem as if you have been depressed all your life. You probably have a hard time enjoying things and having fun. Rather, you might tend to be inactive and withdrawn, you worry frequently, and criticize yourself as being a failure. You may also feel guilty, irritable, sluggish, and have difficulty sleeping regularly.  Symptoms have lasted for at least two years.

Symptoms of Dysthymia usually come and go over a period of years, and their intensity can change over time. But typically, symptoms don’t disappear for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression. In children, symptoms of persistent depressive disorder may include depressed mood and irritability. (Mayo Clinic).

Persistent depressive disorder can cause significant impairment and may include the symptoms in the tab below.

• Loss of interest in daily activities
• Sadness, emptiness or feeling down
• Hopelessness
• Tiredness and lack of energy
• Low self-esteem, self-criticism or feeling incapable
• Trouble concentrating and trouble making decisions
• Irritability or excessive anger
• Decreased activity, effectiveness and productivity
• Avoidance of social activities
• Feelings of guilt and worries over the past
• Poor appetite or overeating
• Sleep problems

Treatment For Depression:

Depression is a condition that is treatable.  Cognitive Behavioral therapy is a type of psychotherapy that works on changing thoughts and behaviors that keep the depression going.  Intervention in this area can make a big difference and give people a much better quality of life.  Looking at lifestyle can be an important component in treating depression. Nutrition, exercise, and stress reduction can be invaluable to people living with depression.  Acupuncture, and Reiki can also be very helpful.

Depression is often caused by a chemical imbalance in the brain.  There can also be a genetic component to depression.  When this is the case Medication can be helpful.  A Psychiatrist or a Primary Care Physician can work in conjunction with a psychotherapist to help a person with depression get the best results.

What is Bipolar Disorder?

Bipolar Disorder is a mood disorder that is characterized by mood that alternates between two emotional extremes, or poles: the sadness of depression and the euphoria of mania. Between these emotional swings, there are periods when a person’s mood is quite normal. When a person is in the depressed phase of bipolar illness, he or she will have the same symptoms as those found in major depressive disorder. The depressive episodes can often be severe. While in a manic phase, a person experiences mood that is extremely elevated, expansive, or irritable. Mania can seriously impair one’s normal judgment. When manic, a person is prone towards reckless and inappropriate behavior such as engaging in wild spending sprees or having promiscuous sex. He or she may not be able to realize the harm of his/her behavior and may even lose touch with reality.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for bipolar disorder is based on the specific type of disorder:

• Bipolar I disorder. You’ve had at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).
• Bipolar II disorder. You’ve had at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days, but you’ve never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression. (National Institute of Mental Health).

People having a manic episode may:

• Feel very “up,” “high,” or elated
• Have a lot of energy
• Have increased activity levels
• Feel “jumpy” or “wired”
• Have trouble sleeping
• Become more active than usual
• Talk really fast about a lot of different things
• Be agitated, irritable, or “touchy”
• Feel like their thoughts are going very fast
• Think they can do a lot of things at once
• Do risky things, like spend a lot of money or have reckless sex

People having a depressive episode may:

• Feel very sad, down, empty, or hopeless
• Have very little energy
• Have decreased activity levels
• Have trouble sleeping, they may sleep too little or too much
• Feel like they can’t enjoy anything
• Feel worried and empty
• Have trouble concentrating
• Forget things a lot
• Eat too much or too little
• Feel tired or “slowed down”
• Think about death or suicide

Treatment For Bipolar:

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to control these symptoms.

Medication is an important component to dealing with Bipolar disorder.  There are many classes of medications that a psychiatrist can discuss with you that can help regulate the symptoms.

Psychotherapy is so critical to people living with Bipolar disorder.  This is a chronic illness and people diagnosed with this disorder need help and support with learning how to live with a chronic illness.  There are many skills that people can learn to help them deal with the mood swings. Dialectical Behavior Therapy (DBT) is one approach that can be very helpful.  DBT is a skilled based type of therapy that teaches clients very specific skills that help with emotional regulation.  DBT skills can be done in groups and with individual therapists.