Unfortunately, this is another topic that everyone thinks they know and most people don't care about unless it affects them personally or it comes to media attention, such as with the relatively recent death of Robin Williams. Honestly, I become rather irritated when someone who is feeling "blue" claims that they are depressed or when someone else accuses a person of having depression, as if it is an excuse for certain behaviors (or lack of behaviors) and then proceeds to "cheer them up" with quick fixes like alcohol or sex. True depression is not easily fixed in a few hours or even overnight. True depression is not an excuse or an emotion. It is a complex mood disorder that is still being studied because, honestly, very few people are ever truly "cured" in any permanent way. Psychology and psychiatry are working on it. We've got a long way to go. Let's shed some light on the reality of the disorder.
Mood disorder: a category of psychological disorders affecting an individual's mood or affect. As I mentioned in an earlier post, an emotion such as sadness is a quick, short, instantaneous physiological and cognitive response to a stimulus. Once the emotion subsides, we are left with a milder mood that lasts for hours or as long as days. Mood disorders are classified when an individual's mood appears to be abnormal to their customary behavior or personality pattern or abnormal (i.e. unexpected) to a particular stimulus, outside of the society's expected norms of behavior. Someone laughing hysterically at a tragedy and staying in a positive (NOTE: not optimistic) mood in the aftermath would certainly raise some eyebrows. In order to determine if an individual suffers from a mood disorder, the abnormal behavior has to persist for a significant amount of time. This is to rule out other possible explanations. I am going to focus only on the depressive disorders for this week's post. Mania, cyclothymia, and bipolar disorder are a different side of the coin. The other thing to keep in mind with most mood disorders is that even without treatment, an individual may experience periods of the disorder between periods of normalcy. A depressed individual isn’t necessarily always suffering from depression all day, every day. They may experience joy between episodes. Treatment helps to increase the length of those “normal” moments and reduce the abnormal periods.
Dysthymia: a mild depressive mood disorder, usually caused by a stimulus outside the individual (loss of job, breakup, etc.), that lasts at least 2 years or more before diagnosis. Many cases of dysthymia go longer than 2 years before diagnosis occurs. Part of the idea is that this mild mood disruption will work itself out in most people; you're supposed to "get over" whatever the cause is long before the 2-year mark. Symptoms are also not as severe as other depressive disorders. People with dysthymia usually maintain their regular routines and social patterns, but with less vigor than before. They may feel like life is sometimes a big effort, but they haven't lost all their motivation to continue day-to-day activities. People who know them might take a while to grasp that something more serious is afoot, trying to be understanding until they lose patience with the sufferer. Cognitive therapy is often the most successful with this type of depression, as there is an actual root cause that can be dealt with.
Major depression (also known as clinical depression): severe depressive mood disorder that comes on suddenly, has no apparent outside stimulus, and lasts at least 6 months. This is the type of depression that presents the most danger to the individual and is the most difficult to treat with a blanket treatment. Symptoms are much more severe than with dysthymia, thus the shorter time frame for diagnostics. Many people suffering from clinical depression find it difficult to do much. They may lack the motivation to get out of bed, go to work or school, interact with friends or family, eat or drink, or take pleasure in their usual enjoyments.
A subset of major depression known as endogenous depression appears to have no single catalyst to its onset. It is believed by many therapists to be caused by some form of chemical imbalance in the brain. The primary suspects are serotonin, dopamine, and norepinephrine. It is believed that severe depression, another label for this mood disorder, is caused by an imbalance in one or more of these chemicals. Unfortunately, there is no test that I know of to determine an individual's neurotransmitter levels, so many physicians must experiment with various antidepressant mixes until the right one is found for each individual patient.
The worst cases of major depression occur when patients do not respond to any medication or alternative treatment. Psychotherapy may help, but not without a lot of work on the part of the patient and support (NOT coddling!) from the patient's social support network. Time is also a key factor in successful treatment. The ugly truth is, however, that even if a person is cured of their severe depression, they have a high risk of succumbing to the disorder once again. This is also the type of depressive disorder most associated with suicide. With no external cause and treatments that can be frustrating in their duration, many patients simply give up, looking for an escape from their problem. Sometimes a patient who appears to be on the mend may turn to suicide because the treatment has helped them regain just enough energy and motivation to end their life but not enough yet to keep fighting for it.
Postpartum depression: depressive disorder affecting some women after giving birth. A milder form of this is commonly known as "baby blues" and it may affect as many as two-thirds of women. Baby blues typically involves mild feelings of anxiety, despair, and depression in the first few weeks following childbirth. This does not necessarily involve bouts of uncontrollable mood swings, as shown in the movie Look Who's Talking. Many physicians believe that the hormonal turmoil resulting from pregnancy and delivery put extra emotional strain on the mother. Baby blues usually works itself out before the child's second month, sooner with proper medical treatment and support from friends and family.
For something like 15% of women giving birth, a more serious postpartum depression takes place. This severe depression has similar symptoms to major or clinical depression, but it coincides directly with childbirth. Mothers not only lack motivation to continue their regular routines, they also do not have any desire to care for their children. This can be especially detrimental to the infant, as the first few months are the most critical for bonding. Postpartum depression may last months following childbirth. The sooner the mother receives treatment, the healthier both herself and her baby will be. Again, familiar or other social support is critical for successful treatment.
Seasonal affective disorder: otherwise known as winter depression, a depressive disorder that affects individuals primarily during seasonal periods of lower sunlight, such as autumn and winter. Symptoms include: oversleeping and difficulty staying awake, fatigue, cravings, an inability to cope with day-to-day activities or unexpected experiences, and social withdrawal. The primary cause of SAD (yes, I’m aware of the irony of the acronym) seems to be a sensitivity to levels of sunlight. Individuals suffering from SAD will experience these symptoms during months of longer nights and shorter days. Once the days grow longer, the symptoms recede. Not surprisingly, a larger prevalence is found the further north of the equator one travels. The main mode of treatment is known as phototherapy, in which an individual is exposed to extra hours of sun-like light during the shorter days. I suppose a month-long vacation in the tropics would help too, but I don’t anticipate many insurance policies covering such treatment.
Overall, mood disorders are very serious, but too often misunderstood. We take it for granted that anyone can just flip a switch and get out of their funk. While it may be easy for one person to overcome a personal set-back or tragedy, others are wired such that they need more assistance to “bounce back.” Understanding, but not making excuses, and emotional support are the best things one can do for someone suffering a depressive disorder. Getting to psychotherapy as quickly as possible is also extremely important, even more than finding a magic pill to pop, as psychotherapy has been proven to as effective as, if not more so than, medication, especially when the two methods are combined.