Information Thread: Mood Disorders

Here you can find or post helpful information on Mood Disorders related to Depression.

1. General Information On SAD
2. How to deal with Depression
3. Information on Bipolar Disorder
4. Depression
5. Symptoms: Major Depressive Disorder
6. Symptoms: Hypomanic Episode
7. Symptoms: Mixed Episode
8. Bipolar Affective Disorder
9. Chronic Depression
10. Cyclothymic Disorder
11. Postpartum Depression

Since I suffer from SAD and have been for about 8 years now I thought this would be a good time to post some info on this because the days are starting to get shorter.


Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression that occurs at the same time each year (usually winter) for at least 2 years in a row. It sometimes is called the "winter blues" because most people with seasonal affective disorder have an episode of depression during the winter months, although it is possible to experience SAD during summer months.

SAD consists of four central features:

Recurring major depressive episodes that begin around the same time each year (usually in September or October) and end around the same time each year (usually in April or May)
Full recovery from the symptoms during "nonseasonal" months (usually May through August)
Depressive episodes that occur during the same time of year for 2 consecutive years
Over the lifetime course of the illness, more depressive episodes during winter months than summer months
People with SAD who have episodes of depression in the winter usually live in areas far north of the equator, where there are shorter days in the winter months (such as Alaska and other northern states in the United States, as well as Canada and Scandinavian countries). They begin to get symptoms of depression in the fall, need treatment throughout the winter, and get better in the spring and summer as the days lengthen.

Less is known about seasonal affective disorder in which episodes of depression occur in the summer. Symptoms of summer SAD usually appear in late spring or early summer and resolve in the fall. Summer SAD may be related to excessive heat rather than a lack of light. A person with summer SAD may be irritable or have no energy.

The specific cause of SAD is not clearly understood. However, lack of sunlight caused by the shorter and darker days of winter, darkened or indoor working places, and long cloudy spells have been linked to episodes of depression in people with SAD. Some experts think SAD may be caused by a disturbance in circadian rhythms or problems with the regulation of a brain chemical (neurotransmitter) called serotonin.

SAD can be difficult to distinguish from major depression. A family history of SAD increases the risk of developing SAD. While there is no known cure for SAD, the depressive episodes of SAD can be managed effectively with medications, counseling, light therapy, or a combination of these.


Treatment of SAD's

Treatment studies of light therapy have shown increasingly rigorous methodology with larger sample sizes, less diagnostic heterogeneity, longer treatment periods, and parallel instead of crossover designs. Wavelength of light used in light therapy was examined in two studies. In one study, the ultraviolet (UV) spectrum did not add to the therapeutic efficacy of light therapy. Because of the potential harmful effects of long-term W exposure, light therapy devices should have W filters that block wavelengths below 400 nm. In a comparison light box study, cool-white fluorescent lights were as effective as full-spectrum fluorescent lights, adding evidence to other studies showing that various light sources (including incandescent lights) are effective for treating SAD.

Devices other than light boxes were also studied for light therapy. Two recent studies, with the largest sample sizes in light therapy studies to date, used a light visor. In both studies, there was no relationship between the intensity of light and various measures of response to treatment, despite the fact that very low intensity light (60 lux) was used. This contrasts to most light box studies where a dear intensity-response relationship is found. Several explanations may explain this discrepancy. The proximity of the visor light source to the eye may increase the amount of light that reaches the retina, as compared to a light box. Lux, a unit of illumination, may also not be the best measure of the biologic or therapeutic effect of light. There is increasing evidence that even low illumination can affect biologic parameters, so that for some patients, light as low as 100 lux may be therapeutically effective. Finally, although the response rate was high in both studies (over 60% by strictly defined criteria), a non-specific (placebo) effect of light therapy must also be considered. In this regard, a light box study by Eastman and associates using a non-light control condition (a negative ion generator that, unknown to subjects, was turned off), found no differences between the control condition and bright light treatment (7000 lux for 1 hour in the morning). However, the response rate for the bright light condition (29%) was unusually low compared to other treatment studies. The selection criteria and unusually sunny weather during
the course of their study may have excluded more light-responsive patients. Thus, the issue of placebo effects in light therapy remains unresolved.

The Seattle group conducted a series of studies investigating dawn simulation in SAD. Dawn simulation uses a device that gradually increases illumination exposure, while the patient is sleeping, to simulate a summer dawn during the winter. Significant improvement occurred using dawn simulation compared to various control conditions, despite a final illumination as low as 250 lux.

Two groups studying predictors for light therapy found that hypersomnia and hyperphagia predicted clinical response. Another study, however, reported that only high consumption of sweets in the latter half of the day predicted response to treatment. Of interest is that prospective measures of sleep and eating were used in the latter study, whereas the other studies used global patient self-report.

Light therapy has been considered a rather benign treatment with few side effects. A systematic report of side effects to light therapy using a light visor showed that approximately 20% of patients reported mild side effects, including headache, eyestrain, and "feeling wired". A more controversial topic is the potential for prolonged bright light exposure to produce harmful effects on the retina. The intensities of light used in light therapy regimens are not considered harmful to the human retina based on short term studies, but the retinal effects of long term bright light exposure are not known. Some investigators have called for routine ophthalmologic evaluation prior to starting light therapy because of the small, potential risk of aggravating previously unrecognized retinal conditions (e.g. macular degeneration) [28*]. Others suggest ophthalmologic screening only in patients with a history of pre-existing retinal disease, patients taking highly photosensitizing drugs, and the elderly. Empiric data are still sparse, but a recently reported five-year prospective study of patients on chronic light therapy has not shown any significant clinical or electrophysiologic changes in the eyes .

Finally, antidepressant drugs are also being studied in SAD. An open study showed efficacy of bupropion in treating SAD. One case-study suggested that citaloprim, a selective serotonin reuptake inhibitor, was as effective as light therapy Fluoxetine was reported to be as effective as light therapy for SAD, and results from at least two double-blind studies of serotonin reuptake inhibitors in SAD will soon be available. What remains a question is whether a combination of medications and light therapy is more effective than either alone.


Mental Health
Treatment For SAD

My friend's info...


*Please note though, I am not a doctor nor a viable replace ment for one. If you are feeling ill or suspect you might have Bipolar, please consult your doctor as he or she is the only one who can truly help you diagnose and/treat this illness or any type of illness! We are here only to help you and give support. We are in no way qualified to give proper medical advice. We can only tell you things that we have learned through our own individual experiences. Everyone is different and any given illness will present itself in different ways in different people.*

Bipolar Disorder or also known as Manic Depression, can be generally divided(there are others but these are the most common) in 3 different categories:

-Bipolar Type 1
-Bipolar Type 2
-Rapid Cycling

Bipolar Type 1 is the most severe form of the illness and will always require a hospital stay at least for the first episode. That is the main difference between Type 1 and Type 2. Type 2 never shows psychotic symptoms, only Type 1, thus Type 2 bipolars are never hospitalized. If they are hospitalized that means that they have Type 1. Although Type 1 is the most severe, it is easier to diagnose than Type 2. Type 2 is very difficult to diagnose as it is sometimes confused for depression if the patient suffers from more downs(depression) than mania.

Basically, Bipolar Disorder can be defined as a person experiencing major mood swings alternating from severe depression and severe mania. The severity of it all will depend on which Bipolar you suffer from. If you have Bipolar Type 1, you will experience at least one full-blown psychotic/manic episode, usually being your first episode. Some will experience more depression than others while some people will experience more mania. Some can experience both stages simultaenously or even experience hypomania which is a mild form of mania, oftentimes experienced by the Type 2 sufferer.

Symptoms of mania include the following:(Not all these symptoms need to be present in order for mania to exist)

-Lesser need of sleep(4 hours or less) or insommnia but never tired.
-Very hyper and even sound of laughter will change and sound eerie.
-Feelings of grandiosity or inflated self-esteem(ie. I am the best, I can do anything, etc.)
-Sexually inappropriate behaviour or an obession with sex.
-Shopping sprees. Spend money recklessly via shopping, gambling, etc.
-Irritablitly, easily angered
-Can't sit still, be able to get a million things done at once.
-Rapid speech
-Shoplifting
-More common in men than in woman but may become aggressive or violent.
-Snappy, sarcastic and down right rude behaviour.
-Restlessness
-Extremely productive, making lots of plans, and just all over the place.
-Others as well.

Depression Symptoms: (not all need be present)

-Excess need for sleep, always tired and general loss of energy, fatigue
-Sucidal thoughts/tendencies. Not wanting to live anymore.
-Constant or obsession with suicidal thoughts.
-Self-mutiliation or cutting.
-Very low self esteem, feelings that life is meaningless.
-Extreme sadness, lots of crying
-Bulimia can form as it is related to bipolar
-Feelings of despair, hopelessness, and feeling desperate to end life.
-Stop caring about physical appearance and it will be quite obvious.
-Things that used to be enjoyed(hobbies, etc) are no longer pleasurable.
-Nothing seems worth it anymore.
-Lots of crying , screaming...
-Others

For Type 1 sufferers, these symptoms above are very severe. During an episode, the above can be suffered but as well as psychotic symptoms below:

-Auditory,Visual, and/or Sensory Hallucinations
-Extreme Paranoia
-Delusions
-Loss of touch with reality
-Confusion
-Others

Major depression is one of the most debilitating illnesses affecting Americans today. It can affect your ability to function, think, and feel. More specifically, it is a mood problem noted by pervasive sadness, disappointment, and hopelessness. The depressed person usually has difficulty finding pleasure in life, has feelings of intense loneliness, and has limited energy to engage in life activities. Most people have periods when they feel discouraged about their circumstances. However, true depression goes deeper by lasting longer and impacting one’s whole existence.

People dealing with depression often wish for a better day, but have lost hope that it will come. They do not know how to ‘feel’ better. Those suffering from depression may experience extreme mood fluctuations or a desire to withdraw from interactions with others. Frustrated with the inability to snap out of it, they become more discouraged. In some cases, depression can last for extended periods of time – months or even years. One way to deal with depression is to determine the severity of the experience, understand the influences that prompted its onset, and securing treatment options.

Depression Severity
Depression can impact a person’s life in many different ways. To a large degree, the manifestation of depression depends on the person’s coping style, personality, and previous level of functioning. Following are some symptoms of depression. Review the areas and determine how you compare with the descriptors.

Emotions:

- Blunted emotional presentation or frequent crying spells

- Difficulty in finding pleasure in life activities

Decreased sexual desire

Profound feelings of guilt or shame

Feelings of hopelessness or helplessness

Cold or distant feelings toward family or friends

Behavior:

Decreased interest in participating in activities previously enjoyed

Diminished interest in maintaining one’s hygiene

Neglecting responsibilities

Reduced coping ability

Impaired communication with others (e.g., irritating, sarcastic)

Physical Complaints:

Lack of energy

Compulsive eating or loss of appetite

Headaches, backaches, or general muscle aches without a specific cause

Gastrointestinal problems (e.g., stomach pain, nausea, change in bowel habits)

Insomnia or excessive sleeping

If you have several of these symptoms, you may be seriously depressed. Consulting with a professional counselor may be helpful as you determine a way to handle the problem. One step in this process is to understand the various causes of depression.

What Causes Depression?
Depression can be prompted by a variety of factors. Some episodes of depression are situation-induced. For example, the death of a loved one, the loss of one’s job, or the disappointment of failed efforts to get into graduate school can all initiate an episode of depression. When someone can discern the source of depression, the outlook is more favorable. Specific measures can be incorporated to deal with the pain. However, when no source is clear, the depression may worsen due to lack of treatment.

In addition to situational factors, there are other stressors that prompt depression. Chemical imbalances, personality factors, drug and alcohol use, physical illness, and inadequate dietary practices can influence the onset of depression. Given that so many influences can impact one’s mental health, it is important to monitor one’s lifestyle and health practices.

Treatment Options
All forms of depression are serious if they affect your ability to function. Careful attention to determining the source of inner conflict, strained emotions, and behavioral changes is critical for addressing the development of depression and highlighting treatment options.

Key suggestions for offsetting depression include; exercising to work off tension, meditating to clear the mental impurities of the day, changing the routine aspects of your life, developing a support system, and finding a healthy way to release pent up emotions.

If these initial steps do not provide relief from the pain, other options are available. Consider speaking with a friend, partner, minister, professional counselor, or psychiatrist to canvass a different perspective. In addition to therapy options, there are medicinal treatments that target depression with noted effectiveness.

Self Help

Depression

If you suffer from depression, one thing you will be aware of is that it is far more than just feeling down. In fact, depression affects not only how we feel, but how we think about things, our energy levels, our concentration, our sleep, even our interest in sex. So depression has an effect on many aspects of our lives.

Depression affects our motivation to do things. We feel apathetic and experience a loss of energy and interest - nothing seems worth doing, everything is so pointless that it's hopeless to even try. We have to drag ourselves around. Each day can be a torment of having to force ourselves to perform even the minor activities.


Is all depression the same? No.

That answer was short. There are a number of different types.


Major depression has at least five of the following possible symptoms, which have to be present for at least two weeks.


• Low mood

• Marked loss of pleasure

• Significant change in appetite and a loss of at least 5 percent of normal body weight.

• Sleep disturbance

• Agitation or feelings of being slowed down

• Loss of energy or feeling fatigued virtually every day

• Feeling worthless, low self-esteem, tendency to feel guilty

• Loss of the ability to concentrate

• Thoughts of death and suicide

If you have such a list as this it is best to seek help from a doctor or a mental health professional.


Depression can have an acute onset, (i.e within days or weeks), or come on gradually (over months or years). It can begin at any time.

Sadly, depression is very common. If you suffer from depression you may feel like a failure, if you have a lot of anger and hatred inside, if you are terrified out of your wits, if you think life is not worth living, if you feel trapped and desperate to escape, whatever your feeling, you are not the only one. So many people feel like you do.

Of course knowing this does not make your depression less painful, but it does mean that there is nothing bad about you because you are in this state of mind. These feelings are sadly often part of being depressed. Some people who have not been depressed may not understand it or may tell you to pull yourself together, but this does not mean that there is anything bad about you. It just means that they find it difficult to understand.

Remember, there are many things that can be done to help people who are depressed. There are some good drugs (antidepressants) available and many effective psychological treatments.

SYMPTOMS


A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or major depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood. Social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. For instance, a person who has missed work or school because of their depression, or has stopped attending classes altogether or attending usual social engagements.

A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder generally cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder. Typically the diagnosis of major depression is also not made if the person is grieving over a significant loss in their lives (see note on bereavement below).



Clinical depression is characterized by the presence of the majority of these symptoms:

depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or inappropriate guilt nearly every day
diminished ability to think or concentrate, or indecisiveness, nearly every day
recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Hypomanic Episode

SYMPTOMS

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:


inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

The disturbance in mood and the change in functioning are observable by others.

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

SYMPTOMS

A mixed episode is not a disorder, but rather a part of a mental disorder, most commonly bipolar disorder. It consists of meeting the criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.
Like all mental disorders, the disturbance must be severe enough to cause distress or impairment in social, occupational, education or other important functioning and is not better accounted for by the physiological effects of substance use or abuse (alcohol, drugs, medications) or a general medical condition.

The Facts



We all experience a variety of moods such as happiness, sadness, and anger. Unpleasant moods and changes in mood are normal reactions in everyday life, and we can often identify the events that caused our mood to change. However, when we experience changes in mood or extremes of mood that appear "out of the blue" and make it hard for us to function, these changes are often the result of a mood disorder.

Mood disorders are medical conditions that affect our ability to experience normal mood states, and there are mainly two types: major depressive disorder (also known as unipolar depression), in which all abnormal mood changes involve a lowering of mood, and bipolar disorders (formerly known as manic-depressive disorder), in which at least some of the mood changes involve abnormal elevation of mood.

Bipolar disorder typically begins for people during their mid-twenties. It is unusual for bipolar disorder to begin in childhood without strong familial risk factors and it is rare for its onset to occur after the age of sixty (unless associated with another medical condition). Bipolar disorder occurs in about 2% of the adult population.


Causes



There is no single, proven cause of bipolar disorder, but research suggests that it is the result of abnormalities in the way some nerve cells in the brain function or communicate. Researchers also believe that there is a definite genetic link (family history), in which there is a higher risk for people who have a parent or full-sibling (i.e., a first-relative) with bipolar disorder.

Whatever the precise nature of the cause underlying bipolar disorder, it clearly makes people with the disorder more vulnerable to emotional and physical stresses. As a result, upsetting life experiences, alcohol, illicit drug use, lack of sleep, or other stresses can trigger episodes of illness, even though these stresses do not actually cause the disorder.

Mood disorders are not the fault of the person suffering from them. They are not the result of a "weak" or unstable personality. Mood disorders are treatable medical illnesses for which there are specific medications that help most people.

Symptoms and Complications



Bipolar disorder is a condition in which the person's mood changes in cycles over weeks to months. The nature of mood changes vary from one person to the next. There are four different kinds of mood states or "episodes" in bipolar disorder and these are described in further detail below: mania, hypomania, depression, and mixed episodes involving symptoms of mania and depression. Over the course of the disorder, a person may go through periods of elevated mood, depressed mood, and times when mood is normal.

Mania often begins with a pleasurable sense of heightened energy, creativity, and social ease. However, these feelings quickly progress to full-blown euphoria (extremely elevated mood) or severe irritability. During a manic episode, the person will also have at least four of the following symptoms for at least one week:

needing little sleep
talking so fast that others cannot follow you
having racing thoughts
having hyperactivity or agitation
being so easily distracted that your attention shifts between many topics in just a few minutes
having an inflated feeling of power, greatness, or importance
doing reckless things without concern about possible consequences (e.g., spending too much money, engaging in inappropriate sexual activity, or making risky business investments)
Hypomania is a milder form of mania that has similar but less severe symptoms and has less negative impact on a person's daily activities. During a hypomanic episode, the person may have an elevated mood and be more productive. Because these episodes often feel good, the quest for hypomania may even cause some people with bipolar disorder to stop taking their medications. However, a person does not usually stay in a hypomanic episode for long and gradually shifts into either mania or depression.

Depression: During a depressive episode, the person experiences feelings of sadness or loses interest in the things one normally enjoys. At least four of the following additional symptoms persist for at least two weeks:

insomnia (trouble sleeping) or sleeping too much
loss of appetite or eating too much
decreased interest in pleasurable activities
fatigue or loss of interest
problems concentrating or making decisions
feeling slowed down or feeling too agitated to sit still
feeling worthless or guilty or having very low self-esteem
recurring thoughts of suicide or death
Mixed episodes: The most disabling episodes are those that involve symptoms of both mania and depression together, or alternating frequently during the day. Individuals are excitable or agitated as in mania, but they also feel irritable and depressed. Mixed episodes present the highest risk of suicide. Up to 15% of all people with bipolar disorder may commit suicide.

In severe cases of bipolar disorder, the person may also experience psychotic symptoms which are hallucinations (hearing or seeing things that are not there) or delusions (firmly believing things that are not true).

Patterns of bipolar disorder

People with bipolar disorder vary in the types and frequency of episodes that they experience. Some people may have equal numbers of manic and depressive episodes, while others may have mostly one type or the other. On average, a person has four episodes during the first 10 years of having bipolar disorder.

While several years can pass between the first few episodes, without treatment most people eventually have more frequent episodes. Episodes can last for days, weeks, months, or sometimes even years.

Classifications

According to the episode patterns, bipolar disorder can be classified as:

Bipolar type 1 - a person has one or more manic episodes, usually accompanied by major depressive episodes.
Bipolar type 2 - a person has only hypomanic and depressive episodes, not full mania or mixed episodes. Hypomania often seems normal to the person, and they seek treatment only for depression.
Rapid cycling bipolar disorder - a person has at least four episodes per year in any combination of mania, hypomania, mixed, or depression.

Making the Diagnosis



A doctor will diagnose bipolar disorder based on a pattern of symptoms. Diagnosis usually involves a thorough medical history, questions about family history, a physical exam, and a psychiatric evaluation that assesses the history of depression and mania episodes.

Early and proper diagnosis is an important step towards preventing other complications such as suicide; alcohol or substance abuse; marital or work problems; and more frequent cycling episodes.

Treatment and Prevention



People with bipolar disorder will receive treatment to manage their current episodes as well as treatment on a long-term basis to prevent future episodes. Components of treatment include medications, education, and psychotherapy. Electroconvulsive therapy (ECT) is usually reserved for people who do not respond to treatment with medications for bipolar disorder.

Medications: Treatment for bipolar disorder must be customized to fit the individual because the patterns and severity of this disorder vary from one person to the next. Long-term medications are commonly used to treat bipolar disorder. Medications used to manage bipolar disorder are as follows:

Mood stabilizers: Most people with bipolar disorder are treated with medications called mood stabilizers (e.g., lithium*, divalproex or valproic acid, carbamazepine). These medications provide relief from current episodes, prevent them from recurring, and do not worsen depression or mania, or lead to increased cycling. Sometimes other medications normally used to treat people who have epilepsy are used to treat symptoms of bipolar disorder (e.g., gabapentin, lamotrigine, topiramate). Combination therapy with two mood stabilizers is sometimes recommended for people who do not respond to or develop resistance to the use of one medication. These medications need to be closely monitored by the doctor.

Antidepressants: These medications treat the symptoms of depression, and they work by altering the levels of certain chemicals in the brain in a way that elevates a person's mood. For people with bipolar disorder, antidepressants must be used together with a mood stabilizer medication to prevent cycling into a manic episode. Many types of antidepressants are available, working in different ways, and with different side effect profiles.

Other medications may be prescribed by the doctor for other problems associated with bipolar disorder such as medications for sleeping, anxiety, restlessness, or thought disturbances.

It is important for people with bipolar disorder to keep taking these medications in order for the drugs to work properly in managing this condition. Do not stop taking these medications or adjust the dose on your own, without speaking to your doctor or pharmacist first. Symptoms that recur after medications have been stopped are sometimes much harder to treat. Talk to your doctor and pharmacist if you have any questions about the medications you are taking and ask about possible side effects.

Education and counselling: Learning more about bipolar disorder and seeking counselling can help people and their families learn how to best manage the condition and prevent other complications from occurring.

Psychotherapy: Psychoeducation (or psychotherapy) is usually combined with medication to help people with bipolar disorder and their families understand and deal with the medical condition. Specific psychotherapies (cognitive behavioural, interpersonal, and problem-solving therapy can be as effective as antidepressants in treating the depressive episodes in bipolar disorder).

Other things that a person with bipolar disorder can do to help reduce symptoms include:

learn to recognize early warning signs of a new mood episode
try to get enough sleep, and go to bed at a regular hour each night
exercise regularly
avoid alcoholic beverages and street drugs
reduce stress at work and in everyday life
eat a well-balanced diet
keep a diary to track your daily feelings, activities, sleep patterns, life events, and side effects of medications. This will help you and your doctor determine which treatment works best for you.



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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.

Blues · Chronic Depression

The Facts



Depression is a medical condition characterized by long-lasting feelings of intense sadness and hopelessness coupled with additional mental and physical changes. The condition often affects a person's personal, social, and/or professional life.

About one in five women and one in ten men will suffer from depression at some point in life. Depression in children and adolescents occurs less commonly than in adults. Almost 1.5 million Canadians have serious depression at any given time, but less than one third of these people seek medical help.


Types of Depression

There are several different types of depression, and the diagnosis is mostly determined by the nature and intensity of the mental and physical symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.

Clinical depression (or major depressive disorder, MDD) is the most serious type of depression, in terms of the number and severity of symptoms, but there are significant individual differences in the symptoms and severity. People affected with major depression may not have suicidal tendencies, and may never have received medical treatment. The person's interest and pleasure in many activities, energy levels, and eating and sleeping patterns are usually altered.

Dysthymia (or minor depression) refers to a low-to-moderate level of depression that persists for at least two years, and often longer. While the occurrence of symptoms is not as frequent as in major depression, dysthymia can result in as much disability as major depression. It is often not recognized that dysthymia is a medical condition that responds equally effectively to the same treatments as major depression. Some people with dysthmia develop a major depression at some time during the course of their depression.


Bipolar depression (or manic depression) includes both high and low mood swings, and a variety of other significant symptoms not present in other types of depression.

Other types of depression include seasonal affective disorder (SAD) and post-partum depression. SAD is a sub-type of depression that regularly occurs at the same time of year (most often in the fall or winter months in North America). Post-partum depression begins a few weeks after giving birth and is a sub-type of depression. Post-partum depression is different from the temporary state known as the "baby blues" that often happens 24 to 72 hours after a woman gives birth. This temporary state is caused by the hormonal changes that occur during pregnancy and after giving birth and typically resolves in less than a week.

In some cases, depression is associated with other chronic medical conditions, which negatively impact the person's quality of life and well-being.



Causes



Depression is caused by imbalances of the chemicals that help to send messages in the brain. These chemicals in our brain also help to regulate our emotions, behaviour, and thinking. Depression is not the result of personal weakness or an inability to cope.

Depression has a strong genetic component (i.e., family history). While the tendency to be depressed is genetically inherited, the onset of depression can be provoked by many factors.

Triggers of depression include:

difficult or traumatic life changes (such as losing a loved one)
medical conditions such as Parkinson's disease, stroke, chronic pain, and some types of cancer
use of certain medications, including corticosteroids, anabolic steroids, narcotics, benzodiazepines, and street drugs such as amphetamines
progesterone (found in some female hormonal pills)
alcohol, which has short-term and possibly long-term depressive effects

Symptoms and Complications



Although we all feel sad sometimes, clinical (major) depression is diagnosed when a person experiences depressed mood (sadness) and/or loss of interest or pleasure in daily activities for at least two weeks, plus five of the following symptoms:

changes in appetite or weight
slowed reactions
lack of motivation or energy
insomnia (trouble sleeping) or chronic oversleeping
noticeable changes in activity level (agitated or slowed down)
feelings of worthlessness or guilt
difficulty concentrating or making decisions
recurring thoughts of death or suicide
Clinical depression may vary in its severity, and in its extreme forms (i.e., thoughts of suicide) can be life-threatening and require immediate medical attention.

Symptoms of other forms of depression, although generally milder, may still negatively affect a person's daily activities and quality of life.

Making the Diagnosis



If you meet the criteria in the section "Symptoms and Complications," you may be suffering from depression. Talk things through with your family and friends, and with your doctor. Physicians are trained to help you, and to take depression and its treatment seriously. Together with your doctor, you can begin to identify and manage the nature of the problem, and then develop a treatment plan. This may include a referral to a psychiatrist or psychotherapist.

Treatment and Prevention



Most types of depression respond to either an antidepressant medication or psychotherapy. Sometimes people with depression are unaware that medications can help them, or they are at first hesitant to take antidepressant medications to manage their condition. However there are many different medications available today to help treat depression. You and your doctor can work together to decide what medication is best for you.

Medications used to treat depression begin to work after 2 to 4 weeks of treatment, although improvements in some symptoms may be seen within the first few weeks. In some situations, more than one medication will need to be tried until the most appropriate one is found for an individual. All medications, including antidepressants, can have side effects. Your doctor and pharmacist should explain common side effects to you and help you to manage them should they occur.

Herbals: Studies have shown that St. John's Wort is not effective for people with clinical (major) depression. Although people with mild symptoms may receive some benefit from it, you should talk to your doctor and pharmacist before taking any herbals or over-the-counter medications. Keep in mind that some herbal medications may interact with prescription or over-the-counter medications.

Psychotherapy can be an important part of managing depression. Psychiatrists, psychologists, and some family doctors are trained to help people recognize and overcome the kind of thinking that causes depression. Support groups, friends, and family can also help.

Other treatments:

In more severe cases, electroconvulsive therapy (ECT) is used but is generally reserved for those who do not respond to medications.

Light therapy (or "phototherapy," which involves controlled exposure to artificial sunlight) can help some people overcome symptoms associated with seasonal affective disorder.

Physical activity and sports can improve depression by helping to relieve anxiety, increase appetite, aid sleep, and improve mood and self-esteem. Exercise also increases the body's production of endorphins, a natural mood-elevating hormone.

An active lifestyle, supportive family and friends, and a positive outlook can go a long way in coping with depression.