Mood Disorders

Mood disorders, sometimes referred to as affective disorders, are a type of mental illness that affects a person's mood. Everyone experiences occasional periods of sadness or euphoria (a strong sense of well-being), but people with a mood disorder feel these emotions more strongly than other people and for longer periods. About one in seven people is affected by a mood disorder each year. Possible causes include an inherited predisposition, an imbalance in brain chemicals that regulate mood, and environmental factors—or a combination of all three. The most common mood disorders include depression, bipolar disorder (formerly known as manic depression), and seasonal affective disorder (SAD). In general, mood disorders are among the most treatable of all mental disorders.

Depression

It is normal to feel unhappy in response to a personal loss or stressful situation, but such feelings usually go away with the passage of time. Depression, on the other hand, can cause deep feelings of sadness or despair that can last for months or even years. Depressed men often feel overwhelmed by life and become emotionally and physically withdrawn.

Depression is a serious condition that can have profound effects on a man's quality of life. Long-term bouts of depression can negatively affect your ability to function at work and in social situations. It can also severely limit your capacity to enjoy the basic pleasures of life—your family, your friends, your favorite activities, and your sex life. More than 18 million people experience depression in the United States every year. It can occur at any age but usually seems to first appear between ages 25 and 45. Although men are only half as likely to have severe depression as are women, depressed men are four times as likely to commit suicide than depressed women (although women attempt suicide more frequently). In fact, men over age 55 have the highest risk of suicide among Americans. Untreated depression is the leading cause of suicide in the United States.

Symptoms of depression include persistent sadness or despair, insomnia, decreased appetite, irritability, apathy, withdrawal from social situations, loss of energy, poor self-esteem, feelings of hopelessness or helplessness, an inability to enjoy former interests, a decreased interest in sex, and suicidal thoughts. Depression also can cause you to lose interest in your appearance. The tone of your voice may be dull and flat and your pattern of speech monotonous. Frequent bouts of crying, often with no apparent cause, are common.

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The Warning Signs of Suicide

Depression is the number one risk factor for suicide. In fact, 70 percent of all people who commit suicide are depressed. Although men attempt suicide only a third as often as do women, men are more likely to be successful in the attempt. The highest suicide rates are for men over age 85, but suicide also is the third leading cause of death among younger men aged 15 to 24 years. Married men are less likely to attempt or commit suicide than are separated, divorced, or widowed men. Facing adverse life events, such as financial loss, can alter the chemistry in the brain, increasing the risk for suicide, especially if the person already has an emotional disorder or is abusing drugs or alcohol. Risk factors for suicide include a family history of an emotional disorder, substance abuse, suicide, or physical or sexual abuse; a prior suicide attempt; having a gun in the home; imprisonment; impulsive behavior; and exposure to the suicidal behavior of others (especially for teens or young men).

A suicide attempt—or even talking about suicide—should never be dismissed as a mere attention-getting ploy. Attempted suicide is always a cry for help from a person who is usually battling some type of emotional disorder, such as depression, or a substance abuse problem. Most people with depression or substance abuse can be treated successfully and go on to lead healthy lives. If someone you know begins talking about or threatening to commit suicide, take the person seriously and try to get him or her to see a doctor, or call a suicide hot line. A suicide attempt is often preceded by certain telltale warning signs, such as:

  • talking about suicide or death, even jokingly
  • difficulty dealing with the loss of a loved one or some other adverse life event
  • withdrawal from friends and activities
  • hoarding of pills or purchase of a gun
  • abuse of drugs or alcohol
  • giving away prized possessions
  • a previous suicide attempt
  • writing notes or poems about death
  • changes in eating or sleeping habits
  • neglect of personal appearance

The best way to prevent a suicide attempt is to get professional help for an emotional disorder or substance-abuse problem. Recognition of depression in older men can go a long way toward preventing suicide, especially if they are living alone. Limiting access to guns, especially in combination with treatment of an emotional disorder, also is an effective way to prevent suicide attempts in high-risk men. If someone you know is in immediate danger, call 911 or your local emergency number.

Some people have a recurrent but less severe form of depression, called dys- 347

thymia. Dysthymia is diagnosed when a depressed mood persists for at least 2 Mental years and is accompanied by at least two other symptoms of depression. People Dis°rders with this milder form of depression are susceptible to periodic episodes of major depression.

Doctors think that a number of factors may combine to cause depression. A deficit in certain brain chemicals—particularly serotonin and norepinephrine— seems to cause the anxiety, irritability, and fatigue often experienced in the disorder. A family history of depression also can increase your chances of having the disorder. Certain environmental factors—such as exposure to violence or emotional or physical abuse—also seem to have a role. People who have low self-esteem or a pessimistic outlook seem to be more susceptible to depression than those who are more self-confident and optimistic.

The good news is that depression responds very well to treatment, even in people who have had the disorder for many years. Up to 90 percent of depressed people who receive treatment experience a reversal of their symptoms. If you have symptoms of depression, your primary care doctor probably will refer you to a psychiatrist (a doctor who specializes in treating mental disorders) for treatment. Before he or she prescribes any form of treatment, the psychiatrist will request that your primary care doctor perform a complete physical examination. If these evaluations reveal no physical cause for your symptoms, your psychiatrist will then conduct a psychological evaluation.

Doctors usually treat depression with antidepressant medication, often combined with psychotherapy or psychological counseling. The purpose of drug treatment is to correct any imbalance in brain chemistry. The most common drugs prescribed to treat depression are selective serotonin reuptake inhibitors (such as fluoxetine, fluvoxamine, and paroxetine) and tricyclic antidepressants (such as amitriptyline, desipramine, and nortriptyline). These drugs are not tranquilizers or sedatives and are not addictive. Antidepressant medications can improve the symptoms of depression in 4 to 6 weeks, although the person needs to continue taking them for at least 5 months (usually longer) after symptoms improve.

Psychotherapy may be recommended for an individual or a family, or in a group setting with other people who are experiencing depression. Individual psychotherapy takes place in the office of a psychiatrist or psychologist, in regularly scheduled 30- to 45-minute sessions. The goal of psychotherapy is to relieve the person's distressing symptoms so that he or she can resume a normal routine. There are different types of psychotherapy. One type involves helping the person understand unconscious and unresolved conflicts. Another emphasizes changing negative patterns of thinking. A third attempts to replace ineffective behaviors with more positive constructive behaviors. Ask your therapist which type he or she recommends and why. Treatment can last several weeks, months, or years, depending on the severity of the depression.

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In extreme cases of severe depression, a psychiatrist may admit the person to the psychiatric unit of a hospital for full, 24-hour care. The doctor will develop a treatment plan, which will be carried out by a team of mental health professionals that includes the psychiatrist, psychiatric nurses, a clinical psychologist, a social worker, rehabilitation therapists, and an addiction counselor, if needed. The treatment plan usually includes individual, group, or family therapy, along with medication. The person usually remains hospitalized for about 6 to 12 days.

Bipolar Disorder

Bipolar disorder, in which periods of deep depression alternate with episodes of euphoria or mania, affects about 1 percent of Americans. The disorder's wide mood swings continue indefinitely, interrupted by periods of remission or normal mood. The depressed phase produces typical symptoms of depression, such as sadness or despair, loss of interest in favorite activities, fatigue, and thoughts of suicide (see page 346). During the manic phase, affected people experience persistently elevated mood and energy, delusions of grandeur, feelings of invincibility, unrealistically high self-esteem, agitated movement, talkativeness, abrasive and rapid speech, racing thoughts and distractibility, poor judgment, poor impulse control, and a decreased need for sleep. Some people in the manic phase also go on unrestrained buying sprees or have impulsive, indiscreet sexual encounters. Extreme mania can lead to delirium (mental confusion) or paranoia (excessive or irrational suspiciousness). Manic states can last for days, weeks, or months and may begin gradually or suddenly. They are followed by a period of normal mood or by an episode of depression. Initial episodes of mania frequently occur between ages 15 and 25.

Bipolar disorder affects an equal number of men and women. It tends to run in families; up to 90 percent of those affected have a relative with either bipolar disorder or depression. The illness also has been linked to both an imbalance in brain chemistry and a deficiency in the production of certain hormones (substances produced by the body that control key bodily functions). The severe mood swings characteristic of the disorder can seriously affect a person's life, upsetting personal relationships and disrupting routines at work. Although everyday occurrences can trigger a manic episode, dates that have significant meaning for the person, such as the anniversary of a parent's death, are especially likely to trigger one.

Like depression (see page 345), bipolar disorder is readily treatable, but because the affected person feels so elated and invincible, he or she may dismiss the need for treatment or refuse to comply with prescribed treatment. Medications that are most commonly used to treat bipolar disorder include mood stabilizers (such as lithium), antidepressants (such as fluoxetine or bupropion), and antipsychotic drugs (such as haloperidol), often in combination. The hallmark mood stabilizer for bipolar disorder is lithium carbonate, a naturally occurring 349

mineral salt. Lithium controls the manic phase of bipolar disorder by affecting Mental the central nervous system's control over emotion. Its effectiveness depends on Dis°rders the amount of the drug in the bloodstream, so lithium must be taken exactly as prescribed. A blood test can be performed to ensure a therapeutic level. For people who do not respond well to lithium, doctors may use other mood stabilizers, such as divalproex sodium or carbamazepine. Most mood stabilizers produce side effects, including weight gain, thirst, hand tremors, and muscle weakness.

Doctors may prescribe antidepressants during the depressive phase of bipolar disorder, but they usually instruct the person to resume taking a mood stabilizer once the depressive phase has ended. Antipsychotic drugs are used predominantly for people whose manic phase has escalated into a psychotic episode (loss of awareness of reality).

Psychotherapy, also called talk therapy, can boost the effectiveness of the drugs used to treat bipolar disorder by helping those with the illness learn how to become more aware of their symptoms, deal with stressful life events, and comply with drug treatment. This kind of therapy works best when the therapist is experienced in treating bipolar disorder. Because families also are affected by the disorder, family members may be offered counseling to help strengthen relationships that have been strained by the illness. People with very severe cases of bipolar disorder may need hospitalization or, in extreme cases, electroconvul-sive therapy, in which a current of electricity is passed through the brain to induce seizures. This treatment may be highly effective within a few weeks (usually three treatments per week). Memory loss may occur, but the memory returns within a few months.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a type of mood disorder that brings on depression when the seasons change. The most common type of SAD is known as winter depression, which usually starts in the late fall or early winter and ends in spring. Many people without SAD feel "blue" and more fatigued when the days get shorter. However, people with winter depression experience true depression, along with symptoms that are not typical of a depressive disorder, including excessive sleeping, increased appetite, a craving for high-carbohydrate foods, irritability, and weight gain. A smaller number of people experience another form of the disorder known as summer depression, which usually begins in late spring or early summer. Signs of summer depression include the more typical depressive symptoms of decreased appetite, weight loss, and sleeplessness. The cause of summer depression is not known. Both forms of SAD seem to recur at the same time each year. SAD can occur along with a bipolar disorder (see previous page) or depression (see page 345). Women are affected by SAD four times as often as men.

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Doctors think that winter depression may be brought on by the reduction in the amount of sunlight that occurs during the winter months. A good argument for this theory is that SAD is more common in people living in the northern latitudes than in those living farther south. In addition, artificial, bright-light therapy, also known as phototherapy, is very effective in treating winter depression. In a typical phototherapy session, people with the disorder sit in front of a desktop light box or wear a light visor, initially for 10 to 15 minutes per day, increasing to 30 to 45 minutes per day. Benefits may not be seen for several days to several weeks. It is important to continue phototherapy until spring, when the person can obtain increased natural light from the sun. Phototherapy appears to have few side effects, although some people may experience headaches, fatigue, irritability, and insomnia if they take light therapy too late in the day. These side effects can be reduced by sitting farther from the light source or by decreasing the length of the phototherapy sessions.

Tanning beds are not recommended for the treatment of winter depression because they emit high levels of ultraviolet rays, which are harmful to the eyes and the skin. Phototherapy is often combined with drug therapy or psychotherapy to treat winter depression. The drug of choice for this type of SAD is called a monoamine oxidase inhibitor (such as isocarboxazid or phenelzine).

Doctors treat summer depression differently than the winter form of SAD. Summer depression responds better to the antidepressants usually prescribed for nonseasonal depression (see page 345).

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