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Depression and Mood Disorders

Depression (mood disorders) sometimes creates a negative stigmatizing effect, yet it is a fairly common condition. I think of depression in general terms as a state of being blocked, stuck or subjugated. Depression pertains to the thoughts and concerns about what has happened; Anxiety is frequently associated and observed along with depression. Anxiety pertains to thoughts and concerns about what might happen next. Some people complain that they are depressed because of their anxiety and or that they are anxious because they are depressed.

Are you Depressed?                                     Are you “Manic?”  “Bi-PolAR”

Depression is a term and an actual clinical/psychiatric diagnosis, that describes a state of being that is more serious and pronounced than being sad or a little down or in a funk or having a bad day. There are several types of depression, which we now technically refer to as Mood Disorders. One of the more common diagnoses of mood disorders/depression is referred to as Major Depression and may be assessed to varying degrees of severity. More severe bouts of depression that typically include a general systemic loss of interest or happiness in many aspects of life, is known as “Major Depression.” A less severe, yet much more chronic, lower-level version of Major Depression that has been lingering for a long period of time is known as Dysthymic Disorder.

JOSEPH CONTORER MFT

While there are various degrees, intensities and differing specific diagnoses, depression can be a very serious and debilitating disorder. Many people who are afflicted with depression and other related mood disorders will need professional help to treat their condition and they should have the help, understanding and treatment if they need it.

Bi-polar disorder

Bi-Polar Disorder, has also been referred to as “Manic Depression” and is a term that describes a marked fluctuation and lability of mood. A person diagnosed with Bi-Polar Disorder may be experiencing either a depressed state implying a drop in their mood, or other times they may in a profoundly elevated, abnormally heightened and sometimes agitated or euphoric/grandiose state known as  "mania" (hence the previous description of manic depression.)  A less severe, milder yet chronic lower-level degree of Bi-Polar Disorder is known as Cyclothymic Disorder. Cyclothymia symptoms are present most all of the time for at least 2 years in adults.

Bi-Polar Disorder is a complicated condition but it can be managed fairly well with therapy and medication as prescribed by a medical doctor, often times a Psychiatrist who specializes in psychopharmacology. Part of the challenge with Bi-Polar Disorder is the inconsistency of the symptoms and the condition itself. Sometimes the manic episodes are perceived as positive, pleasant, seemingly productive and euphoric at times, as opposed to also being mindful and aware that the euphoric sense of omnipotence is likely just a precursor to a dangerous inevitable mood crash in to dangerous serious depressive episode. Sometimes the depression is severe and dark enough that there is suicide ideation (SI) associated with them. Hospitalization may be required in more severe cases such as those clients posing a significant danger to self or others.

Treatment for Bi-Polar Disorder typically includes medication management with a mood-stabilizing drug that will possibly be combined with other psychotropic medication, such as anti-depressants as determined by the attending physician. Several approaches could be used for Bi-Polar treatment in addition to medication or possible Cognitive-Behavioral Therapy. For one thing, it is useful for patients managing this condition to feel a sense of validation and understanding as well as a personal level of insight in to their condition. So, being informed about depression, especially the Bi-Polar Disorder (manic depression) is a useful tool itself.

JOSEPH CONTORER MFT

CREATIVE PEOPLE:

It has been suggested by some that there is a notable incidence of Bi-Polar Disorder among creative people. This would include some celebrities or similar or higher profile people in the entertainment industry. So, with actors, musicians, writers, etc., there may be a higher prevalence of Bi-Polar Disorder because of what is erroneously perceived as a sometimes helpful or  necessary energy, productivity and imaginative impact that can occur during manic episodes. This is where the creative energy may line up with the manic symptoms in a temporarily compatible manner.

*Symptoms of Bi-Polar Disorder

(Consult a mental health professional, therapist or physician for technical consultation.)

MANIC EPISODE MAY LOOK LIKE THIS

People having a manic episode may
feel very “up,” “high,” or elated

  • Have a lot of energy
  • Have increased activity levels
  • Feel “jumpy” or “wired”
  • Have trouble sleeping
  • Become more active than usual
  • Talk really fast about a lot of different things
  • Be agitated, irritable, or “touchy”
  • Feel like their thoughts are going very fast
  • Think they can do a lot of things at once
  • Do risky things, like spend a lot of money or have reckless sex

DEPRESSIVE EPISODE MAY LOOK MORE LIKE THIS

People having a depressive episode may
feel very sad, down, empty, or hopeless

  • Have very little energy
  • Have decreased activity levels
  • Have trouble sleeping, they may sleep too little or too much
  • Feel like they can’t enjoy anything
  • Feel worried and empty
  • Have trouble concentrating
  • Forget things a lot
  • Eat too much or too little
  • Feel tired or “slowed down”
  • Think about death or suicide

*From the National Institute of Mental Health

Symptoms and Causes of Depression

Major Depression symptoms may include all or some of the following, consistently present for a minimum of two weeks

  • A persistently overly sad or flat state of being.
  • Feeling hopeless and lacking optimism.
  • Feeling guilty, self-loathing, powerless, lacking empowerment or assertiveness;
  • Feeling stuck, blocked or paralyzed.
  • Loss of interest in most everything, such as hobbies, activities, socializing etc.
  • Decreased energy and feelings of fatigue and lethargy.
  • Sleep disturbance: Excessive sleeping to avoid misery or difficulty sleeping, such as insomnia/mania.
  • Appetite changes- either overeating or under-eating with possible weight gain or loss.
  • Self-destructive behavior, “ideation,” such as suicidal thoughts, threats or possible attempts.
  • Irritable or labile mood or agitation.
  • Physical or somatic complaints, such as aches, pains, gastro-intestinal problems, head aches.

               Most all variations of depression include some degree of an aversion to normal predictable functioning/
(I.e. can’t get out of bed, or at least more difficulty engaging in a normal day/life of routine activities.)

Joseph headshot 3 x 4 size

CAUSES OF DEPRESSION AND ANXIETY

  • Genetics/Hereditary factors: A family history of mood disorders.
  • Chemical Imbalance/ organic, physiological factors.
  • Thinking Errors/ *Irrational thinking.

*Please see later section for examples and definitions of “Cognitive Distortions.

Life Stressors: Complex triggering conditions such as:

  • Death/trauma, grief, loss of friends, family, loved ones, jobs, lifestyle, health
  • Major life/phase of life changes, Major Illness/health conditions and chronic pain
  • Finances, career, personal or family crises,
  • Substance abuse, dependence or other delicate unmanageable problems.
  • Bullying, abuse, alienation/rejection from family/etc, discrimination, harassment
  • Additional stress and responsibility
    Postpartum complications (“Postpartum Depression”)

Treatment for Mood Disorders THERAPY/TREATMENT FOR DEPRESSION AND MOOD DISORDERS

There are various therapy modalities and schools of thought to apply to a variety of problems/diagnoses, such as mood disorders (depression) or anxiety disorders. One of the more frequently utilized approaches is called Cognitive Behavioral Therapy (CBT.) This approach is found to often have a fairly rapid reduction of symptoms. The basic premise suggests that faulty or distorted thinking causes a disrupted mood. Through a set of applied “tools,” it is possible to re-program one’s thinking as well as the related behaviors/actions that compound together to form cognitive-behavioral therapy.

Most all of the self-reportedly "ground-breaking" self-help books that have been repeatedly recycled and re-branded and marketed over the last 40 years are all basically variations of Cognitive-Behavioral Therapy. The power is in the mind… You can change the way you feel.. Take control of your life  etc.. Modifying your behavior, your thinking, your choices, your boundaries and on and on. Yes, it really is an effective rationale.

“You can change the way you feel by modifying the way you think.”

Cognitive Distortions Cognitive Behavioral Therapy will assess and address “Cognitive Distortions.”

The term “Cognitive Distortion,” is a more elaborate expression that describes a erroneous thought, group of thoughts, thinking or thought process that poses significant ramifications. Because these thoughts are “thinking errors,” the thought can be challenged and theoretically they can be corrected to a more accurate and healthy, constructive thought. The thoughts will influence the feelings, which will directly impact mood and or depression, anxiety, triggers to act out etc.

All or Nothing Thinking:
You see things in black or white categories.  If your performance falls short of perfect, you see yourself as a total failure.

Disqualifying the Positive:
You reject positive experiences by insisting that they don’t count for some reason or other.  In this way, you can maintain a negative belief that is contradicted by your everyday experiences.

Emotional Reasoning : “I feel it, so it must be true:”
You assume that your negative emotions necessarily reflect the way things really are.

Jumping to Conclusions/Mind-Reading/ “Fortune Teller Error:”
You make a negative interpretation, even though there are no explicit facts that convincingly support the conclusion.

Labeling and Mislabeling: Extreme form of overgeneralizing:
Involves describing an event with language that is highly “colored” and emotionally loaded (name calling, blaming accusing, etc).  Rather than describe your thinking error, you attach a negative label to yourself, such as “I’m a Loser.”  Conversely, when someone else’s behavior rubs you the wrong way, you attach a negative label to that person as well, rather than disapproving of their behavior.

Magnification and “Catastrophizing:” 
You exaggerate the importance of things, such as your mistakes or imperfections, while shrinking your desirable/positive qualities.  You minimize someone else’s imperfections or errors, while emphasizing and maximizing their attributions/contributions.

Mental Filter:
You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

Overgeneralizing:
You see a single negative event as a never-ending pattern of defeat.

Personalization:
You see yourself as the cause of some negative external event, which in fact, you were not primarily responsible for. The distorted thinking will lead to a conclusion that the problem is your fault and your responsibility.

Should-Statements: “Could’ve, would’ve, should've, ought to, must….._________________”
You try to motivate yourself with “shoulds” and "shouldn'ts" as if you had to be punished before you could be expected to do anything. When you direct should statements towards others, you feel anger, frustration and resentment (can’t cause, change or control others.)

ADDITIONAL TREATMENT APPROACHES for depression, anxiety and many other mental health conditions may also include influences from several psychotherapy modalities such as Family Systems, Psychodynamic/Freudian therapy. Therapy will also consider historical issues, such as family of origin dynamics and what psychodramas are being potentially re-enacted in the present time. All clients will most undoubtedly experience a “Client-Centered” Therapy, where the client is offered helpful mirroring and empathy with or without specific homework/cognitive restructuring goals.

For more technical, clinical details on Depression and Mood Disorders symptoms please follow this link to: National Institute of Mental Health: Depression details from The National Institute of Mental Health

Treatment with Medication Prescribed by Medical Doctor              or Psychiatrist/Psychopharmacologist

MEDICATIONS FOR DEPRESSION AND ANXIETY:

Since the advent of Selective Serotonin Reuptake Inhibitor (SSRI) medication, (I.e.: “Prozac,” (f Fluoxetine) became widely utilized for depression and anxiety disorders after it was approved in 1987) these seem to be the more preferred psychopharmacological options to treat depression and anxiety. There have also been several new drugs approved in the recent years for treatment of Bi-Polar Disorder, which was formerly most always treated with Lithium.

SSRI medication works by chemically blocking a mechanism that limits Serotonin levels; this chemical and this process has been found to be directly linked to alteration of mood, anxiety and or obsessional thinking. There are numerous other medications and classes of medications used to treat mood disorders and other mental health conditions as prescribed by your doctor or psychiatrist. There are numerous derivatives of Fluoxetine (Prozac,) that were approved since the late 1980’s in this class of drugs; patients respond differently to these variations.

MEDICATION AND “TALK THERAPY” COMBINATION

Some clients will be prescribed and or also elect to take anti-depressants, mood stabilizers, anti-anxiety or other similar related psychotropic medications. The need for medication therapy as part of the treatment plan is determined by a medical doctor, often times a psychiatrist and sometimes also involves the psychotherapist. Ultimately, the final decision to enter a course of treatment of psychotropic medications, such as Prozac/other SSRI drugs or Wellbutrin (Bupropion) or a mood stabilizing drug such as Lamictal or Lithium, rests with you, the client.

Some research suggests that medications have been found to greatly influence a positive outcome particularly when they are combined with psychotherapy (talk therapy.) Not every patient who takes anti-depressants is in therapy or has even necessarily had therapy in the past. Similarly, not every patient who is in therapy is concurrently also prescribed psychotropic medications. However, some estimates suggest that approximately 30-50% of therapy clients are either currently on antidepressants or have been on them in the past.

Medications and timelines

“Training Wheels:”

One conclusion suggests that being on medications can help with managing emotions in a constructive manner that allows the patient to better accomplish required therapy tasks and achievements via psychotherapy. Medications can help reduce the intensity of symptoms like depression, anxiety and mania, for example; thus the client may experience an increased ability to manage their depression/anxiety by using therapeutic techniques they experience in psychotherapy.

Some patients have been on medications and various medications for many years and will need to remain on them likely for the remainder of their lives. Other patients are prescribed medications for a more acute episode that is connected to an incident/time-period-case-specific issue and is likely more temporary situation. This may include a single episode of depression or anxiety that is typically connected to a specific event or present stressor, crisis trauma or death/loss etc.

This more temporary type of scenario implies that the patient may opt to discontinue the psychotropic medications in the semi-near future, perhaps as little as 6 months, but usually they are on it about 1 year. Most psychiatrists maintain the following philosophy about psychotropic meds like anti-depressants: If a patient has been prescribed psychotropic medications, like anti-depressants, and they have engaged in trial termination of usage (“titrating off”) but shortly thereafter, they determined that they were unable to stop taking meds because symptoms re-occurred or they felt too uncomfortable/unstable, this patient will likely opt to or need to be placed on medications permanently.

This is especially relevant if they have unsuccessfully tried to stop on several occasions. In these cases the implication is that there are perhaps more biological/organic based chemical conditions at play on top of or instead of a situational type of depression/anxiety. Also relative with longer-term/permanent psychotropic medication necessity, there is usually a family history of clinical and chemical depression, mood disorders or anxiety disorders, often times with a close family member currently under psychiatric care and prescribed medications as well.