When Depression is More Than a Bad Day

Blue, down, bummed out, sad, regretful, lost...

These are some of the words that come to mind when we talk about 'depression.' We've all experienced periods in our lives when we have felt saddened by events we've had no control over, disappointed by the outcome of something important to us, or deeply saddened by a loss. Usually this form of 'depression' has a fairly short life. We are able to find support and shift our view of the 'problem' enough that we eventually feel better. In the meantime we are generally functioning pretty well. We go to school, work, maintain our responsibilities, and our relationships are relatively unaffected by our "feelings." This form of depression is typically referred to as 'situational depression,' and like the name implies, is generally a short term, mild form of depression associated with a particular situation in our lives. However, there are some forms of depression that aren't easily understood or managed.

Bipolar I & Bipolar II: Also known as Manic Depressive Disorder, Bipolar I is typically characterized by episodes of extreme shifts in mood alternating from very high to very low. Alternations in mood can have a general pattern (e.g. 2 months depressed, 2 weeks manic), a seasonal pattern (e.g. depression worsens in winter months), or can be rapid cycling (e.g. mood changes daily, weekly, or monthly in rapid succession). High or elevated moods are referred to as Mania. Manic symptoms generally include an abnormally elevated mood, which may also include, feelings of elation, increased irritability, insomnia, grandiosity, rapid speech, racing thoughts, heightened sexual desires, increased energy, poor judgment, and at times inappropriate social behaviors. Depression can be mild to severe and include psychotic symptoms such as hallucinations or delusional thinking. Bipolar II includes alternating moods between Depression and symptoms of Hypomania. Hypomania is a less severe form of mania. Someone with Hypomania may experience elevations in mood without the same intensity as seen with Mania. Onset for Bipolar disorders is typically late adolescents/young adult hood (average age is 21 years old) with increases in occurrences over time. Bipolar disorders affect both men and women, and occur across all ethnicities. Family history of depression, bipolar disorders, and other mental health diagnoses is common among people with the disorder, however, there is no conclusive link between family history and the disorder. People with Bipolar disorder have an increased rate of substance abuse, which generally occurs in an effort to control or manage symptoms.

Cyclothymia: Similar to Bipolar Disorders, Cyclothymia is a chronic mood disorder characterized by numerous periods of depression and hypomanic symptoms. Cyclothymia differs from Bipolar in that symptoms are typically experienced without reprieve for at least two years.

Dysthymia: A person with Dysthymia will experience a low mood for more days than not for a period of at least two years. Low mood may include feelings of hopelessness, impaired cognitive functioning.( e.g. hard time concentrating, hard time in making decisions ), loss of appetite or overeating, low energy or fatigue, low self-esteem, and problems with sleep. (too much or too little sleep).

Major Depression: The severe form of Dysthymia, Major Depression can become disabling if not treated properly. Major depression is typically characterized by the same symptoms as Dysthymia with the added intensity as well as loss of motivation, loss of pleasure in things, feelings of worthlessness and guilt, recurrent thoughts of death or suicide.

Contributing Factors: Although there are no conclusive causes of Depression there are many contributing factors that play a role in the severity, duration, and frequency of the symptoms of depression. Contributing factors can also play a large role in overall treatment approach. A common factor in symptoms of depression is loss. Whether it's the loss of a loved one, a job, a beloved pet, moving to a new home, getting married, getting divorced; any major change/loss/transition can trigger symptoms of depression or worsen existing symptoms or disorders. The use of substances (drugs and alcohol) can affect mood significantly. Some people with childhood depression may begin using substances early on in an effort to control their moods/feelings. Conversely, some people who use substances may experience symptoms of depression as a result of the drugs natural effects on the brain and bodies functioning. It is very common for people who experience symptoms of depression to have a known family history of mental health issues. However, not all people who experience depression will have a family member with the same symptoms. Sometimes a person with depression may have a family history of anxiety or substance abuse. Typically people who experience symptoms of depression have poor coping skills; meaning that when events occur that trigger feelings of depression the person is often unable to access resources that support them. For example a person who experiences a negative event may withdraw from others and isolate. The more they isolate the more the symptoms of depression increase. Without support that helps the person cope with their feelings, over time the person may become reclusive and have difficulty leaving their homes. Sleep problems are a significant issue in all types of depression. Both in that lack of sleep can be a trigger for depression and symptoms of depression can lead to excessive sleepiness or general poor sleep hygiene. If you have problems with sleep it's important to rule out medical causes such as sleep apnea or mild seizure disorders. Poor nutrition is another important factor in mental health. Again working both as a result and a possible contributing factor to depression. People who are depressed tend to either overeat or under-eat. Typically eating comfort foods or imbalanced meals, or conversely not getting enough nutrients to support a healthy mind and body. Medical conditions including hormone irregularities (also postpartum), certain autoimmune disorders, certain neurological disorders, chronic pain disorders, and any other chronic health issues can contribute to symptoms of depression.

Ages & Stages: For certain disorders there are typical ages of onset. However it's important to note that general types of depression can present in A-typical ways at different age levels. In the most general terms for example, childhood depression may present as an overanxious child, a child who is clingy, has problems sleeping, seems hyperactive, or has more irritability than one might expect. Children with depression may not seem 'sad' but might have problems with concentration at school. They may be easily distracted and have difficulty following tasks. These symptoms can be similar ADHD. In adolescents depression may present with increased irritability, agitation, defiance, withdrawal/isolation, substance use, lack of motivation, lack of focus, loss of interest in things, frequent headaches, body aches, or general reports of not feeling well. In adulthood symptoms present in the most typical manner as described in the above definitions. In the elderly, depression is very common. In addition to the possibility of numerous medical conditions and treatments the elderly are often faced with loss and isolation. The elderly will typically present with depression that reflects great sadness and grief.

Treatments: In treating depression it is important to know what type of depression one is dealing with; as well as taking into account possible contributing factors, the age and typical developmental stage a person might be before taking the next step. Licensed counselors, psychologists, and psychiatrists are all qualified to make a mental health diagnosis. If the patient is a child or elderly person the evaluation should be completed by a person who specializes in those developmental stages. Counselors are typically equipped to provide therapeutic guidance for people with depression. In counseling one may learn new ways of seeing their problems, may develop improved coping skills, and may find relief in having some outside supports. Psychologists generally provide testing and assessments that can more accurately determine types and severity of mental health problems. In some states Psychologists may prescribe medications and provide counseling. Psychiatrists rarely provide counseling. Their role is to treat mental health symptoms medically - usually with psychotropic medications. A general rule of thumb in treating all forms of mental health issues include an increase in physical activity and improvement in nutritional health. There are also numerous alternative treatments; including acupuncture, amino acid/nutritional therapies, mediation, energy work such as Reiki, EFT (Emotional Freedom Technique), body work, and N.E. T. (Neuro-Emotional Technique).

If you, or someone you know is experiencing persistent or serious symptoms of depression there is help. Please consider getting a mental health evaluation and rule out any possible medical causes. Untreated depression can lead to long term health problems, substance abuse issues, and a life of pain. There is help and it is possible to heal from depression.

Lisa K. Jackson, MA, LPCC, NCC, CEP, CWK