Depression and mood difficulties

“Depression” is an everyday word that describes a large range of feelings including sadness, hopelessness, frustration, and disappointment. In contrast, clinical Depression, or ‘Major Depression’, is a clinical condition that differs from common everyday lows in that it is more intense, lasts longer (for more than two weeks), and significantly interferes with one’s day-to-day functioning.

Depression has been labeled the “common cold” of mental health because it is so common – nearly 10% of the population experience depression in a given year, according to the NIMH. Although there are now many effective treatments, many people may still suffer in silence.

Signs and Symptoms of Major Depression
Depression can affect people in different ways, but common signs and symptoms of depression include:

• Persistent sad or “empty” feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Fatigue and decreased energy
• Difficulties with concentration, remembering details, and making decisions
• Insomnia, early morning wakefulness, or excessive sleeping
• Over-eating, or appetite loss
• Thoughts of suicide, or suicide attempts

What causes Depression?
Some people get depressed in reaction to distressing life events, others can feel down for no reason at all. Depression is not usually caused by one thing, but rather, a combination of biological, environmental, and psychological factors that interact with each other. Causes can include:

Biological causes – including genetics, hormones, and chemical causes.

Life events – such as loss of a relationship, traumatic life events, a sense of having failed, losing a job, experiencing the death of a loved one, or experiencing something that has resulted in low self-esteem or feelings of shame.

Psychological – certain types of thinking patterns are associated with depression, including overstressing the negative aspects of situation, jumping to negative conclusions, taking responsibility for the bad things but not the good things, assuming you know what others are thinking about you, and having rigid and inflexible rules about how things “should” be.

Personality factors – some people posses certain personality traits that make them more vulnerable to developing depression, such as perfectionism, a self-focused personality style, shyness, and sensitivities in interpersonal relationships.

Treatments
Major Depression is a common but debilitating problem – Most people who experience depression will need some form of treatment in order to recover and prevent it from re-occurring.  The best approach is to find out as much as you can about the available treatments and then tailor them to suit you. The two most common types of treatment for depression are psychological intervention and medication, and sometimes they are used together.

Psychological Intervention
There are a range of effective therapies for Depression, many of which address and aim to modify thinking and behavioural patterns that contribute to Depression. Examples of evidence-based therapies for Depression include:

• Cognitive Behavioural Therapy (CBT)
• Acceptance and Commitment Therapy (ACT)
• Interpersonal Therapy
• Mindfulness

Skills training can also be effective, including problem solving, social skills, assertiveness skills, and relationship skills.

Medication
Antidepressants are the most common type of medication used for Major Depression, although other medications such as antipsychotics and mood stabilizers are also used depending on the type of depression a person is experiencing. Medication can be particularly helpful when combined with psychological intervention.

If you would like to find out more about Depression and what might be the best treatment options for you, feel free to contact Kathryn on 0478052297 or kathryn@kdpsychology.com.au.

Bipolar Disorder used to be called ‘Manic Depression’. As its old name suggests, it refers to the condition where a person experiences exaggerated mood swings ranging from extreme ‘highs’ (Mania) and extreme ‘lows’ (Depression).

The changes in mood can range from mild to severe and significantly impact on a person’s thinking, emotions, and behaviour. Mood changes can last several weeks (sometimes months), and are more severe than normal ups and downs that most people experience.

Typically, people with Bipolar Disorder shift between a periods of Depression and an abnormally elevated mood called Mania, with periods of stability in between. However, each person’s pattern is quite distinct: for example, some people may experience only one or perhaps two manic episodes in a decade, whereas others may experience multiple episodes of mania in a year.

Features of Bipolar Disorder

Mania
Refers to a ‘high’, euphoric, and driven or irritable mood. Experiencing mania has been described as a feeling that your brakes have failed – that you are going too far and too fast.

Symptoms of Mania include:

• Irritability
• Decreased need for sleep
• Racing thoughts
• Grandiose ideas
• Impulsive or ‘risky’ behaviour (such as excessive spending or rash decision making)
• Uncharacteristically poor judgment
• Psychosis (if the mania is severe)

‘Hypomania’ refers to a less intense experience of mania. Someone who is hypomanic may still be able to function at home and at work, but they may not be their usual self. They may come across as highly energetic, “reved up”, exciting and entertaining, or impulsive.

Depression
Refers to the ‘low’ feeling that often comes after a period of Mania. It can be prolonged, emotionally painful, and cause someone to become withdrawn and isolated from friends and family.

Symptoms of Depression include:

• Persistent sad or “empty” feelings
• Feelings of hopelessness
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest in activities
• Fatigue and decreased energy
• Difficulties with concentration
• Insomnia or excessive sleeping
• Over-eating, or appetite loss
• Thoughts of suicide or suicide attempts

Mixed states
A mixed episode is when a person experiences both manic and depressive feelings everyday for a period of time.  A person’s mood may rapidly shift between overwhelming sad feelings and tearfulness to euphoria, impulsivity, and grandiose ideas.

People with Bipolar Disorder generally experience ‘normal’ moods in between periods of elevated and depressed mood, although some people may continue to experience mild to moderate symptoms of depression and unstable moods in between episodes.

What causes Bipolar Disorder?
The exact cause of Bipolar Disorder is still not exactly known, but it’s generally thought to have biological underpinnings. Stress is then thought to play a considerable role in triggering episodes.

So although an exact cause has not been identified, a variety of factors are thought to paly a role in Bipolar Disorder, including:

Genetics – It tends to run in families.

Brain chemicals – Some theories point to imbalances in particular chemicals in the brain, such as serotonin. 

Environmental factors – Stressful life events are generally linked to the onset of Bipolar Disorder, and often contribute to relapse. Interestingly, seasonal factors are also implication in mood instability, with onset chance increasing in Spring.

Medical conditions – Although medical illnesses aren’t thought to be a cause of Bipolar Disorder, some illnesses can cause a person to become manic.

Substance use – Also not thought to be a cause of Bipolar Disorder, but using drugs and alcohol can certainly trigger episodes of Mania or Depression.

Treatments
Contrary to Major Depression, most people with Bipolar Disorder need medication, which is a vital part of managing the condition. However, psychological treatments are often a valuable and effective adjunct to medical treatments.

Medications
Medical treatments for Bipolar Disorder target the specific episodes (e.g. depression or preventing mania) and support overall mood stability. Often this will involve a ‘mood stabilizer’ (eg. Lithium, Epilim), which can be combined with an antidepressant for some people.

Psychological Treatments
The main aims of psychological treatments for Bipolar Disorder are to address the psychological and behavioural factors that contribute to recovery from episodes (e.g. depression or mania), to learn strategies to maintain stable moods, and to prevent future episodes by minimising stress. Strategies may include:

• Developing awareness of triggers and ‘early warning signs’
• Daily mood and sleep monitoring
• Stress management strategies
• How to achieve life balance and stable routines
• Learning tools and techniques to manage early signs of mania or depression (such as relaxation for mania, or activity scheduling for depression)
• Developing a wellness plan that might be shared with family or loved ones, outlining treatments and interventions to keep a person well

Various evidence-based therapies that can be helpful for managing Bipolar Disorder are Cognitive Behavioural Therapy (CBT) andMindfulness-based strategies.

Kathryn considers working with Bipolar Disorder as an area of expertise. She has a strong awareness of the challenges that those with Bipolar Disorder face, in particular, recovering from Mania and Depression, fear about having a relapse, and achieving a healthy balance between avoiding stress while living the life you want to live.

She works collaboratively with the person to increase awareness of patterns in mood and learn specific techniques to manage stress and to stay well.

When someone’s mood is persistently low for several years, they may have a condition called Dysthymia. Dysthymia is a mild, but chronic form of Depression, the symptoms of which usually last for at least two years. Although less severe than Depression, it can be more debilitating due to it’s the long-lasting nature.

Someone with Dysthymia may come across as chronically unhappy. For some, it may be mistaken for just being part of their personality, coming across as “just a moody person”. A person with dysthymia might feel hopeless, experience low self-esteem, have difficulty getting pleasure out of life, and be irritable, withdrawn, or avoidant.

The causes of Dysthymia are the same as those in Depression, and can consist of a combination of biological, psychological, environmental, and personality factors.

So how is it treated? People with Dysthymia have generally experienced it over several years. A combination of psychological intervention, addressing psychological and emotional factors, and antidepressant medication has been found to be the most effective line of treatment.