Self Esteem Positive Affirmations

Posted on May 30, 2016 by JmaC
Present Tense Affirmations
I have high self esteem
I love and respect myself
I am a great person
I respect myself deeply
My thoughts and opinions are valuable
I am confident that I can achieve anything
I have something special to offer the world
Others like and respect me
I am a wonderful human being
I feel great about myself and my life

 

Future Tense Affirmations
I will succeed
I will always love and respect myself
My self esteem is growing
Each day I believe in myself more and more
My self image is starting to improve
I will always think positively about myself
I will achieve whatever I put my mind to
I am starting to feel more confident in myself
My Confidence, self esteem, and self belief are increasing with each day
I am transforming into someone who is happy and positive

 

Natural Affirmations
I am worthy of having high self esteem
I believe in myself
I deserve to feel good about myself
I know I can achieve anything
Having respect for myself helps others to like and respect me
Feeling good about myself is normal for me
Improving my self esteem is very important
Being confident in myself comes naturally to me
Liking and respecting myself is easy
Speaking my mind with confidence is something I just naturally do
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Mental Disorders Fact Sheet

Posted on May 30, 2016 by JmaC

Key facts

  • There are many different mental disorders, with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others.
  • Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism.
  • There are effective strategies for preventing mental disorders such as depression.
  • There are effective treatments for mental disorders and ways to alleviate the suffering caused by them.
  • Access to health care and social services capable of providing treatment and social support is key.

The burden of mental disorders continues to grow with significant impacts on health and major social, human rights and economic consequences in all countries of the world.

Depression

Depression is a common mental disorder and one of the main causes of disability worldwide. Globally, an estimated 350 million people are affected by depression. More women are affected than men.

Depression is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration. Sufferers may also have multiple physical complaints with no apparent physical cause. Depression can be long-lasting or recurrent, substantially impairing people’s ability to function at work or school and to cope with daily life. At its most severe, depression can lead to suicide.

Prevention programmes have been shown to reduce depression, both for children (e.g. through protection and psychological support following physical and sexual abuse) and adults (e.g. through psychosocial assistance after disasters and conflicts).

There are also effective treatments. Mild to moderate depression can be effectively treated with talking therapies, such as cognitive behaviour therapy or psychotherapy. Antidepressants can be an effective form of treatment for moderate to severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

Management of depression has to include psychosocial aspects, including identifying stress factors, such as financial problems, difficulties at work or physical or mental abuse, and sources of support, such as family members and friends. The maintenance or reactivation of social networks and social activities is important.

Bipolar affective disorder

This disorder affects about 60 million people worldwide. It typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep. People who have manic attacks but do not experience depressive episodes are also classified as having bipolar disorder.

Effective treatments are available for the treatment of the acute phase of bipolar disorder and the prevention of relapse. These are medicines that stabilize mood. Psychosocial support is an important component of treatment.

Schizophrenia and other psychoses

Schizophrenia is a severe mental disorder, affecting about 21 million people worldwide. Psychoses, including schizophrenia, are characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common psychotic experiences include hallucinations (hearing, seeing or feeling things that are not there) and delusions( fixed false beliefs or suspicions that are firmly held even when there is evidence to the contrary). The disorder can make it difficult for people affected to work or study normally.

Stigma and discrimination can result in a lack of access to health and social services. Furthermore, people with psychosis are at high risk of exposure to human rights violations, such as long term confinement in institutions.

Schizophrenia typically begins in late adolescence or early adulthood. Treatment with medicines and psychosocial support is effective. With appropriate treatment and social support, affected people can lead a productive life, be integrated in society. Facilitation of assisted living, supported housing and supported employment can act as a base from which people with severe mental disorders, including Schizophrenia, can achieve numerous recovery goals as they often face difficulty in obtaining or retaining normal employment or housing opportunities..

Dementia

Worldwide, 47.5 million people have dementia. Dementia is usually of a chronic or progressive nature in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

Dementia is caused by a variety of diseases and injuries that affect the brain, such as Alzheimer’s disease or stroke.

Though there is no treatment currently available to cure dementia or to alter its progressive course, many treatments are in various stages of clinical trials. Much can be done, however, to support and improve both the lives of people with dementia and their caregivers and families.

Developmental disorders, including autism

Developmental disorder is an umbrella term covering intellectual disability and pervasive developmental disorders including autism. Developmental disorders usually have a childhood onset but tend to persist into adulthood, causing impairment or delay in functions related to the central nervous system maturation. They generally follow a steady course rather than the periods of remissions and relapses that characterize many other mental disorders.

Intellectual disability is characterized by impairment of skills across multiple developmental area such as cognitive functioning and adaptive behaviour. Lower intelligence diminishes the ability to adapt to the daily demands of life.

Symptoms of pervasive developmental disorders, such as autism, include impaired social behaviour, communication and language, and a narrow range of interests and activities that are both unique to the individual and are carried out repetitively. Developmental disorders often originate in infancy or early childhood. People with these disorders occasionally display some degree of intellectual disability.

Family involvement in care of people with developmental disorders is very important. Knowing what causes affected people both distress and wellbeing is an important element of care, as is finding out what environments are most conductive to better learning. Structure to daily routines help prevent unnecessary stress, with regular times for eating, playing, learning, being with others, and sleeping. Regular follow up by health services of both children and adults with developmental disorders, and their carers, needs to be in place.

The community at large has a role to play in respecting the rights and needs of people with disabilities.

Who is at risk from mental disorders?

Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions, and community support.

Stress, Genetics, nutrition, perinatal infections and exposure to environmental hazards are also contributing factors to mental disorders.

Health and support

Health systems have not yet adequately responded to the burden of mental disorders. As a consequence, the gap between the need for treatment and its provision is wide all over the world. In low- and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder. In high-income countries, between 35% and 50% of people with mental disorders are in the same situation.

A further compounding problem is the poor quality of care for many of those who do receive treatment.

In addition to support from health-care services, people with mental illness require social support and care. They often need help in accessing educational programmes which fit their needs, and in finding employment and housing which enable them to live and be active in their local communities.

WHO response

WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:

  • more effective leadership and governance for mental health;
  • the provision of comprehensive, integrated mental health and social care services in community-based settings;
  • the implementation of strategies for promotion and prevention; and
  • strengthened information systems, evidence and research.

WHO’s Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care.

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Depression Fact Sheet

Posted on May 30, 2016 by JmaC

Key facts

  • Depression is a common mental disorder. Globally, an estimated 350 million people of all ages suffer from depression.
  • Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
  • More women are affected by depression than men.
  • At its worst, depression can lead to suicide.
  • There are effective treatments for depression.

Overview

Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.

Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.

A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.

Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Diagnosis and treatment

There are effective treatments for moderate and severe depression. Health care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

WHO response

Depression is one of the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. The Programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives – even where resources are scarce.

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Defining the Boundaries of Childhood Bipolar Disorder

Posted on May 30, 2016 by JmaC

Pediatric bipolar disorder is notoriously controversial, with the epicenter of the debate being whether the condition can be diagnosed in prepubertal children at all. Some clinicians avoid labeling affectively labile youngsters with bipolar disorder, preferring instead less stigmatizing categories like depression, ADHD, or the ubiquitous yet vacillating “mood disorder not otherwise specified.” Others diagnose prepubertal bipolarity rather liberally, often based solely on the presence of irritability, mood swings, and aggression. At stake is whether the childhood presentation of bipolar disorder represents the same disorder as in adults. If the same, then euphoria, grandiosity, and classic manic symptoms might be required (the narrow phenotype conceptualization [ 1 , 2 ]). If different, then perhaps irritability and nonspecific mood lability would suffice (the broad phenotype [3] ). These terms represent more than semantic differences, laden as they are with implications for treatment, prognosis, and genetic and neuroimaging research.

In favor of the narrow phenotype, one might argue that diagnostic conservatism is justified given few available effective mood stabilizers and their greater risks in children compared with adults (e.g., a higher incidence of Stevens Johnson syndrome associated with lamotrigine [4] or of hepatitis with valproate [5] ). Further, absence of sharp diagnostic refinement could confound studies looking for relevant genes or neural circuits. Finally, if we call admittedly different symptom constellations by the same name, could we not be misleading patients and families?

By contrast, and in favor of the broad phenotype, it might be argued that the childhood presentation of any mental illness is different during childhood, simply due to age-dependent neurobiological and psychosocial changes. In this view, if development is compromised by serious psychopathology, assertive treatment would be warranted, and precision in nomenclature a secondary consideration.

An advocate of the broad phenotype need not invoke childhood exceptionalism, for a similar dilemma exists with adults: is a broad bipolar spectrum valid nosologically (as proposed by Emil Kraepelin in his original manic-depressive illness concept [6] ), or should we maintain the narrow definitions of bipolar disorder currently favored in DSM-IV? Although certainly not without critics, such a viewpoint can be defended by an accumulating literature in adult bipolar disorder indicating that irritable and mixed phenotypes of mood are quite common, perhaps more so than pure mania or pure depression (7 , 8) . If this is correct, then the controversy in children would perhaps not be about childhood presentations per se, but rather about the larger issue of whether the broad definition of the bipolar spectrum is valid(9) . Incidentally, some have argued—and not entirely without a point—that the broadening of the bipolar diagnosis is the handiwork of the pharmaceutical industry (10) . And yet, we doubt that many pharmaceutical detail men called on Kraepelin one hundred years ago, when he first advanced the concept that bipolar disorder was more spectral than categorical (11) .

The most widely accepted approach to validate the boundaries of psychiatric disorders follows the criteria established by Robins and Guze (12) . It is based on the accrual of data from five independent lines of evidence, namely symptoms (phenomenology), course of illness, familial clustering, treatment response, and biological markers. The fact that there are five sources of evidence, and not just one, is critical. This reality reflects the often underappreciated antiessentialism of psychiatric diagnoses (13) : no single criterion is essential to most psychiatric conditions, and thus we need to look for a constellation of evidence, rather than for any one pathognomonic clincher. If this fact were better understood, clinicians would perhaps avoid many a fruitless debate.

While the Robins and Guze approach has been used to validate DSM-III and IV, it has not been quite reflected in DSM criteria themselves: DSM-IV relies almost entirely on cross-sectional phenomenology as the one validator for its diagnostic criteria for primary psychiatric conditions (noteworthy exceptions being schizophrenia and PTSD, with their course and etiology criteria, respectively). By relying mainly on DSM-IV’s cross-sectional phenomenological approach to diagnosis, opponents often end up splitting nosological hairs over whether certain symptoms represent prepubertal mania or ADHD.

Family history, although often complicated by patterns of comorbidity, can be particularly helpful given the usual availability of parents and other relatives for interview, and given the fact that longitudinal course data are in shorter supply. Sometimes treatment response can be used to confirm or refute diagnoses, but this is perhaps the most nonspecific diagnostic validator, since medications are often effective in multiple conditions (e.g., antidepressants) or even in enhancing normal mental states (stimulants). And while poor treatment response or adverse reactions might also be diagnostically informative, such as in the case of antidepressant-induced mania (14) , the logic is insufficient, if not faulty, in retrofitting a diagnostic category to a treatment response.

The remaining major diagnostic validator, that of biological markers, is the one explored for pediatric bipolar disorder in the report by Rich and colleagues in this issue of the Journal . In it, investigators at NIMH enrolled children (mean age=13 years) from three primary diagnostic groups: 1) narrow-phenotype bipolar disorder (having had at least one episode of mania or hypomania as specified in DSM-IV); 2) severe mood dysregulation (nonepisodic irritability, hyperarousal, and overreactivity to negative emotional stimuli at least three times weekly); and 3) healthy comparison subjects. Among the children with bipolar disorder or severe mood dysregulation, there was extensive comorbidity with ADHD and anxiety disorders. The children with severe mood dysregulation were more likely to fulfill criteria for major depressive disorder and oppositional defiant disorder as well. Psychotropic drug administration was much more common among those with bipolar disorder and was not stopped for the study.

The investigators conducted an experimental task in which children reacted to visual targets flashed on a computer screen, earning rewards of 10 cents for each correct response. In the critical part of the test, called a frustration task, even correct answers were arbitrarily judged as too slow, which the subjects indeed found frustrating. The purpose was to elicit negative emotional reactions, which were rated higher in both patient groups than in the healthy subjects. During the test, the investigators recorded visual evoked potentials to the targets and found that, relative to healthy comparison subjects, the bipolar group had lower P3 wave amplitudes during the frustration task, which have been reported in adult bipolar disorder and are thought to represent a defect in executive function. The severe mood dysregulation group had an entirely different deficit, a diminished N1 wave in all phases of the test, which is thought to indicate lower attention paid to the stimuli. The aim of the experiment was not to construct an electrophysiological test for diagnosis but rather to determine if the clinical difference in diagnosis was mirrored by an underlying difference in brain pathophysiology. The investigators conclude that the two groups are indeed different and suggest that severe mood dysregulation, particularly when accompanied by oppositional defiant disorder, is biologically different from pediatric bipolar disorder.

In examining these psychophysiological differences between broad and narrow bipolar phenotypes, the investigators’ efforts do not simply accept, but rather test DSM definitions, as the framers of DSM-III originally hoped for. The research team found that narrow-phenotype bipolar disorder appeared biologically similar to adult bipolar disorder. The chronic irritable broad phenotype did not, and seemed instead to overlap with oppositional defiant disorder. We note that for a condition that has been so singularly divisive, it is only poetic justice that of all things a frustration task was used to elicit differences in the event-related potentials at the core of the experiments.

In assessing any study, one should assess its methods not simply against a gold standard ideal study but also against the current state of the literature. Given much heat and little light in childhood bipolar nosology, this article represents hard-earned and legitimate progress. However, in the future, other studies should attend to at least two methodological issues that could advance our knowledge even further. First, in this study, the broad bipolar phenotype was defined as chronic irritability, but episodicirritability may be more relevant (15) . Further, the study excluded children with episodic decreased need for sleep from its broad bipolar phenotype, even though this neurovegetative feature may hold the key to identifying children with nonclassic bipolar disorder (16) . The key issue may not be overreactivity to stimuli (as in this article) but rather hyper activity (a general state of increased energy/decreased need for sleep). Whether this important feature differentiates bipolar disorder from ADHD in particular was not explicitly addressed.

Second, all nosological studies are observational; there is no way to randomize a nosological study. Hence confounding factors—other differences between the groups besides the topic being studied—may account for the results (17) . In this study, only age was statistically controlled; other differences such as gender and treatment were not, and many other potentially relevant variables (socioeconomic status, presence of psychosis, comorbid medical illnesses, concomitant psychosocial stressors, and history of physical or sexual abuse) were not assessed. Thus, the results observed may be related to the two diagnostic phenotypes, or again they may not. At present, this is what we have, and we should use it with an open mind, aware that much is likely to change in the years ahead. For one, evoked potentials technology undoubtedly will continue to be refined, and sophisticated new methodologies to characterize behavioral phenotypes and endophenotypes increasingly will become available.

What might the practicing clinician conclude? Chronic irritable mood does not appear to be sufficient to justify a bipolar disorder diagnosis, but it still remains possible that an episodic irritable phenotype would biologically correlate with the narrow bipolar disorder phenotype. It remains to be seen whether, as some suspect, some instances of oppositional defiant disorder or ADHD represent childhood harbingers of what ultimately evolves into recognizable bipolar disorder in adulthood. While we wait for newer data, we would urge clinicians to focus on diagnosis and then to seek proven treatments, rather than to engage in a simplistic and potentially risky symptom-ameliorating polypharmacy. The Hippocratic tradition of caution in the face of uncertainty, combined with the modern emphasis on diagnosis, may be the wisest course to take (13) .

In closing, we believe that it is time to emerge from the current diagnostic Tower of Babel and to strive for a unified language: research in juvenile bipolar disorder might look to the history of autism for a lesson. A balkanized approach to diagnosing the pervasive development disorders had stymied progress in that field until consensus guidelines were developed, an accepted set of standard instruments were uniformly embraced, and grassroots efforts from invested parents provided the critically necessary thrust. The high public visibility of juvenile bipolar disorder, the efforts of dedicated though hardly synchronized research groups, and the role of vocal parents committed to the welfare of their affected children, could combine to deliver the flashpoint for a new phase in the research agenda for this condition. Convening a group of investigators and stakeholders to establish consensus diagnostic guidelines would be a natural place to start.

Bipolar Disorder Research Program Emory University School of Medicine Atlanta, Ga.
Yale Child Study Center New Haven, Conn.

Address correspondence and reprint requests to Dr. Martin, Yale Child Study Center, Yale University, 230 South Frontage Rd., New Haven, CT 06520; andres.martin@yale.edu (e-mail).

The authors report no competing interests.

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1. Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS: Defining clinical phenotypes of juvenile mania. Am J Psychiatry 2003; 160:430–437
2. Geller B, Tillman R: Prepubertal and early adolescent bipolar I disorder: review of diagnostic validation by Robins and Guze criteria. J Clin Psychiatry 2005; 66(suppl 7):21–28
3. Wozniak J, Biederman J, Kwon A, Mick E, Faraone S, Orlovsky K, Schnare L, Cargol C, van Grondelle A: How cardinal are cardinal symptoms in pediatric bipolar diosrder? an examination of clinical correlates. Biol Psychiatry 2005; 58:583–588
4. Guberman AH, Besag FM, Brodie MJ, Dooley JM, Duchowny MS, Pellock JM, Richens A, Stern RS, Trevathan E: Lamotrigine-associated rash: risk/benefit considerations in adults and children. Epilepsia 1999; 40:985–991
5. Scheffner D, Konig S, Rauterberg-Ruland I, Kochen W, Hofmann WJ, Unkelbach S: Fatal liver failure in 16 children with valproate therapy. Epilepsia 1988; 29:530–542
6. Angst J, Marneros A: Bipolarity from ancient to modern times: conception, birth and rebirth. J Affect Disord 2001; 67(1–3):3–19
7. Koukopoulos A, Albert MJ, Sani G, Koukopoulos AE, Girardi P: Mixed depressive states: nosologic and therapeutic issues. Int Rev Psychiatry 2005; 17:21–37
8. Benazzi F: Challenging the unipolar-bipolar division: does mixed depression bridge the gap? Prog Neuropsychopharmacol Biol Psychiatry 2006; Sep 13 [epub ahead of print]
9. Faedda GL, Baldessarini RJ, Glovinsky IP, Austin NB: Pediatric bipolar disorder: phenomenology and course of illness. Bipolar Disord 2004; 6:305–313
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11. Ghaemi SN: The newest mania: seeing disease mongering everywhere. PLoS Med 2006; 3(7):e319; author reply e320
12. Robins E, Guze SB: Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry 1970; 126:983–987
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Types if Depression

Posted on May 30, 2016 by JmaC

People often feel sad, blue, or ‘depressed’ from time to time.  These feelings are usually short lived, and do not interfere with daily life.  Major Depressive Disorder, on the other hand, is a serious medical condition that affects the mind and body impacting more than 350 million people around the world.  It is an illness in the same way that diabetes, heart disease and cancer are and is not, as many people believe, a bad attitude or ‘all in the head’.

The primary difference between feeling sad, and Major Depressive Disorder, is time and duration.  If the following symptoms are persistent and last longer than two weeks, start to interfere with daily life, and are negatively impacting relationships, it may be Major Depressive Disorder and time to talk to a doctor.

One in five people will suffer from depression during their lifetime, and it is the leading cause of disability worldwide.  The good news is that depression is treatable.  While we have a long way to go in understanding the brain, there are effective therapies and we are learning more and more every day to provide effective treatment to those in need.

Types of Depression / Symptoms

Major Depression (Also known as Major Depressive Disorder, Chronic Major Depression or Unipolar Depression)

Major Depression is manifested by a combination of symptoms that interferes with the ability to work, study, sleep, eat and enjoy once pleasurable activities. A Major Depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic Major Depression may require a person to continue treatment and monitor lifestyle habits on an ongoing basis.  This disorder is characterized by the presence of the majority of these symptoms:

Symptoms of Major Depression include:

  • Persistent sad, anxious, or “empty” mood most of the day, nearly every day, as indicated by subjective report or observation of others (e.g., appears tearful).  In children and adolescents, this may be characterized as an irritable mood.
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Trouble sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Restlessness, irritability, and/or angry outbursts
  • Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment

Dysthymia

Dysthymia is characterized by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years.  (In children and adolescents, mood can be irritable and duration must be at  least 1 year.)  The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:

Symptoms of Dysthymia

  • Appetite and/or weight changes
  • Trouble sleeping, early-morning awakening, or oversleeping
  • Decreased energy, fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.  Further, the symptoms cannot be due to the direct physiological effects of use or abuse of a substance such as alcohol, drugs or medication or general medical condition.  The symptoms must also cause significant distress or impairment in social, occupational, educational, or other important areas of functioning.

Bipolar Disorder

Another type of depressive illness is bipolar disorder (in the past described as manic-depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over-talkative, and have a great deal of energy.

Bipolar disorder is characterized by more than one bipolar episode.  There are four basic types of bipolar disorder.

1.  Bipolar I Disorder

The primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression that last at least seven days.  Manic episodes may be so severe that the individual may require hospitalization.  Depressive episodes typically last at least two weeks.

2.  Bipolar II Disorder

The primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause market impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others).

3.  Bipolar Disorder Not Otherwise Specified

Symptoms of the disorder exist, but do not meet diagnostic criteria for either Bipolar I or II.   However symptoms are well out of normal range for the individual.

4.  Cyclothymic Disorder

A chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder but have been present for at least two years.

Mania often affects thinking, judgment, and social behavior in ways that cause serious problems.   For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.  Manic episodes are characterized by:

A.  A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary)).

B.  During the period of mood disturbance, three or more of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

Symptoms of Mania

  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • Grandiose notions or increased self-esteem
  • Increased talking or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained purchasing sprees, sexual indiscretions, or foolish business investments).
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior
  • Distractibility (i.e., attention easily drawn to unimportant or irrelevant external stimuli)

Depressive episodes are characterized by symptoms described above for Major Depressive Episode.

Persistent Depressive Disorder

A depression that lasts over 2 years, involving symptoms that come and go in severity.  The key is that the symptoms must be present at least two years

Seasonal Affective Disorder (SAD)

A depression starting in the winter months, usually stemming from low natural sunlight and often lifting in the summer months.  Sad may be effectively treated with light therapy (Full Spectrum Lighting), but about half do not respond to treatment and benefit from a combination of therapy and medication.

Psychotic Depression

A severe depression where the person has some form of psychosis along with other symptoms.  This psychosis can include having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Postpartum Depression

This depression occurs right after giving birth.  It is much more than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It seriously interferes with the woman’s daily activities.  It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Substance Induced Mood Disorder (abuse or dependence)

Substance-Induced Mood Disorder is a common depressive illness of clients in substance abuse treatment.  It is defined in DSM-V-TR as “a prominent and persistent disturbance of mood…that is judged to be due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or somatic treatment for depression, or toxin exposure).  The mood can manifest as manic (expansive, grandiose, irritable), depressed, or a mixture of mania and depression.

Generally, substance-induced mood disorders will only present either during intoxication from the substance or on withdrawal from the substance and therefore do not have as lengthy a course as other depressive illnesses.  However, substance use disorders also frequently co-occur with other depressive disorders. Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression. In addition, more than half of people with bipolar disorder type I (with severe mania) have a co-occurring substance use disorder.

Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression, or a co-occurring condition that more commonly develops in men. Nevertheless, a substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

Comorbidity

When a disease or disorder occurs at the same time as another, but is unrelated to it, it is considered to be comorbid.  Among those suffering with depression, 92% also reported meeting the criteria for at least one additional mental illness.  The most common mental illnesses are:

  • Behavioral disorders (ADD/ADHD, Conduct disorder)
  • Substance abuse disorders
  • Anxiety

 

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