Dr Virgil Davis

Mood Disorders



Posted: Monday, May 16, 2005

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MOOD DISORDERS

 I do not care for anything. I do not care to ride, for the exercise is too violent. I do not care to walk, walking is too strenuous. I do not care to lie down, for I should either have to remain lying, and I do not care to do that, or I should have to get up again, and I do not care to do that either. I do not care at all. (Kierkegaard, 1844, p. 19)

 The nineteenth-century Danish philosopher Søren Kierkegaard, who was subject to recurring bouts of severe depression, wrote this account. It provides a firsthand description of some of the characteristics of depression, the primary symptom of the mood disorders.

 We have all experienced depression on occasion, as a natural response to setbacks such as failing an exam, ending a relationship, or being rejected by a potential employer. Fortunately for most of us, depression is a transitory state that generally lifts in short order as life goes on. However, when feelings of sadness, dejection, and hopelessness persist longer than a few weeks and when these feelings are severe enough to disrupt everyday functioning, the depression is considered to be an abnormal behavioral state.

The common symptoms or signs of depression include a variety of psychological, psychomotor, and physical manifestations, such as severe and prolonged feelings of sadness, hopelessness, and despair low self-esteem a sense of worthlessness eating disturbances (either undereating or overeating) sleep disturbances (either insomnia or excessive sleep) psychomotor disturbances characterized by a marked shift in activity level a variety of somatic or bodily complaints lack of energy with accompanying fatigue loss of interest in and enjoyment of everyday activities indecisiveness difficulty in concentrating and persistent thoughts of suicide and death.

Like anxiety, depression is associated with many varieties of behavioral disorders, including the anxiety and somatoform disorders, substance-related disorders such as alcoholism, and schizophrenia, which we discuss later in this chapter. In these and related conditions, depression is secondary to other symptoms. In contrast, depression is the primary problem in the mood disorders.

DSM-IV distinguishes two major mood disorders: major depressive disorder and bipolar disorder. A major depressive episode is characterized by depressed mood, diminished interest in activities, significant weight loss or gain, sleep disturbances, restlessness, fatigue, diminished ability to concentrate, and/or recurrent thoughts of suicide. In addition, some or all of these symptoms must be severe enough to impair social or occupational functioning.

Bipolar disorder (sometimes called manic depression) is characterized by intermittent episodes of mania, or periods of both depression and mania. Mania is a highly energized state characterized by an inflated self-esteem, decreased need for sleep, increased pressure to talk, racing thoughts, distractibility, and/or increases in directed activity. These symptoms, as well as those for the depressive episode, must be severe enough to impair social or occupational functioning to warrant the diagnosis of bipolar disorder.

The distinction between major depressive disorder and bipolar disorder is an important one that is based on different symptomatology as well as different etiology. Bipolar disorder generally appears during a person’s twenties, whereas major depressive disorder is more likely to develop later, often in a person’s thirties. However, major depressive disorder may occur in children, adolescents, or young adults, and recent research provides evidence of an increased rate in younger people (American Psychiatric Association, 2003). Symptoms of depression may vary somewhat according to the disorder. The depression associated with bipolar disorder typically causes a person to become lethargic and sleep more. In contrast, major depressive disorder is characterized by insomnia and agitation. These two different types of mood disorders also respond quite differently to various treatments.

As many as one out of five Americans may experience a severe depressive episode at some point in time, but only 1 percent of the population will be diagnosed with bipolar disorder (Davison & Neale, 1990). Evidence suggests that the incidence of mood dis-orders has been progressively increasing over the last few decades. It is now estimated that 19 million people in the United States suffer from depression severe enough to interfere with their life and depression is now the leading cause of disability in the United States and worldwide (National Institute of Mental Health, 2003).

Major Depressive Disorder

 People diagnosed as having major depressive disorder typically manifest their symptoms over an extended period, from several months to a year or longer, and their ability to function effectively may be so impaired that hospitalization is warranted. The following brief case study illustrates some of the common symptoms of severe depression:

On admission to the hospital, the patient sat slumped in a chair, frowning deeply, staring at the floor, his face looking sad and drawn. When questioned he answered without looking up, slowly and in a monotone. Sometimes there was such a long pause between question and reply that the patient seemed not to have heard. Every now and then he shifted his position a little, sighed heavily and shook his head from side to side. His first verbal response was, "It’s no use. I’m through. All I can think is I won’t be any good again." In response to further inquiries he made the following comments, relapsing into silence after each short statement until again asked a question. "I feel like I’m dead inside, like a piece of wood. I don’t have any feeling about anything it’s not like living anymore. I’m past hope, there’s nothing to tell." (Cameron, 1947, p. 508)

 Earlier I mentioned that the depression in major depressive disorder is more likely to be accompanied by agitation than it is in bipolar disorder. This state may cause people to pace, wring their hands, or cry out and moan loudly. Depressed people who express this heightened motor activity continue to feel worthless and without hope.

Not surprisingly, people with major depressive disorder almost inevitably experience a breakdown in interpersonal relationships. Most of us do not enjoy being around irritable people, and since many depressed people are irritable, it is understandable that friends, associates, and even family members may eventually gravitate away from such people. In addition, depressed people often seek guidance and support from others, and it can be very frustrating for friends to observe that their efforts to provide help often seem to have no effect. Sometimes people may avoid depressed individuals because such interactions often make them feel gloomy or depressed.

Although often incapacitating and sometimes even life threatening (individuals who contemplate suicide are often deeply depressed), episodes of major depression are generally transitory in nature. In most cases the depression lifts over a period of months, regardless of whether or not it is treated. However, most people with diagnosed major depressive disorder experience one or more recurrence(s) of major depression later on in their lives.

Bipolar (Manic-Depressive) Disorder

 In contrast to major depressive disorder, bipolar disorder is characterized by extreme mood swings. In some cases, periods of mania recycle while in other cases episodes of depression and elation may alternate, with months or years of symptom-free normal functioning between the disordered mood states. Other cases may be characterized by a series of intermittent manic episodes followed by a period of depression. Unlike the normal highs and lows most of us experience in response to life events, the depression and mania associated with bipolar disorder do not seem to be triggered by identifiable events. In some manic-depressives, depressive symptoms may occur concurrently with classic manic features, a condition referred to as mixed mania.

 About one in 100 people suffer from bipolar disorder, a rate comparable to that of schizophrenia but far lower than the incidence of major depression. Men and women are equally likely to develop bipolar disorder. Since the depression experienced in bipolar disorder is quite similar to what we already described as experienced in major depression (with noteworthy differences in sleep and activity level), we focus here on the manic symptoms of the disorder.

According to DSM-IV, manic episodes are characterized by "inflated self-esteem or grandiosity (which may be delusional), decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal-directed activity, psychomotor agitation, and excessive involvement in pleasurable activities that have a high potential for painful consequences that the person often does not recognize." Manic episodes often begin suddenly and escalate rapidly, as revealed in the following case:

Mr. M., a thirty-two-year-old postal worker, had been married for eight years. He and his wife lived comfortably and happily in a middle-class neighborhood with their two children. In retrospect there appeared to be no warning for what was to happen. On February the twelfth Mr. M. let his wife know that he was bursting with energy and ideas, that his job as a mail carrier was unfulfilling, and that he was just wasting his talent. That night he slept little, spending most of the time at a desk, writing furiously. The next morning he left for work at the usual time but returned home at 11:00 a.m., his car filled to overflowing with aquaria and other equipment for tropical fish. He had quit his job and then withdrawn all the money from the family’s savings account. The money had been spent on tropical fish equipment. Mr. M. reported that the previous night he had worked out a way to modify existing equipment so that "the fish won’t die anymore. We’ll be millionaires." After unloading the paraphernalia, Mr. M. set off to canvas the neighborhood for possible buyers, going door to door and talking to anyone who would listen.

The following bit of conversation from the period after Mr. M. entered treatment indicates his incorrigible optimism and provocativeness.

Therapist: Well, you seem pretty happy today.

Client: Happy! Happy! You certainly are a master of understatement, you rogue! (shouting, literally jumping out of his seat). Why I’m ecstatic, I’m leaving for the West Coast today, on my daughter’s bicycle. Only 3,100 miles. That’s nothing, you know. I could probably walk, but I want to get there by next week. And along the way I plan to contact a lot of people about investing in my fish equipment. I’ll get to know more people that way-you know, Doc, "know" in the biblical sense (leering at therapist seductively). Oh, God, how good it feels. (Davison & Neale, 1986, p. 196)

 A manic episode often follows a three-stage course of accelerating intensity. In the first stage, hypomania, individuals typically retain their capacity to function in their daily lives, and may even exhibit high levels of productivity. However, as they progress through the second and third stages of mania and severe mania, their thinking becomes more disorganized, and their behavior often takes on a bizarre psychoticlike quality. These advanced stages may be accompanied by both delusions (exaggerated and rigidly held beliefs that have little or no basis in fact, such as Mr. M.’s belief that he had found a way to keep tropical fish alive forever) and hallucinations (false perceptions that lack a sensory basis, such as hearing or seeing imaginary voices or images). Bizarre symptoms such as those described in this article’s opening case are not often manifested, since modern drugs are quite effective in controlling such behaviors.

Table 1 Suicide Facts

 1. Approximately 30,000 people in the United States take their own lives each year making suicide the 11th leading cause of death (probably an underestimation, since many suicides are not officially recorded).

2. For every successful suicide there are at least 8 to 25 attempts. This translates to approximately a quarter of a million suicide attempts each year in this country.

3. Four times more men than women succeed in committing suicide, although over three times as many women as men attempt suicide. Men often use absolute and irreversible methods, such as guns and hanging, to kill themselves, whereas women are more likely to use drugs, gas, or poison.

4. Suicide rates by age group rise steadily from adolescence to the elderly. The highest rates are for white men over 85.

5. About 80 percent of people who kill themselves provide ample verbal or other behavior clues beforehand.

6. It is believed that more than half of the people who commit suicide are seriously depressed at the time of the act. However, many people who kill themselves do not have a diagnosable psychological disorder.

 SOURCES: National Institute of Mental Health, 2003

  

Episodes of either mania or depression tend to last only a few weeks or months. When they lift, the person recovers and returns to a symptom-free life. Unfortunately, however, the symptoms tend to recur, and many people require periodic treatment and sometimes maintenance medication throughout their lives. This pattern takes its toll in the form of alienated friends and loved ones, financial problems, and careers that remain on hold due to the unpredictable nature of symptoms. One of the most devastating aspects of this disorder is the high risk of suicide associated with it (see Table 1). Available evidence indicates that people with bipolar disorders are more likely to kill themselves than any other group of people with a behavioral disorder.

 

 

 

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Dr. Virgil Davis is currently a full professor of psychology. Davis has published several articles and is co-author of the books "Understanding Psychology". (4 editions) Dr. Davis is owner of Davis Karate Studios, holds a 7th degree black belt in karate and is also a Reiki Master.

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» left by One Of Your Students
from Ashland 5 years 307 days ago.
I would like to say that is a interesting article and you did a great job. Glad to know that you also share your knowledge with more than just your students.
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