Depression

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If you have been to informational websites on depression, then you have a sense of what psychologists consider to be depressive disorders.  The typical symptoms are well known, and discussed all the time.  Depression actually falls within the general category of  “Mood Disorders.”  Anyone who has suffered with a bout of moderate Major Depression does not have to be convinced of its impact on work and family life.  Many have no doubt run across the term “Bipolar Disorder” and its older antiquated name “Manic-depression.”  I consider this diagnosis  at greater length in another category on the blog titled “Bipolar.”

The major difference between Major Depression and Bipolar Disorder is a cycle of mania or hypomania.  This is not a trivial distinction, whatsoever.  Even its milder variant, hypomania, is alarming to others over prolonged periods, and negatively affects occupational and social functioning.  Mania is alarming to others over rather brief periods.  It is the polar opposite of Major Depression.  Often those afflicted are not aware of their expansive mood, or consider it to be a blessing.  Depressive people are aware of their symptoms, and sometimes dwell on them excessively.  Chronically irritated depressives are often not aware they are depressed, but they are aware of their anger.  Consider asking a confidant about your symptoms, since they may provide a fresh prospective.  We only know ourselves through the eyes of others.

Bipolar Disorders are less common than Major Depression.  Bipolar Disorders are often more debilitating, and with less effective long-term treatment.  Severe Major Depression is a nightmare, but add the disorganized frenzy of mania, and it sums to a complete breakdown in functioning.  People who suffer with a severe Major Depression have a willingness to commit suicide, and may even experience psychotic symptoms.  The type of delusions experienced by people with Major Depression and Bipolar Disorder are quite different, though either disorder may become self-destructive.

Most people using this site are more likely to have a mild form of  Major Depression than a Bipolar Disorder.  The Bipolar subcategory on this blog is more useful to significant others, than for those who suffer themselves.  This is not true for the hypomanic person, as they tend to maintain greater self-awareness than someone with mania.  It’s that the hypomanic tends to feel quite elated and energetic, such that a boring old computer blog is not their idea of entertainment.  Perhaps those suffering with acute mania are too frantic to web surf, and those with hypomania lack the awareness to consider their condition a problem.

Bipolar Disorder is often misdiagnosed.  Hypomania is mistaken for mania, and normal mood swings are taken for hypomania.  It is a very serious illness that has almost been reduced to a fad.  Twenty years ago, Borderline Personality Disorder was constantly diagnosed and questioned.  It is doubtful that Bipolar Disorder will be the last diagnostic fad in the fields of psychology and psychiatry.

Most people have had at least one bout of Major Depression in their lives.  Statistically, it’s almost deviant to avoid a Major Depressive Episode one’s whole life.  Whereas Bipolar Disorders are rarely aware of their problematic symptoms while manic, the chronic depressive knows they are depressed, but often under-appreciates the severity of their suffering.  The depression becomes a backdrop to their life, to the point good spirits seem strange and disconcerting.  Once the depression reaches the Moderate stage, it grabs one’s attention in a different way.  Physical symptoms rear their ugly heads.  Suddenly, you cannot sleep, or conversely, one can’t seem to rouse the whole day.  Your appetite is either nil or not capable of being appeased.  Chronic anxious rumination is not able to be suppressed.  It is not always easy to link all the cognitive symptoms of a depression together, in order for someone to realize they are depressed.  Most outpatients initially seek treatment in the moderate stage of a Major Depression, as the physical symptoms assert themselves.  It is likely that the moderate stage of depression inspires many web searches.

Generally, treatment is a combination of psychotherapy and medication.  The combined treatment is nearly four times as effective as either treatment used in isolation.  I believe this rule is most true for Moderate to Severe Major Depressions.  I recommend cognitive-behavioral or psychodynamic therapy for treatment of mild depression.  I am less concerned about attribution errors in more severe depressions than a milder depression.  For example, many of my patients are worried when antidepressant therapy is decreased or discontinued.  Often these patients had taken an antidepressant for years without positive results, or were placed on too low a dose of the antidepressant to be clinically effective.  Depressive patients often fail to give themselves credit for their hard work in psychotherapy.  This is an attribution error, and we all are prone to this sort of error.  Please share your comments regarding this post in the space provided below.

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