Information Thread: Mood Disorders

by **Butterfly Faerie** » Thu May 18, 2006 3:22 pm

Cyclothymia

The Facts

Cyclothymic disorder is a type of mood disorder, where people experience numerous periods of mood "highs" and "lows" that are unrelated to life circumstances. The mood instability - mild elation or mild depression - is related to bipolar disorder (formerly known as manic depression), and is in fact considered to be a milder form of bipolar disorder. Though less severe, cyclothymia can have great impact on a person's life, with unexpected and extreme mood changes disrupting the ability to function normally.

Both men and women are equally likely to suffer from cyclothymia, affecting up to 1% of the population. Cyclothymic disorder generally starts appearing during young adulthood, though onset may also occur at a later age.

Causes

The exact causes of cyclothymia are not known, but it is often a result of the same genetic factors that cause bipolar disorder. In fact, approximately one in three people with cyclothymia will eventually be diagnosed with bipolar disorder following a full-blown manic episode or major depression. There is usually a family history of major depression, bipolar disorder, suicide, or alcohol or drug dependence in people with cyclothymic disorder.

Symptoms and Complications

Radical changes in mood and behaviour, alternating between highs and lows, are typical signs of cyclothymia. Mood "highs" in cyclothymia are similar to hypomania but do not fulfill complete hypomania criteria (i.e., in cyclothymia the duration of the "high" is less than the four-day minimum for hypomania and/or there is less than the three associated mental or physical symptoms required for a diagnosis of hypomania). Likewise the mood "lows" in cyclothymia are similar to major depression but do not fulfill full major depression criterion (i.e., in cyclothymia the duration of the depression is less than the two-week minimum required for major depression and/or there is less than the associated minimum of five mental or physical symptoms found in major depression).

The continual - and unpredictable - mood cycling often takes its toll on an individual's life, even though altered mood episodes aren't as extreme as with manic depression. Mood changes make it difficult to sustain enthusiasm for new projects, or for work. Personal relationships tend to suffer from the "warm-cool" ups and downs associated with hypomanic and depressive episodes, and from the abrupt personality changes that a cyclothymic individual will display. Over time, mood cycling can lead to repeated loss of employment and may become destructive to personal relationships.

Making the Diagnosis

Doctors consider that a diagnosis of cyclothymia can be made if there is a history of mood instability over a period of at least two years, and symptom-free intervals never last more than two months. For children and adolescents, symptoms only need to be present over a one-year period.

Cyclothymia will otherwise be difficult to diagnose if a person's mood instability has not been recognized and tracked over at least a couple of years. Because mood may be normal and stable for long periods of time - and mood elevations or depressions can be quite mild - symptoms do not always attract medical attention. People may not look for help until symptoms and mood swings become severe enough to interrupt normal functioning and activities.

If a person has experienced major depressive, manic, or mixed episodes, the diagnosis will likely be changed to bipolar I or II disorder. Your doctor will usually also need to rule out other conditions as these symptoms could be caused by substance abuse, physiological effects of certain medications, or an unrelated medical condition.

Treatment and Prevention

Medical options for treating cyclothymia include the use of lithium, a mood stabilizer that is also used in the treatment of bipolar disorder. Lithium can reduce the frequency of mood-cycling, as well as control hypomanic symptoms. Low-dose valproic acid* has also been shown to be a treatment option.

Because symptoms can be mild, it is possible that cyclothymia might never be diagnosed. It is also possible that it does not necessarily require treatment. In fact, a degree of hypomania may be responsible for a person's success in life, be it business- or leadership-drive or other achievements. However, for those who have a family history of bipolar disorder or are at risk for a depressive episode, the symptoms may hit them hard and have drastic consequences. In such cases, awareness of cyclothymic and bipolar disorders - coupled with medical monitoring - can help prepare the individual for these episodes and ensure that they get prompt and effective treatment.

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*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

Postpartum Blues

The Facts

Having a baby is one of life's most wonderful experiences. It's exciting and joyous, but it can also be very frightening. After a woman has had a baby, she may find that she is confused and overwhelmed about the various emotions that she feels. She may worry that she's unable to deal with the responsibility of being a full-time parent.

After childbirth, many women experience symptoms of depression that can range from a brief attack of the "baby blues" to a serious and major clinical depression known as postpartum depression. A great majority of new mothers, about 80%, will experience a mild form of "baby blues", usually within a few days after giving birth. These feelings will usually resolve on their own and disappear over a few weeks time. Postpartum depression affects about 10% to 15% of new mothers. This type of depression can affect women who have never been depressed before. Approximately 50% of women who were depressed during or after their pregnancy will also experience depression during future pregnancies.

Postpartum psychosis is the most severe form of postpartum depression. It is relatively rare, and requires immediate discussion and treatment with a qualified health-care provider.

Causes

There has been no single cause identified for postpartum depression. In fact, many factors can contribute to it. They may include:

hormonal changes
disappointment in birth experience
a sense of loss from no longer being pregnant
level of marital satisfaction
caring for a very needy baby
lack of family and social support
exhaustion
family history of postpartum depression
history of depression

Symptoms and Complications

For women experiencing the "baby blues", feelings of sadness, anger, irritability, and insecurity are common. Self-doubts about being a competent mother may contribute to these feelings. Bursting into tears often occurs without reason. "Baby blues" may also include the occasional negative thought about the baby. While these feelings are upsetting and disturbing, they're actually perfectly normal, and women shouldn't feel guilty for feeling them.

Postpartum depression is more severe and longer-lasting than the "baby blues." In addition to the above symptoms women may also experience:

constant fatigue
lack of joy in life
sense of numbness
social withdrawal from family and friends
lack of concern for self or the newborn baby
severe insomnia
overconcern for the baby
loss of sexual responsiveness
strong sense of failure and inadequacy
severe mood swings
appetite changes
thoughts of suicide
Postpartum depression actually resembles many other forms of depression, with the added dimension that some of the symptoms involve thoughts about the baby. For example, the woman may not be either too concerned about the baby or not concerned enough; or she may have thoughts or fears of harming the baby.

Postpartum psychosis is a very serious condition that usually begins a couple of days or weeks after childbirth. A woman experiencing this form of depression has become severely depressed and may experience acute anxiety, restlessness, hallucinations, paranoia, and hysteria and have thoughts related to harming herself or the baby.

Making the Diagnosis

Postpartum depression is often overlooked because new mothers spend a lot of time alone with their infants, and it may take some time before anyone notices that they're depressed and in need of professional help. Because they get less sleep, most new mothers are generally exhausted anyway, and family and friends may consider strange or different behaviour to be a reaction to being tired and coping with a new baby.

If you're a new mother and experience any of the above symptoms, you should speak to your doctor as soon as possible. Your doctor may wish to investigate the possibility of postpartum depression. Your doctor will want to spend some time discussing the symptoms with you, and may refer you for counselling or psychological support. If you are close to a new mother and notice symptoms of postpartum depression, remember that it is important to report these concerns to the family doctor immediately.

Treatment and Prevention

If you're experiencing mild depression or the "baby blues" you should take care of yourself by getting adequate rest, eating a nutritious diet, exercising in moderation, and accessing your social support system. Listen and respond to your body's cues for rest. If possible, get some rest during the day while the baby is napping.

If you're suffering from one of the more severe forms of postpartum depression, you should seek early treatment with a doctor so you can have a more rapid recovery. Treatment methods vary and may include counselling, antidepressant medication, anti-anxiety medication, and hormone therapy. Support groups may also be very helpful. Concerned family members should always discuss these symptoms with the family doctor if the new mother does not want to speak with the doctor herself. People suffering from this type of depression are often the last to admit how they really feel.

In some cases, hospitalization may be necessary. Usually, the baby will be admitted with the mother or taken in for visits. The goal of treatment for postpartum psychosis is to keep mother and baby safe and to preserve the mother's sense of competence as a parent while she recovers.

If you're prescribed certain medications, you may need to stop breast-feeding and turn to bottle-feeding instead, as some antidepressants can enter breast milk and affect the baby's health. However, this is not the case with all antidepressants. If you want to continue breast-feeding, ask your doctor about medications that are safe to use while nursing.

The good news is that there's a very high recovery rate for postpartum depression. While a few women may have a longer-lasting experience with depression, most women will find the condition improves within two to three months.

Information Thread: Mood Disorders

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