DEPRESSION & MOOD DISORDERS

WHAT IS A DEPRESSION OR A MAJOR DEPRESSIVE EPISODE?

A depression or a major depressive episode is an unusual psychological and physical condition for the individual who has been affected, characterized by a sad or depressed mood, a markedly diminished or loss of interest or pleasure to what is usually pleasant or desired (non-reactive mood), psychomotor slowing and other symptoms that indicate a lower level of energy, a disturbance of the sleep/wake cycle, and self-destructive attitudes. In major depressive disorder with melancholic features, cardinal features also include early-morning awakening, appetite loss and/or weight loss, and the depression being worse in the morning. The intensity of the major depressive episode can vary, from mild, posing therefore a limited handicap to social and professional life, to severe, therefore prohibiting normal activity. Melancholic depression is an extremely severe form of depression, which tends to recur and be accompanied by psychotic features in 10%-15% of patients, and more common after 50 years of age.

WHAT ARE THE CAUSES OF DEPRESSION (MAJOR DEPRESSIVE EPISODE)?

As with other mental disorders, the causes of a major depressive episode are multifactorial, involving an interaction of genetic, congenital, learning and social factors. From a biological standpoint, an abnormality of synaptic transmission (interval between the neurons) in terms of the concentrations of neurotransmitters such as serotonin and norepinephrine has been mentioned. This hypothesis is the basis of which the antidepressants acting at this level are used.

WHAT ARE THE COMMON SYMPTOMS OF DEPRESSION (MAJOR DEPRESSIVE EPISODE)?

People with depression (major depressive disorder) usually have a combination of symptoms such as:

• Persistent sadness;
• Loss of interest for activities that the individual usually enjoys;
• Psychomotor slowing with physical and mental fatigue (at its worst the individual remains lying in bed), loss of creative capacity, difficulty reading, difficulty concentrating, poor memory;
• Decrease of self-care, or hygiene neglect;
• Social withdrawal, irritability in their interactions with the social environment;
• Increase or loss of appetite with weight gain or loss;
• Sleep disorders: Insomnia or hypersomnia;
• Worsening of symptoms in the morning, while there is an improvement in the late afternoon;
• Destructive behaviors (self-cutting, overdose) sometimes leading to suicide attempt.

This episode occurs outside of bereavement or medical or drug cause (some medications can cause depression).

In depression, “rumination” is an actively or automatically chosen strategy with the goal to understand personal problems and their meaning and to find solutions. It consists of repetitive thoughts oriented towards the past, unanswerable questions, with low effectiveness with respect to real world solutions. There is a focus on past failures or bad memories, leading to a cascade of negative thoughts, making it difficult to find meaningful solutions. It can be understood as problem solving “gone awry”.

If major depressive episodes of severe intensity are easily diagnosed, the mild episodes may go unnoticed: fatigue, sluggishness, loss of creativity, mild social withdrawal. These mild presentations are no less destructive to the individual’s quality of life or to their professional and social life.

A major depressive episode may remain isolated or repeat itself either because a trial of psychotherapy has not been effective, or because the individual is dealing with a recurrent depression or bipolar disorder, predominantly Bipolar Disorder II.

WHAT IS THE TREATMENT FOR DEPRESSION OR A MAJOR DEPRESSIVE EPISODE?

Depression or a major depressive disorder is usually treated with psychotherapy, medication management or both. Antidepressants usually provide a net relief of symptoms after 21-42 days of treatment. The treatment is usually extended over a period of several months because early cessation increases the risk of relapse.

Cognitive Behavioral therapies (CBT) have their efficacy particularly well documented in numbers of publications, but other approaches may be indicated such as analytical therapies, interpersonal psychotherapy, EMDR, group therapy etc. Given the reluctance of some individuals to take antidepressant medications, one can turn to other treatments such as St. John’s wort that seems particularly used in some countries but is not devoid of side effects (photosensitivity, inhibition of the action of certain contraceptive pills). Studies were able to show the effectiveness of the electro-acupuncture practiced by Chinese experts.

In the case of resistant depression, new techniques have been developed such as transcranial magnetic stimulation.

When depression reaches an alarming intensity or chronicity, and in cases of suicide risk, one should not hesitate to hospitalize.

If you have a friend, relative or loved one who suffers with depression (major depressive disorder), the goal is to get them to agree to seek treatment. And of course this is even more important when the depressive episode is severe.

What is MANIA OR HYPOMAnia?

Mania, or manic episode is characterized by an increase in mood, a state of euphoria that is unrelated to a specific context, and psychological and physical arousal. A hypomanic state is a milder form of mania.

What are the causes of mania or hypomania?

Similar to other psychological disorders, the causes are multifactorial, involving an interaction of genetic, congenital, learning and social factors. Mania and hypomania evolve generally within the framework of bipolar disorder. Similar hyperarousal states can be caused by drugs or certain diseases.

WHAT are the common symptoms of mania and hypomania?

People with mania frequently present:

1. Hyperactivity;
2. Grandiose delusion (feeling great about oneself) and decreased need for sleep
3. Pressured speech and Logorrhea (the individual speaks all the time);
4. Distractibility
5. Disinhibition, which can be sexual but can also implies a spending spree

The individual who presents in a manic state is intolerable for those around them. This is a state of hyperarousal which can last at least one week. Hypomania is an attenuated form of a manic state, with a lesser impact on the occupational and social life of the individual.

WHAT is the treatment of mania or hypomania?

The treatment is mainly based on medication to stabilize the manic state. Psychiatric hospitalization is often required for further stabilization, as the individual in a manic state often poses danger to themselves and others. Medication management consists usually of a tranquilizing neuroleptic or mood stabilizer. Treating an individual in a manic phase in a private psychiatric office is virtually impossible. Many of these individuals are so aroused that they will not come to consult with a psychiatrist. Much rests on prevention, i.e establishing a strong therapeutic alliance so that the individual will call the psychiatrist when they feel that the episode is about to happen.

what is bipolar disorder?

Bipolar disorder (bipolar affective disorder) is a mood disorder that was called in the past manic depression or manic-depressive illness. Bipolar disorder is characterized by major mood swings alternating periods of depression with periods of hyperarousal called mania or hypomania. Between depressive episodes on one hand and hypomanic or manic on the other hand, there are periods when the individual’s mood is normal, the so-called “euthymic” phases.

what causes bipolar disorder?

As with other mental disorders, the causes of bipolar disorder are multifactorial, consisting of an interaction of genetic, congenital and social factors. Research has particularly highlighted the genetic and biological correlates.

what are the common symptoms of bipolar disorder?

People who suffer from bipolar disorder experience alternating episodes of mood swings such as:

1. Manic or hypomanic intervals characterized by manic excitement, euphoria, grandiosity, decreased need for sleep, heightened libido. This arousal is particularly intense in the case of mania and less so in the case of hypomania;
2. Intervals of depression characterized by a sad or depressed mood, lack of interest, psychomotor retardation, feelings of helplessness and sometimes destructive impulses;
3. Sometimes the so-called episodes called “mixed” in which manic and depressive symptoms coexist.

Between these periods there are the so-called “euthymic” intervals during which the mood is normal.

what is the treatment of bipolar disorder?

The treatment of bipolar disorder is based primarily on medication first: antidepressant treatment in a depressive phase, and tranquilizer (neuroleptic) in a manic or hypomanic excitement phase. There are medications called “mood stabilizers” whose purpose is to prevent mood swings, for example, Lithium, Valproic Acid, Carbamazepine, Lamotrigine.

In some cases of bipolar disorder hospitalization is necessary, such as when the episode of excitement or depression is too intense. Psychotherapy is recommended to mitigate the impact of mood swings on the overall functioning of the individual. Therapy is also centered on helping the individual becoming more aware of their triggers outside the manic or depressive phase, and express their frustrations and concerns in more adaptive ways.

If you have a relative with bipolar disorder, it is important to learn about this disease. It is likely that in a first phase of their affection, they will not recognize the premises of a depressive phase or conversely of a manic or hypomanic phase. You would probably be the one who will spot the first signs and symptoms, and encourage them to take adequate measures.