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Mood Disorders
From the
Canadian Mental Health Association
The highs and lows of life are experienced
with greater intensity, and for longer periods, by people with mood disorders.
People with these disorders may experience depressive episodes (feeling very
"low") or manic episodes (feeling very "high"), or both.
Mood disorders are among the most common
mental disorders – approximately one in 10 people experiences a mood disorder.
Depression
Seasonal
Affective Disorder (SAD)
Postpartum
Depression
Bipolar
Disorder (formerly known as Manic Depression)
TORONTO THERAPISTS:
What is
depression? 
Depression
is a clinical term used by psychiatrists to describe a period of time when a
person feels very sad to the point of feeling worthless, hopeless and helpless.
Everyone experiences unhappiness at some time in his or her life, and many
people may become depressed temporarily when things do not go as they would
like. When a depressed mood persists however, and begins to interfere with
everyday living, it may be the sign of a serious state of depression that
requires professional help.
What
causes depression?
There is no single cause
of depression. Stressful and discouraging situations naturally overwhelm and
have the potential to become serious. Experiences of failure commonly result in
temporary feelings of worthlessness and self-blame, while personal loss causes
feelings of sadness, disappointment and emptiness.
The onset of depression
may sometimes be attributed to some of these factors:
a genetic
predisposition
death or illness of
friend/family member
financial difficulties
difficulties with job
or personal relationship
poor self-esteem
seasonal or hormonal
changes
addictions
Researchers believe that a
deficiency of certain chemicals in the brain and/or genetics may also affect how
likely we are to develop an ongoing or serious depression. Any of the factors
listed above may act as triggers to release disturbances in brain chemical
function.
What are
the symptoms?
Depression can change the
way a person thinks and behaves, and how his or her body functions.
Some of the signs to look
for are:
feelings of despair
and hopelessness
feeling detached from
life and those around you
continued fatigue or
loss of energy
feelings of sadness
– crying for no apparent reason
inability to
concentrate or make decisions
thoughts of suicide
changes in eating or
sleeping patterns
persistent or
recurring headaches or frequent gastrointestinal upsets
What can
friends and family do?
It is important to know
that depression is an illness and no individual or family member should feel
responsible for the depression. The depressed person should not be blamed or
told to 'pull themselves up by their boot straps'. Some people who are depressed
keep to themselves, while others might not want to be alone. Listen and offer
support rather than trying to contradict or talk an individual out of it. It is
important that you let them know that it is all right to talk about their
feelings and thoughts. Ask them how you can help and go with them to their
family doctor or a mental health professional. Most of all, do not do it alone
– get other people to provide help and support.
What are
the treatments?
Depression is a treatable
illness. No one has to suffer endlessly. Most people with clinical depression
feel a sense of relief when they learn the facts about this illness; they
realize depression is not a personal weakness, and most importantly, they learn
they are not alone.
Each case of depression is
unique, so people may require different methods of treatment. The most common
and successfully used treatments for depression are psychological counselling in
combination with anti-depressant medication. Support from family, friends and
self-help groups can also make a big difference.
Where can
one go for help?
Remember you are not
alone. You will be taking a major step toward recovery when you begin to seek
help.
Seasonal
Affective Disorder (SAD)
How is a
"seasonal pattern" of depression defined?
Seasonal affective
disorder (SAD) is a subtype of major depression characterized by onset at a
certain time of year, usually the winter. First defined in 1984, SAD is also
called 'seasonal depression,' 'winter depression,' or 'major depression with a
seasonal pattern.' Each of these terms refers to a subtype of major depressive
disorder.
SAD is characterized by
the following four central features:
Recurrent major
depressive episodes that start at approximately the same time every year
(e.g., September-October) and end around the same time every year (e.g.,
March-April).
Full remission of
symptoms during the unaffected period of the year (e.g., May-August). To be
considered a full remission, symptoms of the seasonal episode must be absent
for at least two consecutive months.
Over the lifetime
course of the illness, there are more seasonal depressive episodes than
non-seasonal episodes of depression.
Seasonal depressive
episodes occur in at least two consecutive years.
What are
the symptoms of depression in SAD?
Individuals suffering from
SAD have all the typical symptoms of depression, including low mood, reduced
interest, decreased concentration, low energy and fatigue. In addition, however,
they also tend to have a specific symptom cluster comprised of
increased sleep (70-90
percent of people with SAD)
increased appetite (70-80
percent of people with SAD)
unacceptable weight gain
(70-80 percent of people with SAD)
carbohydrate/sweets
craving (80-90 percent of people with SAD).
Is the
diagnosis of SAD stable over time?
Long-term follow-up
studies of SAD have found that over 60 percent of individuals diagnosed with the
disorder continue to demonstrate a seasonal disturbance of mood and/or behaviour
over time. Approximately 20 percent of people with SAD can have complete
remission within several years of first diagnosis. The stability of the
diagnosis of SAD seems to be similar to the long-term stability of the diagnosis
of major depression itself (i.e., 44 to 76 percent of individuals with major
depression maintain the diagnosis over several years of follow-up).
Do SAD
patients frequently have bipolar illnesses?
The majority of people
with SAD have unipolar depression, but as many as 20 percent may have or go on
to develop bipolar depression. Typically the manic or hypomanic episodes occur
in the spring and summer, and it is critical that these episodes be
distinguished from the improved mood related to the remission of SAD for that
season. There are important treatment differences for individuals with bipolar
as compared with unipolar illness.
What is
the prevalence of SAD?
In Canada, the prevalence
rate of SAD is between 2 and 3 percent. In the United States, however, the rate
is less than 1 percent. European community-based studies have estimated the
prevalence of SAD to be between 1.3 and 3 percent of the European population,
whereas studies in Asia report rates of 0 to 0.9 percent of their population.
What is
the female to male ratio?
Women are more likely to
suffer from SAD than are men, with an average ratio of approximately 1.8 to 1.
However, some studies place the female to male ratio much higher, at 4 to 1.
What is
the prevalence with respect to age?
The lifetime prevalence of
SAD increases with age until people are in their fifties. After the age of 50 to
54, prevalence rates decline dramatically, and the occurrence of SAD in people
over the age of 65 is very low.
For every woman, having a baby is a
challenging time, both physically and emotionally. It is natural for many new
mothers to have mood swings after delivery, feeling joyful one minute and
depressed the next. These feelings are sometimes known as the 'baby blues', and
often go away within 10 days of delivery. However, some women may experience a
deep and ongoing depression which lasts much longer. This is called postpartum
depression.
References to postpartum depression date
back as far as the 4th century BC. Despite this early awareness, it has not
always been recognized as an illness. As a result, postpartum depression
continues to be under-diagnosed. It is an illness that can be effectively
treated. The sooner the condition is diagnosed, the more effective the
treatment. It is important to recognize and acknowledge the symptoms of
postpartum depression in yourself or another as soon as possible. This can be
difficult, since the depressive feelings often involve intense and irrational
feelings of fear. The mother may fear she is losing her mind or fear that others
may feel she is unfit to be a mother.
Women with postpartum depression may feel
like they are bad mothers and be reluctant to seek help. It is important to
remember that hope and treatment are available to women in need.
Defining postpartum
depression
Researchers have identified three types of
postpartum depression: baby blues; postpartum depression and postpartum
psychosis.
The 'baby blues' is the most minor form of
postpartum depression. It usually starts 1 to 3 days after delivery, and is
characterized by weeping, irritability, lack of sleep, mood changes and a
feeling of vulnerability. These 'blues' can last several weeks. It's estimated
that between 50% and 80% of mothers experience them.
Postpartum depression is more debilitating
than the 'blues.' Women with this condition suffer despondency, tearfulness,
feelings of inadequacy, guilt, anxiety, irritability and fatigue. Physical
symptoms include headaches, numbness, chest pain and hyperventilation. A woman
with postpartum depression may regard her child with ambivalence, negativity or
disinterest. An adverse effect on the bonding between mother and child may
result. Because this syndrome is still poorly defined and under studied, it
tends to be under reported. Estimates of its occurrence range from 3% to 20% of
births. The depression can begin at any time between delivery and 6 months
post-birth, and may last up to several months or even a year.
Postpartum psychosis is a relatively rare
disorder. The symptoms include extreme confusion, fatigue, agitation,
alterations in mood, feelings of hopelessness and shame, hallucinations and
rapid speech or mania. Studies indicate that it affects only one in 1000 births.
Causes and risk factors
The exact cause of postpartum depression is
not known. One factor may be the changes in hormone levels that occur during
pregnancy and immediately after childbirth. Also, when the experience of having
a child does not match the mother's expectations, the resultant stress can
trigger depression. Studies have also considered the possible effects of
maternal age, expectations of motherhood, birthing practices and the level of
social support for the new mother.
There is no one trigger; postpartum
depression is believed to result from many complex factors. It is important,
however, to communicate to women with postpartum depression that they did not
bring it upon themselves.
One certain fact is that women who have
experienced depression before becoming pregnant are at higher risk for
postpartum depression. Women in this situation should discuss it with their
doctor so that they may receive appropriate treatment, if required. In addition,
an estimated 10% to 35% of women will experience a recurrence of postpartum
depression.
The amount of sick leave taken during
pregnancy and the frequency of medical consultation may also be warning signs.
Women who have the most doctor visits during their pregnancy and who also took
the most sick-leave days have been found to be most likely to develop postpartum
depression. The risk increases in women who have experienced 2 or more
abortions, or women who have a history of obstetric complications.
Other factors which increase the risk of
postpartum depression are severe premenstrual syndrome (PMS), a difficult
relationship, lack of a support network, stressful events during the pregnancy
or after delivery.
How is postpartum
depression treated?
Therapy, support networks and medicines such
as antidepressants are used to treat postpartum depression. Psychotherapy has
been shown to be an effective treatment, and an acceptable choice for women who
wish to avoid taking medications while breastfeeding.
Coping with postpartum
depression
First, remember that you are not alone - up
to 20% of new mothers experience postpartum depression. Equally important is
remembering that you are not to blame. Here are some suggestions for coping:
If you think a friend or family member is
suffering from postpartum depression, offer your support and reassurance. You
may be able to direct them towards useful sources of information about
postpartum depression. Easing the isolation they feel is an important step.
Bipolar Disorder
(formerly
known as Manic Depression)
What is bipolar disorder?
Bipolar disorder is characterized by
opposing moods which accompany the illness. People with bipolar disorder
experience great highs (manic stage) and great lows (depressive stage). Bipolar
illness often begins with a depression in adolescence or early adulthood,
although the first manic episode may not occur until several years later.
Bipolar disorder affects 1% of the
population
The first major depression usually occurs
during a person’s 20s
Depression is 4 to 5 times higher in people
between ages 18-44
If untreated, 20% of depressive episodes can
last for up to two years
What causes bipolar
disorder?
There is no single cause of bipolar
disorder. Researchers believe however that biological factors such as genetics
and the brain’s chemistry seem to play a major role in producing the illness.
One’s personality, along with stresses in the environment, may also play a
part in bringing on an acute episode of mania or depression. Stress management
along with medication has been very helpful in controlling manic and depressive
episodes.
What are the symptoms?
An individual who has bipolar disorder
experiences both mania and depression. Attacks of mania come on very quickly,
sometimes within a single day, or can build slowly. Manic episodes can last for
hours, weeks or months.
Symptoms of the manic phase (some or all may
be present):
a sudden onset of exhilaration and giddiness
that increases in intensity – the individual’s mood seems excessively good
expressions of unwarranted optimism and lack
of judgment – self-confidence can reach the point of grandiose delusions,
including beliefs such as having a special connection with God
the individual may think that nothing, not
even the laws of gravity, can prevent the accomplishment of a goal – as a
result, the person may think it possible to step off a building or out of a
moving car without being hurt (hallucinations may occur)
excessive plans or participation in numerous
activities – the individual fails to recognize that there is not enough time
in the day to complete all his or her tasks
mania can result in reckless driving,
spending sprees, increased intake of alcohol or other drugs, foolish business
investments or sexual behavior unusual for the person
flight of ideas – thoughts race
uncontrollably and words spill out in a non-stop rush
ideas change abruptly from topic to topic
– in a severe manic episode, loud rapid speech becomes difficult to interpret
because thoughts are so disorganized and incoherent
decreased need for sleep – the individual
can go for days with little or no sleep without feeling tired
distractibility – attention is easily
diverted to inconsequential or unimportant details
sudden irritability, rage, paranoia – when
the individual’s grandiose plans are thwarted or excessive social overtures
are refused, an emotional outburst may ensue.
Without treatment the manic phase can last
for about 4 months. The individual may then have a period of normal mood and
behaviour, but the depressive stage soon sets in. In some people, the depressive
mood occurs immediately or within a few months. For others a long interval of a
few years may precede the next manic or depressive interval. Depressions come
and go more slowly.
Symptoms of the depressive phase (some or
all may be present):
What are the treatments?
Bipolar disorder responds well to treatment
once the illness has been diagnosed. The diagnosis should be made by a physician
who is familiar with bipolar disorder and depression, since the symptoms of
bipolar disorder can be confused with other illnesses. There are many different
types of medication that can be used to help manage an individual’s mood
swings. Through a combination of psychotherapy and medication, an individual can
lead a full, productive life. Any medication must be monitored carefully by a
trained physician.
Where can one go for help?
Remember, you are not alone. You will be
taking a major step toward recovery when you begin to seek help.
Ingrid Dresher CONTACT INFORMATION
THERAPY IN ETOBICOKE: Susan Wood
THERAPY IN SCARBOROUGH: Beth Mares
THERAPY IN GUELPH: Bruce Stiles
| Marital
Counselling | Jungian
Analysis |
| Contact
Ingrid |