Depression & Bipolar Disorders

depressive disorders is a diagnostic category as are bipolar disorders

People who are depressed often feel helpless to change their life. Just identifying and describing their problems seems overwhelming. Family and friends are often a part of those problems and can offer little assistance. Psychotherapy is not a quick fix. Many modern therapies are techniques to work around problems, not understand and solve them. Patients often drift from one therapist to another in search of relief. Just scheduling an appointment makes you feel better, but true progress and peace with yourself requires more than temporary relief. Are you ready to work on what is really bothering you?

Depression:

Major Depressive Episode – at least two weeks depressed mood or loss of interest, most of the day, every day, decreased pleasure from activities, change of weight (>5% in a month), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, diminished ability to think, concentrate or decide, and/or recurrent thoughts of death.

Manic Episode – at least one week of persistently elevated, expansive or irritable mood, accompanied by inflated self-esteem, decreased need for sleep, pressure of speech, racing thoughts, distractibility, agitation, and/or excessive involvement in risky behaviors.

Hypomanic Episode – at least four days of manic symptoms (as described above).

Mixed Episode – meets the criteria for both manic and major depressive episodes with symptoms sufficient to cause marked impairment in social and/or occupational functioning and is not the result of substance use or a general medical condition.

Major Depressive Disorder involves the symptoms of major depressive episode previously discussed. This disorder must be differentiated from other disorder (for example, schizophrenia) that may have similar symptoms or upon which major depressive disorder may be superimposed. Thus, the underlying disorder may be something other than major depressive disorder, and this needs to be diagnostically differentiated.

There are two forms of major depressive disorder, both Single Episode and Recurrent.

Major Depressive Disorder, Recurrent, consists of two or more major depressive episodes separated by at least two consecutive months without symptoms of such an episode.

For both Single Episode and Recurrent Major Depressive Disorder, the following aspects of the disorder are specified by the examining psychologist whether:

the severity of the disorder (E.g. mild, moderate, severe),

the disorder is chronic (been continually present for the past two years)

there are catatonic features (immobility/stupor, purposeless activity, extreme negativism, peculiarities of movement, echololalia/echopraxia [E.g. repeating what is said to them]

there are melancholic features (loss of pleasure in most activities, lack of response to pleasurable experiences, depression worse in morning, early morning awakening, agitation or retardation (slowing), appetite decrease or weight loss, or excessive guilt

there are psychotic symptoms (the individual may have bizarre or unusual beliefs),

it follows childbirth (E.g. postpartum onset),

the symptoms are currently in remission

there are atypical features (weight gain rather than loss, increased sleep, heavy feels in arms or legs, pattern of interpersonal rejection, etc)

Dysthymic Disorder is a condition in which the patient has depressed mood most of the day and for most days of any given week. The individual has had this problem for at least two years (although for children and teens, it may be diagnosed after one year and can be expressed as irritability rather than depressed mood). The person suffering from dysthymic disorder may show appetite changes, sleep changes, lack of energy, low self-concept, poor concentration and/or decision making and often feeling of hopelessness. It must be determined that there has been no major depressive episode during that period or manic episode, that it is not due to a health condition or use of medication or drug abuse, and the patient has not been within symptoms for greater than two weeks during the period of the disorder. In the past, this was sometimes referred to as neurotic depression or depressive neurosis since it was associated with unresolved loss or other external obstacles the individual confronted. You do not mention whether you have considered psychological care, and/or what to date you have done about your concerns, but they do warrant your taking time for a clinical opinion from someone in your geographical area. The best of luck, and please let me know what you decide to do.

BIPOLAR I DISORDER involves a clinical course characterized by one or more manic episodes or mixed episodes. Often these patients may have also had one or more major depressive episodes. This can be a first or recurrent episode. Recurrence involves a shift in polarity of the episode from manic to depressive or an interval of at least two months without the manic symptoms. Like Major Depressive Disorder, Bipolar I Disorder can be mild, moderate or severe (with or without psychotic symptoms), with catatonic features, or with postpartum (following childbirth) onset. It can be a chronic disorder, have melancholic or atypical features. And the pattern can be with or without full interepisode recovery, with seasonal pattern and/or with rapid cycling.

SINGLE MANIC EPISODE: no past major depressive episodes

MOST RECENT EPISODE HYPOMANIC: currently or most recently in a hypomanic episode

MOST RECENT EPISODE MANIC: currently or most recently in a manic episode

MOST RECENT EPISODE DEPRESSED: currently or most recently in a major depressive episode

BIPOLAR II DISORDER (RECURRENT MAJOR DEPRESSIVE EPISODES WITH AT LEAST ONE HYPOMANIC EPISODES):

As with Bipolar I Disorder, the individual may have mild, moderate or severe (with or without psychotic) symptoms, with catatonic features, or with postpartum (following childbirth) onset, but Bipolar II Disorder is categorized as: HYPOMANIC or DEPRESSED

The chief way of conceptualizing the difference difference between Bipolar I and Bipolar II Disorders is that one involves manic episodes (Bipolar I) and the other has hypomanic episodes.

CYCLOTHYMIC DISORDER – a patient may have a history of at least two years of hypomanic episodes with periods of depressive symptoms that are not severe enough to be considered a major depressive episode. This disorder is called Cyclothymic Disorder. To be diagnosed with Cyclothymic Disorder, the individual must have a history of at least two years of recurrent hypomanic episodes interspersed with numerous periods of depressive symptoms. The person is not without the symptoms for more than three months. And, as in all mood disorders, it must be determined if the symptoms are not better accounted for by drug abuse, adverse prescribed drug reaction or another mental disorder that has not been previously diagnosed. In the case of Cyclothymic Disorder, it is possible for the individual to later develop true manic episodes in which case, Bipolar I disorder is diagnosed, or to develop major depressive episodes in which case Bipolar II disorder may be diagnosed. Thus, it is possible for someone with cyclothymic disorder to develop symptoms Bipolar disorder.

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