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Copyright © 2017 Connexion Psychological Practice Ltd.

Depression

Mood Disorder

I. Depression (major depressive disorder or 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.

A major depressive episode may include these symptoms for at least two weeks:

  • Persistent sad, anxious or "empty" mood;

  • Feelings of hopelessness, pessimism;

  • Feelings of guilt, worthlessness, helplessness;

  • Loss of interest or pleasure in hobbies and activities, including sex;

  • Decreased energy, fatigue, feeling "slowed down";

  • Difficulty concentrating, remembering, making decisions;

  • Insomnia, early-morning awakening, or oversleeping;

  • Low appetite and weight loss or overeating and weight gain;

  • Thoughts of death or suicide, suicide attempts;

  • Restlessness, irritability;

  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and pain for which no other cause can be diagnosed.

 

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

  • Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

  • Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

  • Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

  • Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

 

II. Bipolar disorder also known as manic-depressive illness, is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

It is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function.  The mood episodes associated with the disorder persist from days to weeks or longer, and can be dramatic, with periods of being overly high and/or irritable to periods of persistent sadness and hopelessness.

Severe changes in behavior go along with the mood changes. These periods of highs and lows, called episodes of mania and depression, can be distinct episodes often recurring over time, or they may occur together in a so-called mixed state. Often people with bipolar disorder experience periods of normal mood in between mood episodes.

A manic episode is diagnosed if an elevated mood occurs with three or more primary symptoms most of the day, nearly every day, for at least one week. With an irritable mood, four additional symptoms must be present for a diagnosis.

Signs and symptoms of a manic episode can include the following:

  • Increased energy, activity, and restlessness;

  • Excessively high, overly good, euphoric mood;

  • Extreme irritability;

  • Racing thoughts and talking very fast, jumping from one idea to another;

  • Distractibility, inability to concentrate well;

  • Little sleep needed;

  • Unrealistic beliefs in one's abilities and powers;

  • Poor judgment;

  • Spending sprees;

  • A lasting period of behavior that is different from usual;

  • Increased sexual drive;

  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications;

  • Provocative, intrusive, or aggressive behaviour;

  • Denial that anything is wrong.

 

A depressive episode is diagnosed if five or more primary depressive symptoms last most of the day, nearly every day, for a period of two weeks or longer.  Signs and symptoms of a depressive episode can include the following:

  • Lasting sad or empty mood;

  • Feelings of hopelessness or pessimism;

  • Feelings of guilt, worthlessness, or helplessness;

  • Loss of interest or pleasure in activities once enjoyed, including sex;

  • Decreased energy, a feeling of fatigue or of being "slowed down";

  • Difficulty concentrating, remembering, making decisions;

  • Restlessness or irritability;

  • Sleeping too much, or having trouble sleeping;

  • Change in appetite or unintended weight loss or gain;

  • Thoughts of death or suicide; or 

  • Suicide attempts.

 

It can be helpful to think of bipolar disorder as a spectrum of moods.

 

At one end is severe depression, above which is moderate depression, and then mild low mood, which may be called the blues when it is short-lived and dysthymia when it is chronic.

 

Next is normal or balanced mood, then hypomania (mild mania that may feel good and be relatively brief and less severe), and then severe mania, which can include hallucinations, delusions, or other symptoms of psychosis.

Some people may experience symptoms of mania and depression together in what is called a mixed bipolar state. Symptoms often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad hopeless mood even while feeling extremely energized.

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5  include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

 

Treatment for Mood Disorder

 

It is most important for depressed people to feel hopeful as they can easily felt trapped and hopeless.  The pain of trapped feeling can easily lead to self-harm destruction even to the point of suicide.  Thus, it is not a good idea for them to stay too long in this painful trapped experience.   The sooner they received help and support, this will help them to realize their negative belief that people do not care or they are not accepted by others may not be true as they thought. Often depressed people often feel guilty for their needs and wants.  So, treatment need to help them to sort out interpersonal trapped relational problems and find their own needs and boundary as well as respecting others’ to be able to care for their own needs and boundary. This process may fluctuate up and down and it may take some time for them to practice and slowly build up the trust that expressing their true feelings and needs are indeed critical for their recovery of their depression. They may need to take risk in their relational pattern. 

At Connexion, we are here to help you:

  • Experience how to slowly opening up their negative emotions and to receive the positive experience being understood and empathy;

  • To understand how they are trapped in their guilt and anger towards important relationships;

  • Understand the message your depressive symptoms are signalling to you and through understanding and acceptance, you will find the symptoms slowly fade away;

  • How to regulate your emotions especially the negative ones rather than just avoid, deny or defend them;

  • Learning to express your inner needs and vulnerabilities to reach support and connection with people you cared; and

  • Taking baby steps to be genuine with your real self and learning to share with others your true self