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Mood-Related Issues



Major Depression

major depressive disorder symptoms




What is it?

Depression (Major Depressive Disorder) is a psychological disorder characterised by feelings of intense sadness and/or a loss of motivation and enjoyment in life. Depression is more than feeling sad, it is a serious mental health problem that can impacts on a person’s personal and professional life. Depression often begins in the teens, 20s or 30s, but it can happen at any age.

Symptoms

  • Predominant depressed mood (sometimes with periods of irritability)
  • Lack of enjoyment in life
  • Loss of interest in things that used to be enjoyable
  • Loss or increase in weight due to appetite changes
  • Changes in sleeping
  • Loss of sex drive
  • Feeling physically heavy and lacking motivation
  • Feeling hopeless or worthless
  • Trouble making decisions that used to be easy
  • Feeling like your thinking is slowed
  • Feeling like every day is “ground hog day”
  • Thoughts of death or suicide
  • The symptoms must: 1) last at least two weeks for a diagnosis of depression; 2) not be due to a medical condition

Risk Factors

  • Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness during their  lifetime. However, depression can occur in people with no family history, which is why some scientists believe it can be a product of both genetics and life experiences.
  • Personality: People with low self-esteem who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress, may be prone to depression.
  • Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
  • General Medical illnesses: Increased rates of depression have been reported among patients with several general medical illnesses. Among these are cardiovascular disease, AIDS, respiratory disorders, cancer, and several neurologic conditions
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Treatment

Treatment of choice for depression includes Cognitive Behaviour Therapy (CBT) and Metacognitive Therapy (MCT). These approaches are complementary, relatively short-term therapies, focused on assisting the individual to identify unhelpful thoughts, beliefs about thinking, unhelpful behaviours and problematic emotional experiences to learn or relearn healthier skills and habits. Both are well validated, widely used therapies which are stand-alone treatments and/or with medication. Research indicates that individuals who learn CBT and MCT strategies to assist with their depression continue to improve over long-term follow up. Acceptance and Commitment Therapy (ACT) can also be a very useful therapy approach for individuals who wish to work on building a fulfilling life despite their depression, rather than necessarily trying to “get rid of” the depression. If the depressed mood is caused by longer-term patterns that have existed for a long time, then Schema-Focused Therapy is another good treatment option.


Postpartum Depression

postpartum depression

What is it?

Postpartum depression (PPD) also called Postnatal Depression (PND) is when a woman experiences depression between one month and up to one year after the birth of a baby. PPD affects up to one in seven women (almost 16 per cent) giving birth in Australia. Sometimes it can be hard to tell the difference between clinical depression and the normal stress and exhaustion of new parenthood, but if your depressed mood is so strong you are unable to do your daily tasks then you could have PPD symptoms. According to the American Psychiatric Association, PPD can begin in the weeks after pregnancy or even before. (About half of women with PPD have symptoms during pregnancy.)

Symptoms

PPD is present if five or more of the following, including at least one of depressed mood and loss of interest or pleasure within a 2-week period (with an onset in pregnancy or within 4 weeks of delivery)

  • Depressed mood
  • Loss of interest or pleasure, most of the day
  • Change in weight or appetite
  • Sleep disturbance
  • Psychomotor retardation or agitation (observed)
  • Loss of energy or fatigue
  • Worthlessness or guilt
  • Difficulties with decision making
  • Thoughts of harming yourself or your baby
  • Recurrent thoughts of death or suicide
  • Difficulty bonding with your baby

What about the dads?

Most people are surprised to know that around 1 in 20 men experience depression during their partner’s pregnancy (antenatal) and up to 1 in 10 new dads struggle with depression following the birth of their baby (PPD). Life changes in many ways after having a child and sometimes it can be hard to adjust to these changes, particularly when sleep deprived. Like any adjustment, it is important for a new or expecting dad to seek support and treatment as early as possible.

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Treatment

Cognitive-Behavioural Therapy (CBT), Mindfulness-Based CBT, and Behavioural Activation can help alter patterns of thinking, and change the way people feel and behave. Acceptance and Commitment Therapy on the other hand may help individuals manage (rather than try to change) the difficulties they experience while developing new life goals. These are well validated, widely used therapies that can target depressive issues in different ways.


Late Life Depression

What is it?

Late-onset depression or late-life depression is characterised by a person over the age of 60 experiencing a first episode depression. As opposed to early-onset depression, late-life depression is characterised by less emotional symptoms and more cognitive (thinking) and physical symptom and loss of interest. For example, they may be less likely to report feeling sad but describe not wanting to do anything and feeling slowed in their thinking. Often there is an increased likelihood that a medical illness may also be present and there is usually no previous history of depression or family history. It is essential for a person with these symptoms and characteristics to undergo with depression treatment.

Symptoms

The symptoms of late-life depression can include:

  • Slower cognitive processing speed
  • Decision making and memory problems (e.g. feeling slowed in thinking)
  • higher rates of fatigue
  • Increased irritability (described as being short-tempered)
  • Insomnia
  • Self-neglect
  • Psychomotor retardation
depression treatment

Depression vs. Grief

The signs of depression and grief can be similar, although people who have experienced both talk about the ‘sadness’ of grief compared with the ‘numbness’ of major depression. Grieving is a natural process which tales time to lessens or resolve. Depressive symptoms are an expected reaction to loss, but pervasive symptoms lasting more than two months may signify a depressive disorder.

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Why it goes undetected

  • Many older people don’t visit their GP as feeling down is not a physical illness and therefore they seldom mention depression
  • Some people have difficulty putting troubled feelings into words.
  • People born in the early part of the 20th century endured world wars and economic depression and learned to ‘keep their chin up’ and carry on, without complaining.
  • They may be frightened of talking to a doctor about their mental health as they may have fears about being put in a “mental hospital”
  • Many people, including some GPs, seem to think depression is an inevitable part of ageing.

Depression vs. Dementia

Major depression and dementia often co-occur and differential diagnosis is often challenging. Depression can be both an early or midlife risk factor for dementia and an early sign of emerging dementia, with both dementia and depression resulting from the same neurological changes. Conversely, dementia may be a risk factor for depression due to psychological reaction to the cognitive and behavioral changes accompanying dementia. The following table can provide some indication of the differences, however only a comprehensive psychological and medical assessment will be able to clarify the issue.


Childhood Depression

Depression in Children

What is it?

Childhood depression is different from the normal “blues” and everyday emotions. Depression in children is more than just feeling sad. It affects thinking, mood and behaviour. Children experiencing depression often feel negative and hopeless about their situation and their future. If your child is depressed, it can be hard for them to learn, make friends and make the most of daily life because they may lack confidence, attention and motivation. If depression goes on for a long time without treatment, the way your child learns and grows can also be affected. 

The key difference between “being sad” and “being depressed” is if the sadness persists and is disruptive to normal social activities, schoolwork or family life. It is important to note that children with depression are often undiagnosed because they are passed off as “being emotional”. Children often find it difficult to explain how they are feeling, especially when depressed, so may express their feelings with challenging behaviour.

Symptoms

If you notice at least five of the following symptoms for longer than about two weeks, your child might be at risk of depression:

  • Report they are not motivated and “don’t want to do anything”
  • Do not enjoy things they used to
  • Difficulty being attentive and staying on task
  • Exhibit negative self-talk
  • Isolate and avoid spending time with friends
  • Pessimism, unable to identify the positives
  • Difficult to make happy
  • Express anger or seem “always irritable”
  • Increase in tearfulness
  • Appetite fluctuations e.g. not eat or binge
  • Problems with sleep, e.g. over sleeping or difficulties staying asleep



Treatment

Depression is not a passing mood, nor is it a condition that will go away without proper treatment. Psychological treatment of choice for childhood depression is Cognitive Behaviour Therapy (CBT), with a strong behavioural component.

For adolescents,  Interpersonal Therapy (IPT) may also be an effective therapy approach for depression.


Bipolar Disorders

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What is it?

Bipolar disorder, previously known as manic-depressive disorder, is a mood disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks. There are different types of bipolar disorder and symptoms of bipolar disorder can be severe. 

They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Symptoms

Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity levels, thoughts, or behaviour. People may have periods of mania or hypomania, depression and ‘mixed episodes’ (a mixture of manic and depressive symptoms). These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Most people with bipolar disorder experience multiple episodes at an average of one episode every two to three years, with each phase lasting about three to six months. If a person has four or more episodes in a 12-month period, their condition is termed ‘rapid cycling’ bipolar disorder.

bipolar disorder

 

Bipolar Disorder is commonly classified into two subtypes: Bipolar I disorder and Bipolar II disorder. Bipolar I disorder is characterized by oscillation between manic and depressive episodes, with symptoms and duration of episodes often being severe and may result in hospitalization. Bipolar II disorder is characterized by oscillation between hypomanic and depressive episodes.

Manic Episode

  • Increased energy and overactivity
  • Feeling “jumpy” or “wired”
  • Increased spending or reckless and impulsive behaviours
  • Increased sex drive
  • Rapid speech
  • Trouble sleeping/ decreased need for sleep
  • Being agitated and irritable
  • Racing thoughts
  • Distractibility
  • An increase in goal-directed activity
  • Grandiose ideas
  • Hallucinations and/or delusions

Depressive Episode

  • Feeling very “down” or sad
  • Too much or too little sleep
  • Decreased or lack of enjoyment in things
  • Feeling worried and empty
  • Trouble concentrating
  • Memory difficulties
  • Difficulty managing small tasks or making simple decisions
  • Change in appetite
  • Irritability
  • Lack of motivation
  • Mental and physical slowing or restlessness
  • Low self-esteem
  • Suicidal thoughts
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Treatment

Treatment can do much to reduce and even eliminate symptoms. Medication and psychological therapy are often utilised. The evidence suggests that medication plays an important role in treatment in most cases, but both medication and psychological treatment  are usually essential for best outcome. 

The types of psychological treatment that may assist in the management of Bipolar Disorder include; Cognitive-Behavioural Therapy, Acceptance and Commitment Therapy (ACT), Family-Based therapies, and Dialectical Behaviour Therapy (DBT).


Premenstrual Dysphoric Disorder

Premenstrual symptoms


What is it?

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). Many women experience fleeting physical and psychological changes around the time of their menstruation. For most women, symptoms are mild but for a certain group of women, these symptoms can be disabling. PMDD causes severe, debilitating symptoms that interfere with a woman’s ability to function. The main symptoms that distinguish PMDD from other mood disorders or menstrual conditions is when symptoms start and how long they last. Symptoms of PMDD can emerge 1-2 weeks preceding menses and typically resolve with the onset of menses. 

Symptoms

PMDD occurs when over the course of a year, during most menstrual cycles, 5 or more of the following symptoms are present:

  • Depressed mood
  • Anger or irritability
  • Trouble concentrating
  • Lack of interest in activities once enjoyed
  • Moodiness
  • Increased appetite
  • Insomnia or the need for more sleep
  • Feeling overwhelmed or out of control
  • Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
  • Symptoms that disturb your ability to function in social, work, or other situations

How common is it?

PMDD is a medical illness that impacts only 3% to 8% of women usually emerging during a woman’s 20’s. These symptoms may worsen over time; for example, it has been observed that some women may experience worsening premenstrual symptoms as they enter menopause. Less commonly, PMDD may begin during adolescence, with case reports suggesting that successful treatment options in adolescents with PMDD are like those used for adult women. The major risk factors for PMDD include psychiatric history of a mood or anxiety disorder, family history of premenstrual mood dysregulation and are aged in their late 20’s to mid-30’s.


Treatment

The psychological treatment of choice for Premenstrual Dysphoric Disorder is Cognitive Behaviour Therapy (CBT), aimed at symptom management. 

Another beneficial treatment option is Acceptance and Commitment Therapy (ACT), which helps an individual learn to live a meaningful life alongside their symptoms – if symptoms persist. 

A number of medical treatment options may be complimentary to psychological therapy, which can be discussed with your GP.


Brain Injury-Related Depression

levels of depression

What is it?

Acquired Brain injury (ABI) can result from a variety of issues, including: stroke, brain tumour, accidents (referred to as traumatic brain injury or TBI), lack of oxygen to the brain, or degenerative diseases. And although it is normal for someone who has had a brain injury to feel down as a result of the issues caused by this injury, those feelings can extend beyond normal feelings of sadness and lead to different levels of depression. People with depression feel sad, lack energy or feel tired, or have difficulty enjoying routine events almost daily. There is cause for concern when feeling depressed or losing interest in usual activities occurs at least several days per week and lasts for more than two weeks.

Symptoms

The symptoms of depression after brain injury are the same as those of Major Depression (see earlier section). Importantly though, a number of these symptoms can be the direct cause of injury to particular areas of the brain due to brain injury (e.g. loss of sex drive, emotional changes, fatigue, cognitive changes etc.); as such, treatment methods need to take this into account.
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Causes and Risk Factors

Various factors are involved in the development of depression for individuals with brain injury. These may include:

  • Physical changes in the brain due to injury. Depression may result from injury to the areas of the brain that control emotions (e.g. structural damage in specific brain areas such as the prefrontal cortex, hippocampus, and cingulate gyrus can lead to depression).
  • Personality changes directly due to brain injury may also impact development of depression.
  • Changes in capabilities and competencies due to cognitive and physical deficits from brain injury may increase the likelihood of depression for people with ABI. Self-awareness has been shown to play a role in the development of depression as the person slowly recognizes how these deficits will impact their future life.
  • Emotional response to injury such as struggling to adjust to temporary or lasting disability, losses or role changes within the family and society might contribute to development of depression.
  • Other factors unrelated to the injury, such as pre-injury social functioning, history of mental health issues, and hereditary factors, also influence how a person will react to the brain injury.
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Treatment

Psychological therapies have been shown to be helpful for depression in individuals with brain injury. Cognitive-behavioral therapy (CBT) and Behavioural Activation can help alter patterns of thinking, and change the way people feel and behave. Often these therapies need to be adjusted according to cognitive or physical deficits the person may be experiencing from the brain injury. Acceptance and Commitment Therapy on the other hand may help individuals manage (rather than try to change) the difficulties they experience while developing new life goals. Neuropsychological rehabilitation techniques via use of compensatory mechanisms may also be of benefit to help the person better manage and deal with the cognitive or physical deficits resulting from the brain injury that may be contributing to depression.