Myth: Hard Work Beats Depression

Depression affects nearly one in six people at some point in their lives, so folk remedies and half-truths about this common illness abound. One such idea: throw yourself into work and you’ll feel better. For a mild case of the blues, this may indeed help, but depression is a different animal. Overworking can actually be a sign of clinical depression, especially in men.

Myth: It’s Not a Real Illness

Depression is a serious medical condition — and the top cause of disability in American adults. But it’s still confused with ordinary sadness. Biological evidence of the illness can be seen in brain scans, which show abnormal activity levels. Key brain chemicals that carry signals between nerves (shown here) also appear to be out of balance in depressed people.

Fact: Men Fly Under the Radar

A depressed man, his loved ones, and even his doctor may not recognize depression. That’s because men are less likely than women to talk about their feelings — and some depressed men don’t appear sad or down. Instead, men may be irritable, angry, or restless. They may even lash out at others. Some men try to cope with depression through reckless behavior, drinking, or drugs.

Myth: Depression Is Just Self-Pity

Our culture admires will power and mental toughness and is quick to label anyone who falls back as a whiner. But people who have clinical depression are not lazy or simply feeling sorry for themselves. Nor can they “will” depression to go away. Depression is a medical illness — a health problem related to changes in the brain. Like other illnesses, it usually improves with appropriate treatment.

Fact: Anyone Can Get Depressed

Poet or linebacker, shy or outgoing, anyone from any ethnic background can develop depression. The illness is twice as common in women as in men, but it may be that women are more likely to seek help. It’s often first noticed in the late teens or 20s, but an episode can develop at any age. Tough personal experiences can trigger depression, or it may develop out of the blue.

Fact: It Can Sneak Up Slowly

Depression can creep up gradually, which makes it harder to identify than a sudden illness. A bad day turns into a rut and you start skipping work, school, or social occasions. One type, called dysthymia, can last for years as a chronic, low-level illness – a malaise that silently undermines your career and relationships. Or depression can become a severe, disabling condition. With treatment, many feel substantial relief in 4-6 weeks.

Myth: Help Means Drugs for Life

Despite the buzz about a “Prozac Nation,” medication is only one of the tools used to lift depression. And asking for help does not mean you’ll be pressured to take prescription drugs. In fact, studies suggest that “talk” therapy works as well as drugs for mild to moderate depression. Even if you do use antidepressants, it probably won’t be for life. Your doctor will help you determine the right time to stop your medication.

Myth: Depressed People Cry a Lot

Not always. Some people don’t cry or even act terribly sad when they’re depressed. Instead they are emotionally “blank” and may feel worthless or useless. Even without dramatic symptoms, untreated depression prevents people from living life to its fullest — and takes a toll on families.

Fact: Family History Is Not Destiny

If depression appears in your family tree, you’re more likely to get it too. But chances are you won’t. People with a family history can watch for early symptoms of depression and take positive action promptly — whether that means reducing stress, getting more exercise, counseling, or other professional treatment.

Myth: Depression Is Part of Aging

Most people navigate the challenges of aging without becoming depressed. But when it does occur, it may be overlooked. Older people may hide their sadness or have different, vague symptoms: food just doesn’t taste good anymore, aches and pains worsen, or sleep patterns change. Medical problems can trigger depression in seniors — and depression can slow recovery from a heart attack or surgery.

Fact: Depression Imitates Dementia

In seniors, depression can be the root cause of memory problems, confusion, and in some cases, delusions. Caregivers and doctors may mistake these problems for signs of dementia, or an age-related decline in memory. Getting treatment lifts the cloud for the majority of older people with depression. Psychotherapy is particularly useful for people who can’t or don’t want to take medication.

Myth: Talking Makes Things Worse

People were once advised not to “dwell on” problems by talking about them. Today, there’s evidence that guided discussions with a professional can make things much better. Different types of psychotherapy help treat depression by addressing negative thought patterns, unconscious feelings, or relationship troubles. The first step is to talk to a mental health professional.

Fact: Positive Thinking May Help

The old advice to “accentuate the positive” has advanced into a practice that can ease depression. It’s called cognitive behavioral therapy (CBT). People learn new ways of thinking and behaving. Negative “self-talk” and behavior is identified and replaced with more upbeat thoughts and a more positive mood. Used alone or with medication, CBT works for many people.

Myth: Teens Are Unhappy by Nature

Although many teens are moody, argumentative, and intrigued by “the dark side,” prolongued sadness or irritability is not normal for teens. When unhappiness lasts more than two weeks, it may be a sign of depression — which develops in about one in 11 teens. Other signs a teen may need help include: being constantly sad or irritable even with friends, taking no pleasure in favorite activities, or a sudden drop in grades.

Fact: Exercise Is Good Medicine

Very good studies now show that regular, moderately intense exercise can improve symptoms of depression and work as well as some medicines for people with mild to moderate depression. Exercising with a group or a good friend adds social support, another mood booster.

Myth: Depression Is Tough to Treat

The reality is most people who take action to lift their depression do get better. In a large study by the National Institute of Mental Health, 70% of people became symptom-free through medications — though not always with the first medicine. Studies show the best treatment is combining medication and talk therapy.

Fact: It’s Not Always Depression

Some life events cause sadness or disappointment, but do not become clinical depression. Grief is normal after a death, divorce, loss of a job, or diagnosis with a serious health problem. One clue of a need for treatment: the sadness is constant every day, most of the day. When people are weathering difficult times appropriately, they can usually be distracted or cheered up for short periods of time.

Fact: Hope for Better Days Is Real

In the depths of depression, people may think there’s no hope for a better life. This hopelessness is part of the illness, not a reality. With treatment, positive thinking gradually replaces negative thoughts. Sleep and appetite improve as the depressed mood lifts. And people who’ve seen a counselor for talk therapy are equipped with better coping skills to deal with the stresses in life that can get you down.

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Although men, women, and teenagers can experience the same depression symptoms, the illness often has different signs in each of these groups.

Unlike regular feelings of sadness that pass relatively quickly, depression is a clinical illness in which negative emotions last for weeks or longer.

It’s one of the most common mental illnesses people experience, affecting an estimated 350 million people across the globe, according to the World Health Organization.

Depression is treatable, and it’s important to know the signs and symptoms of the illness so that you can get help as soon as possible.

Signs of Depression in Adults

Depression doesn’t affect all people in exactly the same way, but the illness is associated with a number of possible symptoms, which include:

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Persistent feelings of sadness or emptiness
Frequently feeling irritated, anxious, frustrated, or angry
Feeling hopeless, worthless, helpless, or guilty
Fatigue and decreased energy
Changes in appetite and eating habits
Inability to concentrate, remember details, or make decisions
Sleep disturbances, such as sleeping more than usual or insomnia
Loss of interest in activities or hobbies that were once enjoyable
Unexplained body aches or pains, headaches, cramps, or digestive problems
Thoughts of death and suicide
Slowed thinking, speaking, or movement
Reckless behavior
Substance abuse
Depression in Men

Although men and women can experience the same symptoms of depression, there are important differences in how often they report specific symptoms, according to a 2013 report in the journal JAMA Psychiatry.

Men with depression are more likely than women to report the following signs of depression:

Anger
Aggression
Drug and alcohol abuse
Risk-taking behavior
Depression in Women

Women are 70 percent more likely than men to experience depression, according to the National Institutes of Health.

Other sources, including the 2013 JAMA Psychiatry report, state that women are twice as likely to be diagnosed with depression.

Women with depression are more likely to report the following symptoms:

Stress
Withdrawal
Irritability
Sleep problems
Loss of interest
Teen Depression

Teenagers experience the same symptoms of depression as adults, but these changes in mood and behavior are sometimes mistaken as a normal part of puberty or adolescence.

Other signs of depression in teenagers can include:
Obsession with death, such as poems and drawings that refer to death
Criminal behavior, such as shoplifting
Withdrawal from family and friends
Sudden sensitivity to criticism
Drop in grades or school attendance
Risky behavior, such as unsafe sex and reckless driving
Drinking alcohol or using drugs
Irrational or bizarre behavior
Sudden, dramatic changes in personality or appearance
Giving away belongings
Complications of Depression

Experiencing and surviving an episode of major depression puts you at risk for more episodes in the future.

Half of people who recover from their first episode of depression will eventually have one or more additional episodes later in their life.

Additionally, 80 percent of people who have experienced two episodes will go on to have additional episodes, according to a 2007 report in Clinical Psychology Review.

Up to two-thirds of all suicides are associated with clinical depression, according to the health information resource A.D.A.M.

Depression can negatively affect your personal relationships and work life.

It may also raise your risk of developing heart disease or obesity, having a heart attack, or experiencing a sharp decline in mental function in old age.

Depression Tests and Diagnosis

There are a number of online tools and self-tests to determine whether you may be depressed and need to seek help, but only your doctor can diagnose clinical depression.

Before diagnosing major depression — the most common type of depression — your doctor will conduct exams and tests to rule out other problems that could be causing your symptoms, such as thyroid issues, brain tumors, sleep apnea, or vitamin deficiencies.

These efforts may include a physical examination and blood tests, as well as a discussion about your medications, some of which may cause depressive symptoms.

Your doctor will also ask in-depth questions about your mood and feelings, and may ask you to fill out a questionnaire.

According to the American Psychiatric Association, you must meet specific criteria to be clinically diagnosed with major depression.
You must have experienced at least five of the following nine symptoms for at least two weeks, and these symptoms must have significantly impaired your ability to function in your daily life:

Feeling sad or having a depressed mood for most of the day
Loss of interest or pleasure in once-enjoyable activities
Unexplained weight loss or gain
Insomnia or sleeping too much
Fatigue or loss of energy
Restlessness or slowed movements, speech, and thoughts
Feelings of worthlessness and guilt
Difficulty thinking, concentrating, or making decisions
Thoughts of death or suicide
Other forms of depression have other specific diagnostic criteria.

Depression Treatment
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
Psychotherapy, medication, and brain stimulation therapy can help treat various forms of depression.

Depression is a serious mental illness that can cause real pain to both you and your loved ones, and can even lead to suicide.

In fact, depression is associated with up to two-thirds of all suicide cases, according to the health information resource A.D.A.M.

Despite this alarming statistic, various medications — as well as medication-free treatments — are available to help you overcome depression before such severe complications develop.

Psychotherapy for Depression

Depression is different for everyone, but it typically develops due to a combination of factors.

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Psychotherapy, or talk therapy, is designed to help people identify and effectively deal with the psychological, behavioral, interpersonal, and situational factors related to their depression.

Different types of psychotherapy have different goals, such as helping people:

Identify life problems that contribute to depression or worsen it
Identify negative or distorted thoughts and beliefs that contribute to depression-related feelings, such as hopelessness and helplessness
Develop skills to better cope with stress and solve problems
Explore relationships and experiences to improve their interactions with other people
Create realistic life goals and personal self-care plans
Regain satisfaction and control in life
Understand painful past events
Two of the most common types of psychotherapy are cognitive behavioral therapy (CBT) and interpersonal therapy.

Effective for a wide range of mental illnesses, CBT attempts to help people uncover unhealthy or negative patterns of thoughts and beliefs, and replace those patterns with positive ones.

People undergoing CBT often have “homework” between sessions in which they record their negative thoughts, among other things.

Interpersonal therapy focuses on exploring a person’s relationships, identifying problems in those relationships, and improving interpersonal skills.

It aims to help people discover their negative social patterns, such as isolation and aggression, and develop strategies to better interact with other people.

Psychotherapy alone may be the best option for people with mild to moderate depression, but it may not be enough for people with severe depression, according to the National Institute of Mental Health.

Antidepressants

Antidepressants, first developed in the 1950s, are a class of drugs that moderate certain chemicals in the brain that affect mood and behavior.

About 10 percent of Americans ages 12 and above report taking antidepressants, according to a 2011 report by the National Center for Health Statistics.

There are a range of depression medications available today, including:
SSRIs
SNRIs
MAOIs
Tricyclic antidepressants
Depression and Electroconvulsive Therapy

If psychotherapy and medications don’t work for you, your psychiatrist may recommend that you undergo a brain stimulation therapy.

Once called electroshock therapy, electroconvulsive therapy (ECT) has come a very long way since it was first used in the 1940s.

In ECT, an electrical current is passed through the brain while you’re under anesthesia.

The treatment causes a brief, controlled seizure that affects neurons and brain chemistry. Most people undergo four to six treatments before they see major improvements, according to the National Alliance on Mental Illness.

ECT may cause temporary side effects, including headaches, muscle pain, nausea, confusion, and memory loss.

Transcranial Magnetic Stimulation for Depression

Instead of using an electrical current, transcranial magnetic stimulation (TMS) uses magnetic fields to stimulate neurons and help relieve depressive symptoms.

The treatment, which doesn’t require anesthesia, targets the brain area thought to be involved with regulating moods.

Side effects of TMS may include facial muscle contractions, headaches or light-headedness, and seizures (if you have a history of them).

Vagus Nerve Stimulation for Depression

For chronic depression or depression that doesn’t respond to ECT or TMS, vagus nerve stimulation (VNS) may be an option.

A kind of pacemaker for the brain, this treatment uses an implanted device to stimulate the vagus nerve — which carries messages to the parts of the brain controlling mood and sleep — with electrical signals throughout the day.

Localized side effects are associated with VNS, such as throat issues (swallowing, pain, and coughing), neck pain, and breathing problems while exercising.

Natural Remedies for Depression

There are a number of natural remedies, as well as complementary or alternative treatments, that may help treat depression when used in combination with other treatments (including medication).
These remedies include:

Exercise, which releases mood-enhancing hormones
Yoga, meditation, and other mind-body techniques that can lower stress and relieve negative emotions
Massage therapy, which can reduce stress hormones and increase mood-stabilizing brain chemicals (neurotransmitters)
Acupuncture, which may also positively affect neurotransmitters
Certain supplements — including folate, SAMe (S-Adenosyl-L-Methionine), and St. John’s wort — may also help treat depression, but more research is needed to prove their efficacy.

Depression Medications
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
Different classes of antidepressants can help treat depression by acting on mood-regulating brain chemicals.

Depression isn’t the same for everyone — multiple types of depression exist, and people experience this treatable illness in varying degrees of severity.

For some people, psychotherapy, lifestyle changes, and natural remedies may be enough to treat their depression.

Many other people, however, also require medications to lift them above the cloud of depression.

According to a 2011 report by the National Center for Health Statistics, about 10 percent of Americans ages 12 and above report taking antidepressants, drugs that work by acting on specific brain chemicals that are involved in regulating your mood.

In addition, antidepressants are the second most commonly prescribed type of drug in the United States, according to the American Psychological Association.

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Numerous depression-fighting medications are available today, so talk to your psychiatrist to learn which treatment may be best for you.

SSRIs

Selective serotonin reuptake inhibitors, or SSRIs, are the most commonly prescribed antidepressants, according to the National Alliance on Mental Illness (NAMI).

These drugs help alleviate depression by making the neurotransmitter serotonin more available to your brain.

According to the National Institute of Mental Health, the most commonly used SSRIs are:

Prozac (fluoxetine)
Zoloft (sertraline)
Lexapro (escitalopram)
Paxil (paroxetine)
Celexa (citalopram)
Common side effects of SSRIs include:

Sexual dysfunction
Gastrointestinal issues, such as nausea, constipation, and diarrhea
Dry mouth
Insomnia
Headache
Nervousness or jitters
Weight gain
Sweating
SNRIs and NDRIs

The second most commonly prescribed class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), block the reabsorption of both serotonin and norepinephrine, making them more available to your brain.

Some common SNRIs include:

Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Fetzima (levomilnacipran)
Savella (milnacipran) is also an SNRI, but it’s used to treat fibromyalgia instead of depression.

These drugs may cause side effects similar to those of SSRIs, as well fatigue and difficulty urinating.

Another popular type of antidepressant that targets norepinephrine is Wellbutrin (bupropion).

This medication affects the neurotransmitter dopamine in addition to norepinephrine, so it’s considered a norepinephrine-dopamine reuptake inhibitor, or NDRI.
Wellbutrin has similar side effects to those of SSRIs and SNRIs, but it’s less likely to cause sexual dysfunction and may increase your risk of seizures.

Tricyclics

Tricyclic antidepressants (tricyclics, or TCAs) are older drugs that work by blocking the reabsorption of serotonin and norepinephrine through a different mechanism than SNRIs.

While effective, these drugs are seldom used today because they can cause a wide range of side effects, some of which may be serious.

But they are sometimes prescribed when other antidepressants are ineffective, according to NAMI.

Examples of tricyclics include:

Elavil (amitriptyline)
Norpramin (desipramine)
Sinequan (doxepin)
Tofranil (imipramine)
Pamelor (nortriptyline)
Avantyl (nortriptyline)
Vivactil (protriptyline)
Some serious potential side effects of tricyclics include:

Blurred vision
Irregular heartbeat
Tremors
Confusion in elderly people
Seizures
MAOIs

The oldest class of antidepressants, monoamine oxidase inhibitors (MAOIs) work by blocking the enzyme monoamine oxidase, which breaks down various neurotransmitters — including serotonin and norepinephrine — in the brain.

Examples of MAOIs include:

Nardil (phenelzine)
Marplan (isocarboxazid)
Parnate (tranylcypromine sulfate)
Emsam (selegiline), a recently developed skin patch that causes fewer side effects than other MAOIs
Like tricyclics, MAOIs are rarely used today because of their potential side effects and interactions.

For example, if you consume a large of amount of the compound tyramine (found in cheese, pickles, and red wine) while taking an MAOI, you could develop hypertensive crisis — a severe spike in blood pressure that can lead to stroke.

You may also experience a severe increase in blood pressure if you take an MAOI with various medications, including certain:

Birth control pills
Prescription pain relievers
Cold and allergy drugs
Herbal supplements
In addition, taking an MAOI along with an SSRI can cause a potentially life-threatening condition called serotonin syndrome.

Other Medications
Various other medications that don’t fit into the classes listed above are also available to treat depression.

These drugs include:

Trazadone
Nefazodone
Remeron (mirtazapine)
Abilify (aripiprazole)
Seroquel (quetiapine
Viibryd (vilazodone)
Brintellix (vortioxetine)

Depression During Pregnancy
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
About one-fifth of pregnant women experience antepartum depression (depression during pregnancy).

Depression is a common mental illness in which you feel strong negative emotions — including sadness, loss of interest, and hopelessness — that interfere with daily life for a prolonged period.

There are multiple types of depression, including:

Major depression (severe depressive symptoms last for at least two weeks)
Persistent depressive disorder (low-level depressive symptoms last for at least two years)
Seasonal affective disorder (depression during the winter or fall due to lack of sunlight)
Although a lot of attention has been paid to postpartum depression — depression that occurs after giving birth — it’s also not uncommon for women to experience some form of depression during pregnancy, which is known as antepartum depression.

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In fact, between 14 and 23 percent of pregnant women experience depression at some point during their pregnancy, according to a 2009 report in the journal Obstetrics & Gynecology.

Causes and Risk Factors

Some women who experience antepartum depression have a history of major depression.

Experiencing an episode of major depression puts you at risk for more depressive episodes in the future.

Many women have their first experience of depression while they’re pregnant.

Antepartum depression is generally thought to be caused by a combination of hormonal changes and psychological disturbances associated with pregnancy.

Other physical changes during pregnancy, such as bodily changes and changes in sleep and eating habits, can contribute to the development of antepartum depression.

In addition to having a history of depression, other risk factors for antepartum depression include:
Lack of a partner or social support during pregnancy
Relationship problems
History of abuse or trauma
Stressful life events
Financial stress, including poverty
Substance abuse
Feeling ambivalent toward your pregnancy
Previous pregnancy losses or abortions
Anxiety about the fetus, such as from having pregnancy complications
Unplanned pregnancy
Signs and Symptoms

Depression during pregnancy is defined by the same major depressive symptoms that people experience outside of pregnancy.

These symptoms, which must last for two weeks or longer to constitute depression, include:

Severe, persistent sadness
Difficulty concentrating, remembering, or making decisions
Feeling hopeless, worthless, or guilty
Loss of interest or pleasure in formerly enjoyable hobbies and activities
Fatigue
Disturbed sleep
Irritability
Thoughts of death or suicide
Sudden changes in appetite
Reckless behavior
It’s important to note that many of these symptoms are similar to pregnancy-related changes that many women experience, making it potentially difficult to identify antepartum depression.

Complications of Depression During Pregnancy

Depressed pregnant women are more likely to develop various pregnancy complications — including severe nausea and vomiting, and preeclampsia (high blood pressure during pregnancy) — than nondepressed pregnant women.

Women with antepartum depression are also at higher risk for postpartum depression, which occurs after about 15 percent of births, according to the National Institute of Mental Health.

Left untreated, antepartum depression may harm your infant by increasing your risk of:

Complications with pregnancy or delivery
Delivering a low-birth-weight baby
Prematurely giving birth
Treating Depression During Pregnancy
Antepartum depression can be successfully treated using normal treatments for major depression. These treatments include:

Counseling or therapy, including specific techniques such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy
Support groups
Brain stimulation therapies, including electroconvulsive therapy (ECT), in which a low-level electrical current is passed through the brain
Prescription antidepressants, which can carry risks to both a mother and her child that need to be balanced carefully against the benefits of using these medications
Practicing yoga, eating a balanced diet, and getting regular exercise can also help treat antepartum depression.

Is your shopping out of control? Find yourself covering up your spending? For some people who are depressed, it is not uncommon for compulsive buying — in stores or on the Internet — to serve as a distraction or self-esteem booster. But “retail therapy” is a short-lived high because it doesn’t address underlying depression. Also be aware that shopping sprees could also be a sign of mania, in bipolar disorder.

Drinking Heavily

Nearly a third of people with major depression abuse alcohol.  If you feel that you need to drink to cope with anxiety and depression, you may be one of them.  Although a drink may seem like it provides a lift when you’re down, alcohol is a depressant, so overdoing it can make depression episodes worse and more frequent.

Forgetfulness

Depression may be one reason for feeling foggy or forgetful. Studies show that prolonged depression or stress can raise the body’s levels of cortisol. This can shrink or weaken the part of the brain associated with memory and learning. Depression-linked memory loss seems to be worse for older people. The good news: Treating depression may also improve depression-related memory problems.

Excessive Internet Use

Prefer virtual social interactions to real-life ones? Spending excessive amounts of time on the Internet? It may be a sign of depression. Studies have shown a link between high levels of depression and excessive Internet use. People who overuse the Internet tend to spend their time on pornography, online community, and game sites.

Binge Eating and Obesity

A 2010 study from the University of Alabama found that young adults who report being depressed tended to gain weight more around their waist — a risk for heart disease. Other studies have linked depression with binge eating, particularly in middle-age people. Treating depression can help treat these problems.

Shoplifting

About a third of shoplifters suffer from depression. For some people who feel powerless and insignificant from depression, shoplifting provides feelings of power and importance.  It can also provide a rush to counter depression “numbness.” For people who shoplift because they are depressed, these feelings are more important than the item they are stealing.

Back Pain

Got a backache that won’t quit? Studies show that depression may be a risk factor for chronic lower back pain. One study showed that up to 42% of people with chronic lower back pain experienced depression before their back pain started. Yet depression can often go ignored or undiagnosed because people don’t associate it with aches and pains. By the same token, having chronic pain puts you at risk for depression.

Risky Sexual Behavior

Depression is more commonly associated with lost libido than with an increased interest in sex. But some people use sex to cope with depression or stress. Increased promiscuity, infidelity, sexual obsession, and high-risk behavior such as unsafe sex can all be signs of depression. It can also reflect problems with impulse control or be a sign of mania in bipolar disorder. And they can have serious, negative effects on health and in your personal life.

Exaggerated Emotions

Often people who are depressed show little emotional expression. Other times, they show too much. They can be suddenly irritable or explosive. They may express exaggerated feelings of sadness, hopelessness, worry, or fear. The key is a sudden change in behavior. If a person who is usually flat with their feelings becomes hyperemotional, depression may be the cause.

Problem Gambling

Gambling can make you feel excited and revved up. But if you gamble more than recreationally, you may be depressed or you may suffer from a gambling addiction disorder. Problem gamblers are much more likely than others to be depressed and abuse alcohol. Many say they were anxious and depressed before they started gambling. No matter how much of a quick rush gambling causes, it won’t provide the big payoff — relief from depression.

Smoking

Having trouble quitting smoking? Being depressed doubles your risk of smoking. Heavy smoking – more than a pack a day – and having a cigarette within 5 minutes of waking are common habits among smokers who are depressed, according to the CDC. While depressed smokers are less likely to quit, they can. Quitting programs that use techniques similar to those used to treat depression, such as cognitive-behavioral therapy or antidepressant medications, seem to help.

Not Taking Care of Yourself

What does fastening your seatbelt have to do with depression? Suddenly neglecting basic self-care can be a sign of depression and low self-esteem. The signs may be as small as not buckling up or brushing your teeth or as big as skipping physical exams or not tending to chronic conditions such as heart disease or diabetes. Get help for your depression and you’ll likely begin to take care of yourself again.

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Rapid Cycling and its Treatment

What is bipolar disorder?

Bipolar disorder, also known as manic depression, is a treatable illness involving extreme changes in mood, thought, energy, and behavior. A person with bipolar disorder has moods that usually alternate between mania, or extremely “up” mood, and depression, or extremely “down” mood. This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.

Manic episode

A distinct period of elevated, enthusiastic or irritable mood lasting at least one week (or less than one week if hospitalization is required), that includes at least three of the following symptoms:

• Increased physical and mental activity and energy
• Exaggerated optimism and self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without becoming tired
• Grandiose thoughts, extreme sense of self-importance
• Racing speech, racing thoughts, impulsiveness, poor judgment
• Reckless behavior such as spending sprees, impulsive business decisions, erratic driving and sexual indiscretions
• In severe cases, delusions and hallucinations

Hypomanic episode

Similar to a manic episode, except that it is less severe and there are no delusions or hallucinations. It is clearly different from an individual’s non-depressed mood with a clear change in activity and attitude, an d v isible behavior that is unusual or out-of-character.

Major depressive episode

A period of two weeks or more during which five or more of the following symptoms are present:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation, anxiety
• Pessimism, indifference
• Loss of energy, persistent exhaustion
• Unexplained aches and pains
• Feelings of guilt, worthlessness and/or hopelessness
• Inability to concentrate; indecisiveness
• Inability to take pleasure in former interests; social withdrawal
• Excessive consumption of alcohol or use of chemical substances
• Recurring thoughts of death or suicide

Mixed state (also called mixed mania):

A period during which symptoms of a manic and a depressive episode are present at the same time. People who experience mixed states describe feeling activated and “revved up,” but also full of anguish and despair. Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts and a feeling of “being in blackness” can all happen over the course of minutes.

Who gets bipolar disorder?

Bipolar disorder affects more than two and a half million adult Americans during any given year. The illness usually begins during a person’s late teen years, although it can sometimes start in early childhood or as late as a person’s 40s or 50s. An equal number of men and women develop this illness, and it affects people of all races, ethnic groups and social classes.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known. We do know that it is a brain-based medical illness and that certain structures of the brain related to emotions, behavior, and thinking are affected. Bipolar disorder may be related to an imbalance in certain chemicals in the brain, called neurotransmitters. There is a genetic component, meaning the illness runs in families, although genetics does not completely predict who will develop bipolar disorder and who will not.

Are there different types of bipolar disorder?

Physicians and researchers agree there are several kinds of bipolar disorder. Most people who have the illness experience episodes of mania and periods of depression, but the length, frequency, and pattern of these highs and lows vary. Sometimes individuals with bipolar disorder experience frequent mixed states. Some of the different combinations of symptoms may not be medically significant, while others are important enough to be classified as specific types of bipolar disorder that may be treated in very different ways. For more information, see DBSA’s brochure, Guide to Depression and Manic Depression.

What is rapid cycling?

Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. With rapid cycling, mood swings can quickly go from low to high and back again, and occur over periods of a few days and sometimes even hours. The person feels like he or she is on a roller coaster, with mood and energy changes that are out-of control and disabling. In some individuals, rapid cycling is characterized by severe irritability, anger, impulsivity, and uncontrollable outbursts. While the term “rapid cycling” may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Some patients with rapid cycling appear to experience true manic, mild manic, or depressive episodes that last only for a day. If there are four mood episodes within a month, it is called ultra-rapid cycling, and when several mood switches occur within a day, on several days during one week, it is called ultra-ultra-rapid, or ultradian cycling. Typically, however, someone who experiences such short mood swings has longer episodes as well. Some individuals experience rapid cycling at the beginning of their illness, but for the majority, rapid cycling begins gradually. Most individuals with bipolar disorder, in fact, experience shorter and more frequent episodes over time if their illness is not adequately treated. For most people, rapid cycling is a temporary occurrence. They may experience rapid cycling for a time, then return to a pattern of longer, less frequent episodes, or, in the best case, return to a stabilized mood with the help of treatment. A small number of individuals continue in a rapid cycling pattern indefinitely.

Who develops rapid cycling?

As many as half of all people with bipolar disorder may develop rapid cycling at some time during their illness. While there are no absolute rules about who will develop this pattern, women may be more likely to do so, even though bipolar disorder is equally common in both genders. Use of certain antidepressants to treat bipolar disorder can bring on or worsen rapid cycling. Often, the cycling decreases when the antidepressant medication is stopped. However, when stopping an antidepressant, a person should be aware of the possibility of depressive episodes re-occuring, work closely with a doctor to find a more effective medication combination, and never stop taking a medication or change a dosage without first talking with a doctor about it. There may also be a link between rapid cycling and drug or alcohol abuse. A history of substance abuse may make an individual more likely to have rapid cycling. Studies also show that substance abuse is more common in families of people with rapid cycling than in families of people with bipolar disorder who do not have rapid cycling. It is not known whether this is the result of a genetic link between substance abuse and rapid cycling, or if it is evidence of “self-medication” among people with rapid cycling.

What causes rapid cycling?

The basic cause of rapid cycling remains unknown, but three overlapping theories exist:

Kindling (Sensitization):

According to the “kindling” theory, early episodes are triggered by actual or anticipated life events such as the death of a loved one or an upcoming job interview. Over time, the person with the illness becomes increasingly sensitive to more minor “triggers” or stressors, and becomes more likely to have an episode in response to these events. Eventually the person may begin to have episodes without any “triggers.” Episodes become increasingly frequent and the end result of this process, when the illness is not properly treated, may be rapid, ultra-rapid or ultradian cycling.

Biological rhythm disturbances:

This theory proposes that people with rapid cycling have daily biological rhythms that are out of sync with typical “time-giving” events such as dawn and dusk. This theory could account for the sleep disturbances typical of mania and depression and explain other symptoms as well. If biological rhythms are important, a link between rapid cycling and seasonal affective disorder (SAD) may be suggested. It is also possible that abnormal daily biological rhythms do not cause the illness itself but do contribute to the length and seriousness of a manic or depressive episode. For example, if insomnia is treated early and aggressively, mild or moderate symptoms can be prevented from snowballing into a severe and destructive episode.

Hypothyroidism:

This theory proposes that rapid cycling is due to inadequate amounts of thyroid hormone in the brain. Most people with rapid cycling do have adequate levels of thyroid hormone in the blood, but they may respond well to treatment with thyroid hormone regardless of their initial blood levels.

Are there effective treatments for rapid cycling?

Yes, although it can be challenging to find the right treatment. People with bipolar disorder shouldn’t give up hope if the first few medications or medication combinations prescribed are not successful. There are many different treatment options to try. Keep a good record of what has worked, has not worked, or has partially worked to help your doctor with future medication choices for you. For more information about medications for bipolar disorder, read DBSA’s Brochure, Finding Peace of Mind: Medication and Treatment Strategies for Bipolar Disorder. Be sure to talk to your doctor before adding any medication—including prescriptions, natural/herbal supplements and over-the-counter remedies—to your treatment.

Psychotherapy can be an important part of your treatment plan. Not only are people with bipolar disorder at risk for further manic or depressive episodes, it’s possible to experience difficulty as a result of past episodes. Characteristics such as irritability, tendency to cry, racing thoughts or impulsiveness may cause social problems. Because people with bipolar disorder are often unfairly judged, they may lose opportunities to develop friendships or romantic involvement, or have trouble achieving their career goals. These struggles may contribute to self-esteem problems. That’s why it’s helpful for people with bipolar disorder to consult their physicians or mental health professionals about one-on-one counseling and/or the benefits of couples, family, or group therapy. Discussing sticking to a treatment plan that works and managing and preventing suicidal thoughts can prove to be lifesaving.

Charting your moods can help you and your doctor identify patterns and things that cause stress, track your improvement on different medications or get an idea of when new episodes might occur. DBSA offers the Personal Calendar as a mood-tracking tool. This calendar has a place for you to record the medication you take each day, changes in your mood level, stressful life events, side effects and other symptoms.

Helping yourself, helping others: The value of local DBSA support groups

No one with bipolar disorder (rapid cycling or any other type) needs to feel alone or ashamed. With a grassroots network of nearly 1,000 support groups, DBSA offers an opportunity for people to meet and share coping skills, support and inspiration with others who understand. Each group has a professional advisor and an appointed facilitator. Members are people with depression or bipolar disorder and their family members. When combined with a treatment plan, DBSA support groups: Can help you stick with your treatment plan and may help you avoid hospitalization. Provide a place for mutual acceptance, understanding and self-discovery. Help you understand that a mood disorder does not define who you are. Give you the opportunity to benefit from the experiences of those who have “been there.” Take the next step toward wellness for yourself or someone you love. Call DBSA at (800) 826-3632 to find the DBSA chapter or support group nearest you, or click here. If there is no group in your area, DBSA can help you start one.

Conclusion

Research suggests that rapid cycling differs from other forms of bipolar disorder. Individuals with these patterns of mood changes may respond differently to standard and experimental treatments than other people with bipolar disorder. With its sudden and unpredictable mood changes, rapid cycling may be more difficult to manage than other types of bipolar disorder. This challenge makes it particularly important for people with this illness to work closely with their physicians and/or mental health professionals to get the best results possible, to stick with the treatment plan they are given, to find support and not to give up hope. As we learn more about the brain, many more treatments will become available. A great deal of progress has been made recently, and more discoveries are expected in the years ahead.

What is bipolar disorder?

Bipolar disorder, also known as manic depression, is a treatable illness involving extreme changes in mood, thought, energy, and behavior. A person with bipolar disorder has moods that usually alternate between mania, or extremely “up” mood, and depression, or extremely “down” mood. This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.

Manic episode

A distinct period of elevated, enthusiastic or irritable mood lasting at least one week (or less than one week if hospitalization is required), that includes at least three of the following symptoms:

• Increased physical and mental activity and energy
• Exaggerated optimism and self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without becoming tired
• Grandiose thoughts, extreme sense of self-importance
• Racing speech, racing thoughts, impulsiveness, poor judgment
• Reckless behavior such as spending sprees, impulsive business decisions, erratic driving and sexual indiscretions
• In severe cases, delusions and hallucinations

Hypomanic episode

Similar to a manic episode, except that it is less severe and there are no delusions or hallucinations. It is clearly different from an individual’s non-depressed mood with a clear change in activity and attitude, an d v isible behavior that is unusual or out-of-character.

Major depressive episode

A period of two weeks or more during which five or more of the following symptoms are present:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation, anxiety
• Pessimism, indifference
• Loss of energy, persistent exhaustion
• Unexplained aches and pains
• Feelings of guilt, worthlessness and/or hopelessness
• Inability to concentrate; indecisiveness
• Inability to take pleasure in former interests; social withdrawal
• Excessive consumption of alcohol or use of chemical substances
• Recurring thoughts of death or suicide

Mixed state (also called mixed mania):

A period during which symptoms of a manic and a depressive episode are present at the same time. People who experience mixed states describe feeling activated and “revved up,” but also full of anguish and despair. Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts and a feeling of “being in blackness” can all happen over the course of minutes.

Who gets bipolar disorder?

Bipolar disorder affects more than two and a half million adult Americans during any given year. The illness usually begins during a person’s late teen years, although it can sometimes start in early childhood or as late as a person’s 40s or 50s. An equal number of men and women develop this illness, and it affects people of all races, ethnic groups and social classes.

What causes bipolar disorder?

The exact cause of bipolar disorder is not known. We do know that it is a brain-based medical illness and that certain structures of the brain related to emotions, behavior, and thinking are affected. Bipolar disorder may be related to an imbalance in certain chemicals in the brain, called neurotransmitters. There is a genetic component, meaning the illness runs in families, although genetics does not completely predict who will develop bipolar disorder and who will not.

Are there different types of bipolar disorder?

Physicians and researchers agree there are several kinds of bipolar disorder. Most people who have the illness experience episodes of mania and periods of depression, but the length, frequency, and pattern of these highs and lows vary. Sometimes individuals with bipolar disorder experience frequent mixed states. Some of the different combinations of symptoms may not be medically significant, while others are important enough to be classified as specific types of bipolar disorder that may be treated in very different ways. For more information, see DBSA’s brochure, Guide to Depression and Manic Depression.

What is rapid cycling?

Rapid cycling is defined as four or more manic, hypomanic, or depressive episodes in any 12-month period. With rapid cycling, mood swings can quickly go from low to high and back again, and occur over periods of a few days and sometimes even hours. The person feels like he or she is on a roller coaster, with mood and energy changes that are out-of control and disabling. In some individuals, rapid cycling is characterized by severe irritability, anger, impulsivity, and uncontrollable outbursts. While the term “rapid cycling” may make it sound as if the episodes occur in regular cycles, episodes actually often follow a random pattern. Some patients with rapid cycling appear to experience true manic, mild manic, or depressive episodes that last only for a day. If there are four mood episodes within a month, it is called ultra-rapid cycling, and when several mood switches occur within a day, on several days during one week, it is called ultra-ultra-rapid, or ultradian cycling. Typically, however, someone who experiences such short mood swings has longer episodes as well. Some individuals experience rapid cycling at the beginning of their illness, but for the majority, rapid cycling begins gradually. Most individuals with bipolar disorder, in fact, experience shorter and more frequent episodes over time if their illness is not adequately treated. For most people, rapid cycling is a temporary occurrence. They may experience rapid cycling for a time, then return to a pattern of longer, less frequent episodes, or, in the best case, return to a stabilized mood with the help of treatment. A small number of individuals continue in a rapid cycling pattern indefinitely.

Who develops rapid cycling?

As many as half of all people with bipolar disorder may develop rapid cycling at some time during their illness. While there are no absolute rules about who will develop this pattern, women may be more likely to do so, even though bipolar disorder is equally common in both genders. Use of certain antidepressants to treat bipolar disorder can bring on or worsen rapid cycling. Often, the cycling decreases when the antidepressant medication is stopped. However, when stopping an antidepressant, a person should be aware of the possibility of depressive episodes re-occuring, work closely with a doctor to find a more effective medication combination, and never stop taking a medication or change a dosage without first talking with a doctor about it. There may also be a link between rapid cycling and drug or alcohol abuse. A history of substance abuse may make an individual more likely to have rapid cycling. Studies also show that substance abuse is more common in families of people with rapid cycling than in families of people with bipolar disorder who do not have rapid cycling. It is not known whether this is the result of a genetic link between substance abuse and rapid cycling, or if it is evidence of “self-medication” among people with rapid cycling.

What causes rapid cycling?

The basic cause of rapid cycling remains unknown, but three overlapping theories exist:

Kindling (Sensitization):

According to the “kindling” theory, early episodes are triggered by actual or anticipated life events such as the death of a loved one or an upcoming job interview. Over time, the person with the illness becomes increasingly sensitive to more minor “triggers” or stressors, and becomes more likely to have an episode in response to these events. Eventually the person may begin to have episodes without any “triggers.” Episodes become increasingly frequent and the end result of this process, when the illness is not properly treated, may be rapid, ultra-rapid or ultradian cycling.

Biological rhythm disturbances:

This theory proposes that people with rapid cycling have daily biological rhythms that are out of sync with typical “time-giving” events such as dawn and dusk. This theory could account for the sleep disturbances typical of mania and depression and explain other symptoms as well. If biological rhythms are important, a link between rapid cycling and seasonal affective disorder (SAD) may be suggested. It is also possible that abnormal daily biological rhythms do not cause the illness itself but do contribute to the length and seriousness of a manic or depressive episode. For example, if insomnia is treated early and aggressively, mild or moderate symptoms can be prevented from snowballing into a severe and destructive episode.

Hypothyroidism:

This theory proposes that rapid cycling is due to inadequate amounts of thyroid hormone in the brain. Most people with rapid cycling do have adequate levels of thyroid hormone in the blood, but they may respond well to treatment with thyroid hormone regardless of their initial blood levels.

Are there effective treatments for rapid cycling?

Yes, although it can be challenging to find the right treatment. People with bipolar disorder shouldn’t give up hope if the first few medications or medication combinations prescribed are not successful. There are many different treatment options to try. Keep a good record of what has worked, has not worked, or has partially worked to help your doctor with future medication choices for you. For more information about medications for bipolar disorder, read DBSA’s Brochure, Finding Peace of Mind: Medication and Treatment Strategies for Bipolar Disorder. Be sure to talk to your doctor before adding any medication—including prescriptions, natural/herbal supplements and over-the-counter remedies—to your treatment.

Psychotherapy can be an important part of your treatment plan. Not only are people with bipolar disorder at risk for further manic or depressive episodes, it’s possible to experience difficulty as a result of past episodes. Characteristics such as irritability, tendency to cry, racing thoughts or impulsiveness may cause social problems. Because people with bipolar disorder are often unfairly judged, they may lose opportunities to develop friendships or romantic involvement, or have trouble achieving their career goals. These struggles may contribute to self-esteem problems. That’s why it’s helpful for people with bipolar disorder to consult their physicians or mental health professionals about one-on-one counseling and/or the benefits of couples, family, or group therapy. Discussing sticking to a treatment plan that works and managing and preventing suicidal thoughts can prove to be lifesaving.

Charting your moods can help you and your doctor identify patterns and things that cause stress, track your improvement on different medications or get an idea of when new episodes might occur. DBSA offers the Personal Calendar as a mood-tracking tool. This calendar has a place for you to record the medication you take each day, changes in your mood level, stressful life events, side effects and other symptoms.

Helping yourself, helping others: The value of local DBSA support groups

No one with bipolar disorder (rapid cycling or any other type) needs to feel alone or ashamed. With a grassroots network of nearly 1,000 support groups, DBSA offers an opportunity for people to meet and share coping skills, support and inspiration with others who understand. Each group has a professional advisor and an appointed facilitator. Members are people with depression or bipolar disorder and their family members. When combined with a treatment plan, DBSA support groups: Can help you stick with your treatment plan and may help you avoid hospitalization. Provide a place for mutual acceptance, understanding and self-discovery. Help you understand that a mood disorder does not define who you are. Give you the opportunity to benefit from the experiences of those who have “been there.” Take the next step toward wellness for yourself or someone you love. Call DBSA at (800) 826-3632 to find the DBSA chapter or support group nearest you, or click here. If there is no group in your area, DBSA can help you start one.

Conclusion

Research suggests that rapid cycling differs from other forms of bipolar disorder. Individuals with these patterns of mood changes may respond differently to standard and experimental treatments than other people with bipolar disorder. With its sudden and unpredictable mood changes, rapid cycling may be more difficult to manage than other types of bipolar disorder. This challenge makes it particularly important for people with this illness to work closely with their physicians and/or mental health professionals to get the best results possible, to stick with the treatment plan they are given, to find support and not to give up hope. As we learn more about the brain, many more treatments will become available. A great deal of progress has been made recently, and more discoveries are expected in the years ahead.

Being in control feels safe, but you can feel safe when you’re not in control too. The world is unpredictable and your power is limited, so feeling safe without control is a valuable skill.

When the world disappoints your expectations, your brain releases cortisol and it feels like an emergency. You can re-wire your brain to feel safe when you’re not in control. That doesn’t mean being out of control or giving up. It means building a new neural pathway to replace that old cortisol circuit.

Your brain will build a new pathway if you repeat a new thought or behavior for forty-five days. So give up control of something for the next six weeks and you will like the results!

Notice your usual strategy for feeling “on top of things,” and do the opposite. 
For example, if you are a person who tries to bake the perfect soufflé, spend forty-five days cooking without recipes. Conversely, if you are a person who likes to just throw things into a pot, spend forty-five days following recipes.

If you are a person who likes everything neat, let junk pile up for six weeks. But if you are a person who hates order and loves chaos, put things away as soon as you use them for six weeks.

Color outside the lines if that’s new for you, but if you already pride yourself on that, courageously stay inside the lines. It might feel awful on Day One, but forty-four days later it will feel curiously safe.

Don’t quit your day job to beg with a rice bowl. Just stop checking the weather report, buying lottery tickets, and expecting the world to work according to your rules. You will not like the cortisol at first, but you will train your brain to know that it doesn’t kill you. You will learn to feel safe in the world despite your inability to control it.

Getting rid of the clock is a great way to experiment with control, because you can’t control time.
We all have habits for managing the harsh reality of time. For some it’s chronic lateness and for others it’s constant clock-checking. You may think you can’t change your relationship with time, but here are three great ways to ignore the clock and make friends with the passage of time:

1. Start an activity without having an exact time you need to stop. Finish the activity without ever checking the clock the whole time. It’s over when you feel like it’s over.
2. Set aside a time each day to spend with no plan.
3. Designate a day you can wake up without looking at the clock and continue through your day with no time-checking.

No matter how busy you are, you can find a way to relax your efforts to control time. You may be surprised at the bad feelings that come up, despite your abiding wish to escape time pressure. The bad feelings won’t kill you, however, and accepting them helps you accept the harsh realities of time.

Your mammal brain feels good about things it can control. Some people break traffic laws to enjoy a sense of control, while others feel their power by scolding those who break traffic laws. Whatever gives you a sense of power won’t work all the time, however. You will end up feeling weak and unimportant some of the time. That triggers cortisol, but you can learn to feel safe when you are not in control.

Learn more about your mammal brain and building new neural pathways in my bookHabits of a Happy Brain: Retrain Your Brain to Boost Your Serotonin, Dopamine, Oxytocin, & Endorphin Levels.

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This article originally appeared on http://www.womenworking.com