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05.02 Mood Disorders: You are so moody! “This is my depressed stance. When you're depressed, it makes a lot of difference how you stand. The worst thing you can do is straighten up and hold your head high because then you'll start to feel better. If you're going to get any joy out of being depressed, you've got to stand like this.” ~Charlie Brown Mood disorders run in families. In the cartoon, Charlie Brown, we see Charlie as a sad person who could be looked at as depressed (since we never see him happy). To find the root of his unhappiness we would need to look at one of two causes: if his parents were depressed from a biological, or nature, point of view and we would need to evaluate his environment from the nurture point of view. Psychologists do agree that mood disorders are attributed to the neurotransmitters in the brain. A lack of serotonin leaves a person feeling sad and can lead to depression. Serotonin: A neurotransmitter that plays an important role in anger, aggression, body temperature, mood, sleep, sexuality, appetite, and metabolism. Objectives: After completing this lesson, you will be able to: Distinguish major depressive disorder from bipolar disorder. Contrast major depressive disorder with bipolar disorder. 05.02 Mood Disorders: You are so moody! Mood: An individual's emotional state. A mental disturbance in an individual's mood is characterized by a depressed mood, an exaggerated or elevated mood, or an alternation between the two. The two disorders in this lesson are classified as mood disorders. Major Depressive Disorder Samantha writes the following in her blog about how she has been feeling: Even though it has been days since I last ate, I am not hungry. I am really tired and I don’t feel like going to the football games nor do I want to go to the parties afterward. I feel so ugly and I wish I could just go back to sleep. My grades are slipping since I cannot concentrate and I just want to sleep! I wish I knew what was wrong with me. I miss my friends! Tania, a friend of family and counselor reads Samantha’s blog and commented: Samantha, I am sorry to hear that you have been feeling so sad. I would love to talk to you. Samantha calls Tania and they begin to talk. Tania asks when Samantha can first remember feeling this way. Samantha reports that she started to feel like this about two months ago. Tania explains she is suffering from major depressive disorder. This disorder is different than feeling sad or blue and that she may need some medication to help her to feel better. Tania goes on to tell her there are many different medications to treat depression such as Paxil, Lexapro, Zoloft, and many others. Tania also recommends that Samantha seek the help of a mental health professional as well. Teen Depression http://app.discoveryeducation.com/player/?assetGuid=66ffc255-6e1b-41b9-ac65a4b7a30e9f7c&fromMyDe=0&isPrinterFriendly=0&provider=&isLessonFromHealth=0&productcode=US&isAssigned=false&include Header=YES&homeworkGuid= Discovery Education Teen Depression—Text Version Life as an adolescent can be overwhelming. Boy #1: You’re just not aware of what they’re going through. Roughly 500,000 teenagers will attempt suicide this year; almost 5,000 will succeed. Boy #2: When you’re depressed, nobody and nothing is going to make you that much happier. Thirty years ago, depression was considered an adult illness; today we realize depression affects nearly 5% of the adolescent population. Karen Hacker, MD: What I see, as a physician, a lot of the time though, is young people who aren’t very communicative with friends, aren’t necessarily having a great time at school, aren’t necessarily having a great time at home and then when you start to talk to them about their feelings, it becomes pretty evident that they’ve become very isolated. Many teens are reluctant to share their feelings; their silence can contribute to the problem. Karen Hacker, MD: You have to get a sense of where they’re at, and I think that’s difficult because some of the classic responses from a teenager is “fine”; or you know, the “one word” response. Is it easy to tell the difference between normal teenage moodiness and something that might need treatment? Karen Hacker, MD: You’re seeing real shifts in the person’s behavior. You know, for example, if the young person always does something that seems to make them happy, and that’s somehow now not in their life; playing a computer game, or they could be talking to a certain friend, or they could be playing a sport, and all of a sudden they’re not involved with that. Certainly there is chronic depression in young people. Other symptoms include violent behavior, changes in sleeping patterns, a drop in academic performance, or a withdrawal from friends. Influential: Something that is of considerable importance or influence. Electroconvulsive Therapy: Administration of electric current to the brain through electrodes placed on the head in order to induce seizure activity in the brain, used in the treatment of certain mental disorders, especially in severe mental disorders. Are mental health issues more common today than they were 50 years ago, 30 years ago, or even 10 years ago? No, they are not. It is just considered less taboo to be diagnosed with a mental disorder and to go for therapy. Mental disorders are thought of as an illness that needs support (therapy and medically) to get through rather than as "being crazy." Advances in medicine coupled with a greater understanding of the human mind have educated the Western world. It is important to note that while this education has occurred in the United States, this may not be true for all countries and all cultures. For example, in the 1940s, people were brought to state hospitals and psychiatric facilities for depression. Depression was misunderstood and many people thought that depressed people were melancholy and since they could not "snap out of it" they were deemed fit for the psychiatric ward. Today, we know depression is a real disease and many people suffer from this disorder. The DSM-IVR classifies depression as feelings of moodiness or sadness for longer than two weeks. The causes of depression are not known, but research has shown genetics can be influential. Many people take anti-depressant medication to assist in the formation of serotonin. Treatment for depression has spanned from electroconvulsive therapy to psychotherapy. Bipolar Disorder Bipolar: Describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania. Euphoria: A state of very intense happiness and feelings of well-being. The term manic depressive used to be what we now call bipolar. Manic depressive describes the two poles—mania and depression. The mania is a super elevated mood almost like euphoria. The person feels like he or she is superhuman and can conquer the world. Some people believe they can fly (and attempt to do so) while others spend money (excessively) and others clean their house at three in the morning. The manic effect of bipolar is like a person that just found out they won the lottery! This feeling lasts for a short time period (one to two days). During this manic state, the person cannot sleep or concentrate, yet seems happier than ever! After this short elated period, the person crashes into depression. What felt like a drug-like high is now a deadly low. The bipolar term can be explained like the two poles on Earth. They are opposite and so is the bipolar person’s mood. The cause of bipolar is unknown, yet much of the research points to genetics. Lithium is a medication used in the treatment for bipolar. Most people do live their life to the fullest while on medication. However, some people with bipolar stop taking their medication, as the love for the manic episodes are desired. There is no cure for bipolar, but a person who takes their medication regularly can live a life similar to a person who does not have bipolar. Therapy can be coupled with the medication and regular trips to the doctor are required as lithium can damage a person’s liver. What is bipolar disorder? Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person’s late teens or early adult years. At least half of all 1 cases start before age 25. Some people have their fi rst symptoms during childhood, while others may develop symptoms late in life. Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life. What are the symptoms of bipolar disorder? People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania. A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home. Symptoms of bipolar disorder are described below. Symptoms of mania or a manic episode include: Mood Changes • • A long period of feeling “high,” or an overly happy or outgoing mood Extremely irritable mood, agitation, feeling “jumpy” or “wired.” Behavioral Changes • • • • • • • Talking very fast, jumping from one idea to another, having racing thoughts Being easily distracted Increasing goal-directed activities, such as taking on new projects Being restless Sleeping little Having an unrealistic belief in one’s abilities Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments. Symptoms of depression or a depressive episode include: Mood Changes • • A long period of feeling worried or empty Loss of interest in activities once enjoyed, including sex. Behavioral Changes • • • • • Feeling tired or “slowed down” Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide Assessment 05.02 Mood Disorders: You are so moody! 1. Complete the reading for this lesson. 2. Review your notes from the "05.01 Anxiety Disorders: What makes you anxious?” and "05.02 Mood Disorders: You are so moody!" lessons. 3. Access and take the "05.02 Mood Disorders: You are so moody!" quiz. Know the characteristics of Bipolar Disorder & Major Depressive Disorder Activity 5.02 Which disorder fits these symptoms? Alisa reports she cannot come home after dark if her mom leaves the porch light on. When asked why, she stated that the light attracts the frogs and she feels like she cannot breathe when she sees these frogs. Ron reports he felt like he had a heart attack. He reports he was sweating, unable to breathe, and his heart was palpitating so fast he felt like it was going to burst out of his chest. Jennifer reports it takes her a long time to get out of the house in the morning. When asked about her morning routine she states she gets up, brushes her teeth, gets dressed and undressed three times, brushes her teeth again, makes her bed, and walks down the stairs four times before heading out to school. She reports she has to do this routine every day or else she is afraid she will get into a car accident on her way home from school. Nelly reports her family often refers to her as "Worry Nelly." She explains she worries from the time she gets up in the morning until the time she goes to bed. She reports she worries about what the weather will be like tomorrow and how her favorite football team will do on Sunday. Warren, a football player reports he never takes his football helmet off for interviews because he is fearful of the crowd and being in open spaces. Quinn reports he has no control over his life. He states he wants to go into the army but he is stressed out over passing English. He also reports he cannot possible face one more recruiter right now. Devon reports he is always afraid he left the stove on. He states he has to check the stove five times every night before going to bed. Luis reports the thought of climbing the stairs to go onto the roller-coaster just sends his stomach rolling. He states heights are something that should be avoided. Thomas reported he felt like he could run a marathon and he was up all night cleaning and organizing his closet. Sara, a life-long ballet student, reports she feels like she does not want to participate in ballet anymore. She also states she is tired and cannot seem to get enough sleep. Sean, reported after being so happy for two full days where he reports he “never needed much sleep” now is stating he is so sad and he cannot stop crying. David reports while on medication he feels fine, but that he loves the happy and elated feeling he experiences when he stops taking the medication. Frank reports he is feeling like a superhero. He feels like he can fly and he is getting upset because his sister is telling him he cannot fly. Walter reports he is feeling like he has no reason to live. He reports “everyone” thinks he is ugly and he agrees. He states he cannot do anything right. Stan, a 70 year-old man reports he was once given electroconvulsive therapy as a way to "shock" his mind into feeling better.