Engage in risky sexual escapades
Gamble excessively
Make foolish business decisions
Spend too much money, and get into serious debt
Talk fast and furiously
Think that they have super-special talents or abilities
Manic episodes can involve mildly unwise decisions and excesses, or reach extremes. People in manic states can cause ruin for themselves or their families. Their behaviour can get so out of control that they may seek hospital treatment and a period of inpatient care. Alternatively, they may be sectioned – detained in hospital under certain sections of the Mental Health Act at the request of the authorities, or their closest relative.
Most people with bipolar disorder also go through cycles of mild to severe depression. They go from feeling great to gruesome, sometimes during the same day. The depression that follows a manic episode can be unexpected and devastating. The contrast from the high to the low is particularly painful. People with untreated bipolar disorder typically feel out of control, hopeless, and helpless. Not surprisingly, the risk of suicide is higher for bipolar disorder than for any of the other type of depression.
Bipolar disorder is generally chronic (lasts for a long time), but if you’re diagnosed as having bipolar disorder, don’t despair. The condition can be successfully managed. Medication and psychotherapy, usually in combination, can ease a lot of the most debilitating symptoms. Research is also finding new treatments and medication.
Emily finishes dressing, grabs her keys, and dashes out the door. She feels so excited that she can hardly wait to share her good news with her friend, Samantha. ‘Sam, guess what?’ she gushes. ‘I’ve decided I’m going to move to London! I just know I can make it in the theatre. I just have to go! I’ve handed in my notice and I’m on my way. In fact, I’m leaving today!’
Emily’s excitable speech, let alone what she’s saying, really worries Samantha. She asks Emily when she decided to move, what she’s going to do about the lease on her flat, and does she have a job offer in London? What on earth is she thinking? This is so sudden!
Emily replies that she hasn’t been sleeping for the past three days. Her mind has been racing and overflowing with ideas. She has decided that her life is too boring and she needs a change. She says that her boss can go to hell and so can the landlord. She’s bought a first-class train ticket using her credit card, and emptied the last £200 from her bank account. She is going to work out what to do when she gets to London. Emily suffers from a bipolar disorder, and is having a manic episode.
Bipolar disorder is a complicated and serious illness. The condition has many subtle variations. If you suspect that you or someone you know has any signs of bipolar disorder, seek professional help at once.
Seasonal affective disorder: Dark depression
Some depressions come and go with the seasons, as regularly as clockwork. People who repeatedly experience depression during autumn or winter may have seasonal affective disorder (SAD). They may also experience a few unusual symptoms, such as:
A sense of heaviness in the arms and legs
Carbohydrate cravings
Increased appetite
Increased desire for sleep
Irritability
Many mental health professionals believe that the reduced amount of sunlight in the winter triggers this form of depression in vulnerable individuals. Support for this theory comes from the fact that this form of depression occurs more frequently among people who live in northern climates where summers are short and winters long and dark. (We discuss evidence concerning treatment of this disorder using bright lights in Chapter 16.)
What does a bear do to get ready for winter? Bears energetically forage for food, get as fat as they can, and then hibernate in a cosy cave. Perhaps it’s not a coincidence that people with SAD typically gain weight, crave carbohydrates, have reduced energy, and feel like staying snuggled in bed for the winter.
SAD is increasingly being recognised, and a variety of treatments are available, some with more scientific backing and evidence than others (see Chapter 16 for more detail). Research is also finding new treatments and medication. Taking a walk outside to experience more natural light may be helpful – and certainly can’t hurt.
Premenstrual dysphoric disorder and postnatal depression: Horrible hormones?
Occasional, minor premenstrual changes in mood occur in a majority of women. A smaller percentage of women experience significant and disturbing symptoms known as premenstrual dysphoric disorder (PDD). PDD is a more extreme form of the more widely known premenstrual syndrome (PMS) or premenstrual tension (PMT).
Although hormones probably play a significant role in PDD, research hasn’t yet explained the causes. Women suffering from full-blown PDD experience some of the following symptoms almost every month, during the week before their period. (These same symptoms can also occur – probably because of hormonal fluctuations – in the years leading up to, during, and following menopause.)
Anger
Anxiety
Bloating
Fatigue
Food cravings
Guilt and self-blame
Irritability
Sadness
Tearfulness
Withdrawal
Diane drives to the supermarket after work. Impatiently, she pushes her trolley along the aisle, only to find another customer is blocking her way. She feels a rush of annoyance and coughs loudly. The other woman looks up and apologises. Diane quickly overtakes the offending trolley, giving it a shove as she passes.
In the queue, her irritation gets worse. The man in front of her fumbles for his chequebook and discovers he has no cheques left. Then he takes out a handful of change, and after counting it, realises he doesn’t have enough. Next, he starts rummaging through his overstuffed wallet for a credit card. Diane finds herself unable to suppress her fury and snaps, ‘We don’t have all day to queue just waiting for the likes of you! What’s the matter with you, anyway?’
The man’s face turns bright red and he mutters, ‘I’m so sorry, madam.’ The cashier mutters under her breath ‘That really wasn’t necessary. Humiliating him like that! It could happen to anyone.’ Suddenly ashamed, Diane breaks into tears and starts sobbing. She feels like she’s going crazy. And this isn’t the first time Diane has felt this way. In fact, it happens to her almost on a monthly basis.
Postnatal depression is another type of serious mood disorder that’s widely thought to be related to hormonal fluctuations, although no one knows for sure how and why the hormones profoundly affect the moods of some women and not others. This depression occurs within days or weeks after giving birth. The symptoms appear quite similar to those of major depressive disorder. (For a complete discussion of these symptoms, see ‘Major depressive disorder: Can’t even get out of bed’ , earlier in this chapter.)
Faith had tried unsuccessfully to conceive for the past eight years. She and her husband Sean are overwhelmed with joy when at last the home pregnancy test registers positive. Their cheerful, cosy nursery looks like a picture in a baby magazine, only better, because it’s theirs.
Faith and Sean weep with happiness at the sight of their newborn. Faith feels exhausted, but Sean assumes that’s normal. He takes charge the first day home so that she can rest. Faith feels the same way the next day, so Sean continues to take over the responsibilities of caring for the baby. Sean becomes alarmed when Faith shows no interest in holding the baby. In fact, she seems irritated by the baby’s crying and mentions that maybe she shouldn’t have become a mother. At the end of the second week, Faith tells Sean that he can’t go back to work because she doesn’t think that she can take care of the baby. Faith is suffering from postnatal depression.
Most women feel a bit low shortly after delivery – it’s called the ‘baby blues’. The down feelings aren’t usually severe and they tend to go within two weeks. However, if you begin to feel like Faith in the earlier story, you need to get professional
help immediately.
Dangers of Severe Postnatal Depression
Occasionally, women with severe cases of postnatal depression develop psychoses (see the sidebar ‘Understanding psychosis’ for details of common psychotic symptoms). Postnatal psychosis is psychosis that occurs shortly after giving birth. Psychotic beliefs often focus on the baby and can include thinking that the baby is possessed or would be better off in heaven than living here on earth.
The risk of postnatal psychosis increases greatly for any births following an initial diagnosis. In 2007 Richard Talby came home to find his wife and two sons dead. His wife, Susan, had killed the two boys (by suffocation or strangulation), and then hanged herself. Susan suffered postnatal depression following the birth of her youngest son, but had seemed to be doing okay.
As we mention throughout this book, if you suspect that you or some one you know may be suffering from depression, including post-natal depression, do all you can to make sure that you seek professional help.
Linking Drugs, Diseases, and Depression
The interaction of depression with illness and disease can form a vicious cycle. Illness and disease (and related medications) can hasten the onset or intensify the effects of depression. And depression can further complicate the various diseases. Depression can suppress the immune system, release stress hormones, and affect your body and mind’s capacity to cope. Depression may increase whatever pain you have and further diminish your crucial resources. In this section, we focus on the role of medication and illness in the development and worsening of depression.
Drugs with depressive side effects
Dealing with an illness is hard enough without having the medication make you feel even worse. Some medication can actually appear to cause depression. Of course, recognising whether it’s merely the experience of the illness, or if it’s the drug that’s causing the depression is difficult. However, in a number of cases, medication does appear to contribute directly to depression.
If you notice inexplicable feelings of sadness shortly after starting a new prescription, tell your doctor. The medication could be causing your feelings, and an alternative treatment that won’t affect you in this way may be available. Table 2-1 lists the most common medications that have potential depressive side effects.
Table 2-1 Potentially Depressing Drugs
Medication
Condition Typically Prescribed For
Antabuse
Alcohol addiction
Anticonvulsants
Seizures
Barbiturates
Seizures and (rarely) anxiety
Benzodiazepines
Anxiety and insomnia
Beta blockers
High blood pressure and heart problems
Calcium channel blockers
High blood pressure and heart problems
Corticosteroids
Inflammation and chronic lung diseases
Hormones
Birth control and menopausal symptoms
Interferon
Hepatitis and certain cancers
Levodopa, amantadine
Parkinson’s disease
Statins
High cholesterol
Zovirax
Herpes or shingles
Depression-inducing illnesses
Chronic illnesses interfere with life. Some chronic illnesses require lifestyle adjustments, frequent GP and hospital appointments, and time off work. These illnesses disrupt relationships, and cause physical pain. Feeling upset by such things is normal. But these problems may trigger depression, especially in vulnerable people.
Also, some illnesses can disrupt the nervous system in ways that cause depression. If you suffer from one of these diseases, talk to your doctor, especially if you find your mood begins to deteriorate. Diseases that are thought to directly influence depression include:
AIDS
Asthma
Cancer
Chronic fatigue syndrome
Coronary artery disease and heart attacks
Diabetes
Hepatitis
Lupus
Multiple sclerosis
Parkinson’s disease
Stroke
Ulcerative colitis
Knowing Where Grief Ends and Depression Begins
When you lose someone you love, you’re likely to feel pain and sadness. You may experience sleep disturbance and want to withdraw from people. The idea of going out and having a good time probably sounds offensive. Feelings like these can go on for weeks or months. Are these the signs of depression? Yes and no.
Although grieving involves many of the same reactions that are associated with depression, the two aren’t the same. Depression almost always includes a diminished sense of personal worth or feelings of excessive guilt. Grief, when not accompanied by depression, doesn’t typically involve lowered self-esteem and unreasonable self-blame. Furthermore, the intensity of grief usually diminishes slowly (sometimes excruciatingly slowly) but surely over time. Depression, on the other hand, can sometimes refuse to budge at all.
Mental health professionals don’t all agree on how to best deal with grief. Some professionals advocate immediate treatment of any disturbing reactions involving grief; these professionals often advise taking antidepressant medication (see Chapter 15 for more information about antidepressants). Others believe that grief is part of a natural healing process and that is best dealt with by allowing its natural course to unfold.
We tend to agree with this latter group, but if, and only if, the grief isn’t complicated by an accompanying depression. (See Chapter 13 where we talk about getting through loss and grief.) Still, the decision is an individual choice. In either case, a grieving person needs to be aware that depression can impose itself on grief. If you’re dealing with grief, seek treatment if it goes on too long or includes other serious symptoms of depression.
Monitoring Mood
You may be pretty sure that you or someone you care about has depression. Now what? Keeping track of how your mood changes from day to day is one important step in the recovery process. Why?
You may discover patterns (perhaps you get very depressed every Monday).
You may discover specific triggers for your depressed moods.
You can see how your efforts progress over time.
You can quickly decide if you’re not making progress, or even if you’re getting worse. This suggests that you need to seek help.
We suggest that you keep a ‘Mood Diary’ (see Table 2-2). You can benefit from tracking your moods and taking notes on relevant incidents, and thoughts. Try it for a few weeks.
Use a rating scale from 1 to 100 to rate your mood each day (or at several regular times throughout the day). A rating of 100 means that you feel ecstatic. You feel on top of the world, perhaps as if you’ve just won the lottery, or been awarded the Nobel Peace Prize – whatever’s really important for you. A rating of 50 means just a normal day. Your mood is fine – neither especially, good, or bad. A rating of 1 is just about the worst day imaginable. Interestingly, we find that most people without depression rate their average mood at around 70, even though we define 50 as middle range.
As well as your mood rating, jot down a few notes about your day. Include anything that may relate to your mood such as:
Clashes with friends, colleagues, or your partner
Difficult times of the day
Overcoming Depression For Dummies Page 7
