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Dr. Zabrin Inan, MD
Child, Adolescent and Adult Psychiatry
 Chicago

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Depression/Mood Disorders

Depressive disorders, also called mood disorders, come in different forms, just as do other illnesses such as heart disease. There are variations in the number of symptoms, their severity and duration. The three distinct types are major depressive disorder (unipolar depression), dysthymia (less severe depression) and bipolar disorder (manic-depression).

Major depression is manifested by a combination of symptoms that interferes with or may even disable the ability to work, study, sleep, eat and enjoy once- pleasurable activities.  Some affected individuals will experience a disabling episode of depression only once, but the disorder more typically occurs several times in a lifetime.

FOR MORE INFORMATION

American Academy of Child
and Adolescent Psychiatry

www.aacap.org

American Psychiatric Association
www.psych.org

National Institute of Mental Health 
www.nimh.nih.org

Dysthymia is a less severe but typically more chronic form of depression.  It is often diagnosed when depressed mood persists and is accompanied by other symptoms. People with dysthymia may also experience major depressive episodes at some time in their life.  (Also see �Anxiety Disorder.�)

Bipolar disorder, sometimes called manic-depressive disorder, is characterized by cycling mood changes, severe highs (mania) and severe lows (depression).  Individuals with bipolar disorder can have any or all of the symptoms of a depressive disorder. Then, during the manic cycle, they may feel elated and full of grand schemes.  And, they may exhibit poor judgment and unwise decisions, for example unbridled overspending, that can negatively affect their family and job. Untreated mania can deteriorate to a psychotic state.  (Also see �About Bipolar Disorder.�)

The Symptoms

Some people experience a few symptoms, others many. The number of symptoms experienced is not as important as the severity of specific symptoms, frequency of occurrence, and the effect on well-being.

Common depressive symptoms among adults:

  • Persistent sad, anxious or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities or sex
  • Decreased energy, fatigue, being "slowed down"
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss, or overeating and weight gain
  • Recurrent thoughts of death or suicide, suicide attempts
  • Restlessness, irritability
  • Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness

Some other depressive symptoms most often unique to children and adolescents:

  • Frequent absences from school or poor performance in school
  • Talk of or efforts to run away from home
  • Outbursts of shouting, complaining, unexplained irritability, or crying
  • Extreme sensitivity to rejection or failure
  • Increased irritability, anger or hostility
  • Reckless behavior

(Note: Children suffering from depression must be very closely monitored for mania, and any rapid-cycling or mood swings during the day (see below).

Common mania symptoms

  • Abnormal or excessive elation
  • Unusual irritability
  • Decreased need for sleep
  • Grandiose notions
  • Excessive spending
  • Increased talking
  • Racing thoughts
  • Increased sexual desire
  • Markedly increased energy
  • Poor judgment
  • Inappropriate social behavior

Physical illness, environmental stresses and depression

Recent research shows that physical changes in the body can be accompanied by mental changes.  A combination of genetic, psychological and environmental factors can be involved in the onset of a depressive disorder.  Physical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and HIV and hormonal disorders also can trigger depressive illness, and sometimes prolong the recovery period.  Likewise, a serious loss, difficult relationship, financial problem, or change in life patterns can trigger a depressive episode.

Women: Specific hormonal changes that come with pregnancy, miscarriage and childbirth may contribute to depression.  Many women are particularly vulnerable after the birth of a baby.  While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires intervention. In order for the affected mother to recover physical and mental well-being and the ability to care for and enjoy her infant, she will need cooperation and coordination among the psychiatrist (who is also an M.D.), the family�s physician and the family itself.

Men: Depression can affect the physical health in men differently from women. A new study shows that although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate. The symptoms of depression in men typically are irritability, anger and discouragement.  They tend not to experience feelings of hopelessness and helplessness, so depression in men may be difficult to recognize. Studies show that men are less likely to admit to or seek treatment for depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, despite the fact that more women attempt it.  In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.  Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members, friends or significant others can make a difference in helping men understand and accept depression as a real illness that needs treatment.

Elderly: Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, studies have shown that most feel satisfied with their lives. However, when depression develops in an older person, the individual may accept it as a normal part of aging.  During visits to his or her doctor, the elderly individual suffering from depression may describe only physical symptoms and avoid discussing feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.  These symptoms should be disclosed because a diagnosis of depression and the resulting treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. 

Children: Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die.  Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved. In adolescents there also is an increased risk for substance abuse and suicidal behavior.  Depression in young people often co-occurs with other mental disorders, most commonly anxiety, disruptive behavior or substance abuse disorders, and with physical illnesses, such as diabetes.



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