For most of us, depression comes and goes, or at least that’s how we describe this state of being, much like we describe fluctuations in the economy or the housing market.
We say we’re depressed after a relationship ends, or when we fail to get a new job, or when our computer crashes or gets plagued with hard drive eating viruses. Burnt eggs, or a store not having our size in a particular sweater also elicit declarations of depression.
In fact, the number of daily occurrences that cause us to state our “depression” are almost endless, which, unfortunately, often misleads and diminishes the seriousness of this mental disorder. Even what we label “the blues,” those “down” times everyone experiences once in awhile are not, usually, what needs treatment and intervention.
Most individuals are able to eventually extricate themselves from these down times, a spiral that doesn’t go as deep, or doesn’t immerse an individual as perniciously as a clinical diagnosis of depression.
Classified as a Mood Disorder
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), depression is a mood disorder, which is also called affective - a synonym for mood – disorder. This illness causes an individual’s mood to be distorted or inappropriate to the context or conditions of that person’s life.
Depression is an illness like other medical illnesses. Without treatment, those who suffer with it do not get better, and left untreated, the condition leads to other serious mental and physical health problems and illnesses. It also is the leading cause of suicide in the country.
Depression is a chronic condition that causes unrelenting pain, similar to other medical conditions that must be managed and treated as a long-term illness. But the good news is that psychotherapists have a large body of therapies, based on evidence-based research, to tackle and control this disorder’s destructive effects.
The Many Faces of Depression
Those who work in the mental health field know the many manifestations of depression, how it affects each individual differently, how some are so miserable that getting out of bed or grooming takes too much energy or effort.
Others are able to work or perform everyday tasks, yet feelings of low self-worth, guilt, or suicidal ideation constantly prey on their thoughts. This underlying depression takes its toll, removing joy and a sense of purpose from lives, keeping individuals moving within a fog of irritability, confusion, and a type of psychological numbness.
In order to make a diagnosis of depression, mental health practitioners use the guidelines as described by the DSM-IV. Using these guidelines, they also map the disorder along a continuum, from mild, to moderate, to severe. They judge the severity of the condition based on the number of symptoms, the severity of the symptoms, and the degree to which an individual’s everyday functioning is impaired.
DSM-IV Categories of Depression
Major Depressive Disorder (MDD) - Unipolar Depression
Individuals must have experienced mood difficulties for at least 2 weeks, and have evidence of any four depressive symptoms:
- loss of energy or fatigue
- weight loss or gain
- low self-worth
- suicidal ideation
- inability to focus
- difficulty making decisions
- too little or too much sleep
MDD symptoms that fall toward the severe end of the continuum can be accompanied by psychotic episodes, and might cause some individuals to be hospitalized or housebound.
(If an individual is suffering with loss and/or bereavement issues or taking certain medications known to cause depression, it generally is not considered major depressive disorder.)
Individuals exhibiting at least two of the above depressive symptoms, and having a depressed mood for at least two years, or one year for children, for more days than not, have dysthymic disorder.
Depressive Disorder NOS (Not Otherwise Specified)
Depressive conditions that are not MDD or dysthymic disorder, but have depressive qualities that seriously impact everyday functioning including occupational and social impairments, fall under depressive disorder NOS. For example, someone experiencing two depressive episodes of at least two days in a two-week period have what practitioners describe as minor depressive disorder. And those who have these 2-day, 2-week episodes at least once a month for one year have another type of depression classified as NOS and called recurrent brief depressive disorder.
Premenstrual dysphoric disorder (PMDD) also falls under depressive disorder NOS, a depression occurring one week prior to menstruation during most months of the year.
And a severe depressive disorder that occurs during a psychotic episode of schizophrenia or another psychotic disorder – called postpsychotic depressive disorder – is also categorized as depressive disorder NOS.
Individuals with this type of depression have alternating periods of extreme lows and highs. (see Bipolar Disorder). The lows are marked by intense depressive episodes; the highs by manic periods - periods of highly elevated moods, overly energetic and expansive behaviors. Some individuals experience these mood shifts sporadically throughout the year, others experience them every day.
Mixed episodes are where individuals experience depression and mania at the same time.
If major depressive disorder takes many forms, bipolar disorder is even more individualized. For some, the depression aspect of bipolar disorder causes a lot of dysfunction. Others have a deeper problem with mania, staying “high” for several days or weeks.
Manic highs have different degrees of dysfunction, causing some individuals to experience a rush of creativity and manically create several new artworks, work on several house or car projects, or work nonstop at their jobs - even without sleeping. Some go on buying binges, impulsively buying things they don’t need, causing severe financial problems. Others talk nonstop, not letting others talk or express their opinions.
The DSM-IV breaks bipolar disorder, also called manic depression, into three subtypes depending on its severity:
These two disorders often co-occur with bipolar disease, unfortunately, contributing to the under-recognition of childhood bipolar disorder. But research combined with more parents and doctors becoming educated about this disorder has led to the strong probability of it as a childhood disorder as well.
A mild form of bipolar disorder, cyclothymia causes some distress and malfunctioning, but typically doesn’t reach the extreme highs and lows of other types of bipolar disorders.
When individuals don’t escalate their moods to the most extreme highs, but still experience increased, exaggerated mood swings, experts call this type of mania hypomania. Individuals with cyclothymia experience hypomania.
Bipolar II disorder
This form of bipolar disorder also is characterized by hypomania rather than full-blown mania. But in this form of bipolar, periods of depression last longer than periods of hypomania.
Bipolar I disorder
This is the most severe form of bipolar disorder, causing crucial lifestyle and personal dysfunctions, affecting jobs, relationships, and all forms of normal daily functioning. It is characterized by full-blown mania and depression, and manic episodes can become dangerous causing extreme and irrational behaviors.
When individuals have severe bipolar disorder, psychosis may occur in either the depressive or manic episodes. Strong, irrational beliefs are delusions, such as everyone is out to kill them, or everyone is mad at them. Hearing voices or seeing things that aren’t there are also forms of psychosis called a hallucination. Both delusions and hallucinations are common in those who are on the severe end of the bipolar spectrum.
Those with bipolar disorder and depression (mood disorders) are known to have high rates of suicidal thoughts (ideation) and behaviors (self-injury and suicidal attempts). For this reason, it is especially critical for those with these disorders to stay in treatment and maintain relationships with primary care doctors, counselors, and therapists.
If you or someone you know has suicidal thoughts, seek help immediately. Suicide hot line numbers (in the U.S.) exist. The toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 has trained counselors available to talk with anyone at any time.
If working as a mental health counselor with those suffering from different forms of mood disorders interests you, contact schools offering degrees in mental health counseling.