Ups and downs

Kari Swanson

We all experience varying degrees of ups and downs in our mood and in our day-to-day functioning. What constitutes a problem with mood? Depression is a difficult thing to grasp. What is the difference between just having the blues and being clinically depressed? Many people struggle with this question and as such people are not seeking help soon enough to treat a very treatable condition… depression.

According to the World Health Organization, 300 million people around the world have depression. In the United States, it is estimated that 16.2 million adults, 6.2 percent of all adults in the country, have experienced a major depressive episode in the past year. Furthermore, 10.3 million U.S. adults experienced an episode that resulted in severe impairment in the past year. Nearly 50 percent of all the people diagnosed with depression are also diagnosed with an anxiety disorder. It is estimated that 15 percent of the adult population will experience depression at some point in their lifetime. These statistics make it very difficult to believe that you are the only person suffering from some form of depression or that you should be handling your depression better.

What is Major Depression? Clinical depression is defined by the intensity, frequency, and duration of the symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines Major Depression Disorder as at least two weeks of a depressed mood or loss of interest or pleasure in almost all activities, as well as at least 5 other symptoms such as:

— Sleep issues on an almost daily basis (difficulty sleeping or sleeping too much)

— Changes in appetite and weight (change of more than 5% body weight in a month) or a decrease or increase in appetite nearly every day

— Decreased energy or fatigue almost every day

— Difficulty concentrating, making decisions and thinking clearly

— Psychomotor agitation or retardation that is observable by others (slow physical movements or unintentional or purposeless motions)

— Recurrent thoughts of death or suicide, a suicide attempt or a specific plan for suicide.

Another form of depression is Bipolar Disorder which has also been referred to, in the past, as Manic Depression. In talking about this disorder we are talking about people who experience very low lows and very high highs typically described as depression and mania respectively. Bipolar Disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year according to the National Institute of Mental Health. The median age of onset for Bipolar Disorder is 25 years old, however, it can start in early childhood or as late as the 40s and 50s. It is important to note that mania presents differently in children than adults. When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, stomachaches or tiredness, poor performance in school, irritability, social isolation and extreme sensitivity to rejection or failure (National Institute of Mental Health).

Bipolar Disorder causes mood shifts from depression to mania (unusually elevated mood) and affects a person’s energy and ability to function. Mood swings associated with Bipolar are very different than those mood swings experienced by people without Bipolar Disorder in that they are far more severe. A person without Bipolar Disorder whose weekend plans got spoiled by rain will be able to exhibit disappointment appropriately, however, someone diagnosed with Bipolar may have a more exaggerated reaction that lasts much longer than necessary. There is a myth about Bipolar and that is that the person exhibits a Jekyll-Hyde personality, the type that can turn on a dime from sad to euphoric. The truth is that the average person diagnosed with Bipolar Disorder will be depressed more often than manic. There are people with Bipolar Disorder who will shift back and forth more quickly than others with Bipolar, however, that is generally not the typical pattern. For the most part what is typical is to have an abnormal mood state shaded by a predominance of high or low. An abnormal mood state is something intense or unexpected in relation to the situation, such as giggling instead of crying when you find out your home will be foreclosed. Moving into the mania phase of Bipolar can be frightening to some people due to losing control of actions and thoughts and sleep. The main description of mania is not “happy” but elevated mood. A person in a manic phase may go on spending sprees, use poor judgment, abuse drugs or alcohol and have difficulty concentrating. Life is very disruptive in manic phases, however, some people prefer the manic phases due to the depressive phases being so intense.

There are strategies that assist people in regulating/managing their Bipolar symptoms such as getting regular aerobic exercise, keeping a regular bedtime, eating a healthy diet, and paying attention to personal warning signs that a shift to depression or mania is coming. If people are aware of their warning signs, such as a person diagnosed with Bipolar knowing that awakening at 4am is a sign he/she is shifting to mania, he/she can pay attention to that pattern. Bipolar Disorder can be managed by talk therapy and medications. Mood stabilizers are often used for those diagnosed with Bipolar Disorder in order to treat the entire mood.

An often not talked about depressive disorder is Postpartum Depression. One in seven women experiences this type of depression. Half of all women diagnosed with Postpartum Depression have never had an episode of depression before. It is common for women to experience stress, sadness, loneliness and exhaustion after giving birth, however, some women experience this to a degree that makes it difficult for them to care for themselves or their babies after giving birth. Bonding with their newborn is very difficult for a woman experiencing Postpartum Depression. Women have a very difficult time understanding why they feel so terribly sad during what is suppose to be one of the happiest experiences in their life. As such, they have a difficult time telling others how they are feeling and seeking help. Birthing classes and all the Doctor’s appointments that women have do not get women ready for the emotional roller coaster that some of them will experience. It is very important to check in with pregnant moms and new moms as this is a silent struggle for many.

It is so important to know that all forms of depression are very treatable. However, according to the National Institute of Mental Health, only about half of all Americans who are diagnosed with depression in a given year get treatment. Those who do seek treatment have waited months or years before seeking help. This is the stigma of mental health. Who would wait months or years before getting a physical ailment, a broken arm/leg or a medical condition looked at? Mental health is real. We all have mental health. We all struggle with varying degrees of mental health. The struggle can be eased by talking, seeking help from a professional and addressing the thoughts and feelings you are experiencing; sooner than later. Be real. Be honest. Be good to yourself. Depression does not define who you are. It is part of your story. What you do with the knowledge that you are experiencing depression in some form is more important. It is treatable. It is okay to not be okay but it is not okay to struggle in silence.

Kari Swanson is a Master’s level clinician with 25 years of working in the mental health field. She is the founder of CORE–Choosing Openness Regarding Experiences which is a non-profit organization with the mission to provide mental health awareness and suicide prevention education to Warren County.