Mood Disorders

Major life changes, such as the death of a loved one, relationship changes, or moving to a new city, can cause stress. Most people get used to changes within a few months. However, for some people, coping with the sadness, hopelessness, and stress associated with change becomes overwhelming.

Adjustment disorders or situational depression are a type of short-term, stress-related mental illness that can occur in some people after a major life event.

Causes of Adjustment Disorder

The type of stress that can trigger adjustment disorder varies from person to person, but can include:

• Divorce
• Job loss or job change
• Difficult circumstances
• Developing a serious illness
  
• Serious illness in a loved one
  
• Being the victim of a crime
  
• Having an accident
  
• Having a big life change - getting married, having a baby or retiring
  
• Living through a natural disaster such as fire, flood or tornado
  
• Money worries
  

Triggers of stress in adolescents and young adults can be:

• Family problems or conflicts
  
• School problems
  
• Sexuality issues
  

Since people differ in their responses to stress, there is no way to predict who can develop an adjustment disorder. Those who cannot cope with changes or do not have a good support system may have a higher risk of developing adjustment disorders.

Signs and symptoms

The symptoms of an adjustment disorder are similar to depression and can be severe enough to affect work, school or social life. Symptoms of an adjustment disorder include:

• Frequent crying
  
• Anxiety and worry
  
• Body aches of unknown explanation
  
• Palpitations (an unpleasant sensation of irregular or forceful beating of the heart)
  
• Problems sleeping
  
• Fatigue
  

Signs of an adjustment disorder include:

• Defiant, impulsive, or destructive behavior
  
• Absence from work or school
  
• Withdrawal or isolation from people and social activities
  
• Changes in appetite, either loss of appetite or overeating
  
• Increase in the use of alcohol or other drugs
  
• Trembling or twitching
  

To be diagnosed with adjustment disorder, the symptoms:

• Are the result of a life change, usually occurring within three months of the event
  
• Are more severe than would be expected
  
• Are only related to adjustment disorder without other mental health disorders involved
  
• Are not part of normal grieving for the death of a loved one
  

Some people who have severe cases of adjustment disorder may have thoughts of suicide or make a suicide attempt.

Diagnosis

After you have ruled out a physical illness, your health care provider may refer you to a mental health assessment to determine your behavior and symptoms.

Types of adjustment disorders are:

• Adjustment disorder with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and experiencing a lack of pleasure in the things you used to enjoy.
• Adjustment disorder with anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.
  
• Adjustment disorder with mixed anxiety and depressed mood. Symptoms include a mix of depression and anxiety.
  
• Adjustment disorder with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting, reckless driving or ignoring your bills. Youths may skip school or vandalize property.
  
• Adjustment disorder with mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
  
• Unspecified adjustment disorder. Symptoms don't fit the other types of adjustment disorders, but often include physical problems, problems with family or friends or work or school problems.
  

Treatment

In cognitive-behavioral therapy (CBT), individuals learn how to break out of the vicious cycle of negative thoughts. The therapist helps the client recognize negative thoughts and feelings and their effects. Then, the therapist teaches the client to use negative thoughts as cues for helpful thoughts and healthy actions.

Medications may be recommended. With the right help and support, patients with adjustment disorders will quickly improve.

Bipolar disorder is a type of mood disorder that causes dramatic changes or extremes of mood, energy, activity that impair the ability to perform daily tasks. It is also known as bipolar affective disorder, manic-depressive disorder, or manic depression. Bipolar disorder is characterized by episodes of manic episodes that can alternate with episodes of major depression.

What is a Manic Episode?

When a person suffers from mania or has a manic episode, they usually feel "high," euphoric, or irritable. Some outward signs of behavior that may indicate that a person is in a manic state include:

• Needing little sleep yet having great amounts of energy
  
• Talking so fast that others can not follow his/her thinking
  
• Having racing thoughts (many thoughts are "racing" fast in their head to the point of not being able to keep up with them)
  
• Being easily distracted, so their attention switches to numerous topics within a few minutes
  
• Having an inflated feeling of power, greatness, or importance
  
• Exhibiting reckless behavior without concern for the consequences.
  

Hypomania is another disorder similar to mania. Hypomania is a milder form of mania with similar but less severe symptoms and less functional impairment. A hypomanic episode is not a disorder in itself, but a description of a part of bipolar type II disorder.

What is a Depressive Episode?

The symptoms of depression that patients experience are similar to those of major depression. These symptoms occur for at least two weeks and cause significant functional impairment. Manic episodes can last for several weeks or even months. A manic episode is characterized by feeling sad, blue, or down in the dumps; loss of joy or interest in things one normally enjoys; and at least four of the following symptoms: 

• Significant changes in sleep patterns
  
• Loss of appetite or overeating
  
• Problems concentrating or making decisions
  
• Feeling slowed down or feeling too agitated to sit still
  
• Feeling worthless or guilty or having very low self-esteem
  
• Loss of energy or constant tiredness
  
• Thoughts of suicide or death
  

Usually, a person experiences a period of mania, and then mania can subside for a while before experiencing a depressive state or vice versa. Bipolar disorder usually begins in adolescence or early adulthood, although it can sometimes begin in early childhood or as late as the 40s or 50s. In the United States, over 1.2% of the adult population suffers from bipolar disorder, which affects more than 2.2 million people.

Mixed Episode

A mixed episode is when an individual experiences symptoms of mania and depression at the same time or alternates frequently during the day. He/she may feel excitable or agitated as in mania but also feel irritable and depressed, instead of feeling on top of the world.

Causes

There is no single proven cause of bipolar disorder, but research suggests that it is often an inherited problem linked to a lack of stability in the transmission of nerve impulses in the brain. This instability in nerve transmission makes people with bipolar disorder more susceptible to emotional and physical stress. If, for example, there is a disruptive life experience or event, the brain's normal mechanisms for restoring cam function do not always work properly.

There are also theories positing that bipolar disorder has a genetic link that predisposes individuals to this disorder. This does not mean that if one of your parents is bipolar, you will have bipolar disorder. Just like other diseases, such as heart disease, a person may inherit a propensity for high blood pressure or cholesterol which makes them more susceptible to heart disease - however, the genetic predisposition on its own is not predetermination of a future health condition.

Types of Bipolar Disorder

• Bipolar Disorder Type I - Characterized by one or more manic or mixed episodes, usually accompanied by depressive episodes.
• Bipolar Disorder Type II - Characterized by one or more depressive episodes accompanied by at least one hypomanic episode.
  

Treatments for Bipolar Disorder

There are three main components to the treatment of bipolar disorders: medication, psychotherapy, and family-focused therapy.

Medication

The two most common types of medication for bipolar disorder are mood stabilizers and antidepressants. Mood stabilizers are used to improve symptoms during acute manic, hypomanic, and mixed episodes. They are used as preventive medicine to maintain a stable mood. However, not everyone responds to medication in the same way; sometimes, multiple types of medication need to be evaluated. Medications used to treat bipolar disorder often include mood-stabilizing medications and some second-generation antipsychotics.

Psychotherapy

Psychotherapy and self-care interventions are essential components in the treatment of bipolar disorder. Most useful psychotherapies generally focus on understanding the disease, learning how to deal with it, and changing ineffective thought patterns. Psychotherapy can help people to identify negative behavioral patterns that may contribute to the disorder and to learn a healthier lifestyle to prevent a full-blown mania or depressive episode. Cognitive behavioral therapy (CBT) is one popular example of psychotherapy used to treat manic disorder.

Family-focused therapy

Family-focused therapy involves family members or friends in supportive roles. They participate by learning about the illness and helping to develop and support the patient's recovery. It is important that the person diagnosed with bipolar disorder and family members learn how best to manage the disorder and prevent its complications. Help from family members and / or friends can provide significant support to the individual in recognizing symptoms of mania and depression, as the individual is sometimes "blinded" by the disorder.

Most people have sometimes felt sad or even depressed, but clinical or severe depression is a serious illness that lasts for more than two weeks and affects a person's mind and body.

Also known as “clinical depression," "unipolar depression" and "unipolar disorder," major depression is a mood disorder that affects all aspects of daily life and robs a person of the joy of life. It causes overwhelming feelings of sadness, hopelessness and worthlessness. Anger, moodiness, difficulty concentrating and indecision are other symptoms of major depression. A person may have thoughts of death or suicide.

Depression also has physical symptoms. Many people cannot sleep well despite feeling mentally and physically exhausted, or they may sleep and eat excessively. They may suffer from crying spells, inexplicable body aches, and loss of interest in previously enjoyable activities.

Depression in Women

Depression symptoms can vary according to gender. Women are twice as likely to develop depression as men. Women with depression tend to sleep more, eat more carbohydrates, and gain weight. Feelings of inappropriate guilt, worthlessness and anxiety are more common in women. They are more likely to develop a seasonal affective disorder (SAD) caused by reduced sunlight during the winter months.

Depression in Men

Men with depression exhibit irritability, hostility and anger. They have tiredness and difficulty concentrating, feel stressed and indecisive. Physical symptoms may include sexual dysfunction and a slowdown in physical movement, speech and thinking. Men with depression may drink too much and act recklessly. As compared to women, men suffering from depression are four times more likely to commit suicide.

Causes of Depression

There is no single cause of depression. It is thought to be caused by a combination of biochemical, hormonal, genetic, psychological, social factors, and even sleep disorders. Depression can begin as a result of loss, such as job loss or death of a friend or family member, but a stressful life event alone does not cause depression.

Diagnosing Depression

Aches and pains are what may bring a person to the doctor, but clinical depression cannot be diagnosed by a laboratory test. A physician can perform tests for other physical ailments, such as hypothyroidism, which can cause similar symptoms. It is important to get a diagnosis, because depression does not improve on its own. It can even lead to heart disease and other serious illnesses due to chemical changes in the body.

Treatment

Depression can be treated with a combination of antidepressants and psychotherapy. Depending on the type of depression, several classes of drugs are available.

For severe cases that do not respond to drug therapy, CHI Health offers Transcranial magnetic stimulation (TMS) therapy. TMS is a newer, non-invasive technology that uses magnetic fields to stimulate areas in the brain that are thought to control mood. These areas are underactive in patients with severe depression.

Seasonal affective disorder (SAD) is a depressive disorder that occurs only at certain times of the year, usually in winter. Also known as winter depression or winter blues, SAD can lead to mood swings that begin with a reduction in daylight. These mood swings are not related to obvious stress-causing events such as seasonal unemployment.

As with other depressive disorders, SAD occurs more frequently in women than in men. Although some children and adolescents develop SAD, it does not normally occur in people under the age of 20.

Seasonal Symptoms of an Affective Disorder

Symptoms of seasonal affective disorder are similar to those of major depression and include:

• Feelings of extreme sadness or emptiness
  
• Hopelessness
  
• Anxiety and irritability
  
• Loss of concentration
  
• Loss of interest in work or pleasurable activities
  
• Increase in sleep
  
• Increase in appetite
  
• Difficulty concentrating
  
• Sluggishness and fatigue
  
• Aches and pains not linked to a specific illness
  

Diagnosis of Seasonal Affective Disorder

There is no single laboratory test or set of tests to detect seasonal affective disorder. Your doctor may refer you to a mental health provider who will diagnose you based on your medical history, current signs and symptoms. A diagnosis of seasonal affective disorder is made after a person has experienced symptoms for two or more years.

Treatment for Seasonal Affective Disorder

Seasonal affective disorder is a depressive disorder that can worsen if left untreated. Psychotherapy, medications and phototherapy, or a combination of the three, can be an effective treatment for seasonal affective disorder.

Light therapy's effectiveness in treating SAD could be related to how light therapy compensates for lost sunlight and helps to reset the body's internal clock. It involves sitting in front of a bright, full-spectrum light box which mimics natural outdoor light.

Self-harm is the act of harming of one’s own body on purpose. It is a mental disorder that affects one in 100 people and usually starts in teen or early adult years. It occurs more often in adolescent females.

Self-harm is known by other names including, deliberate self-harm (DSH), self-injury, self-mutilation and self-abuse.  

People who self-harm feel overwhelmed and use it as an outlet for, or a distraction from their mental distress. They harm themselves as a way of coping with multiple emotions, including: stress, anger, frustration, failure, self-hatred, and past trauma, such as physical and sexual abuse. Self-injury gives them the same emotional release that crying provides for others.

Because they may feel ashamed or afraid of others’ reactions, most people who suffer from it choose to harm areas of the body that are easily hidden by clothing. Since they suffer alone, the stress relief they achieve through the act of self-harm is only temporary. 

When a person commits self-harm, it is not an attempt at suicide. Self harm is done with the purpose of feeling better, while suicide is meant to end all feelings. Self-harm may start as an impulsive act, such as punching a wall. Over time, the behavior escalates and wounds appear more often and in greater numbers.

The most common form of self-harm is skin-cutting (cutting) on the arms and legs, but it includes a wide range of behaviors:

• Scratching
• Punching, banging or hitting body parts
• Burning or branding oneself with hot objects
• Picking at or re-opening wounds
• Hair-pulling (trichotillomania)
• Swallowing toxic substances or objects

Signs and Symptoms

• Scratches that look superficial, but appear regularly
• Making excuses for wounds, such as clumsiness, or cat-scratches
• Wearing long sleeves or long pants (When the weather is warm)
• Spending  a lot of time alone
• Relationship changes
• Changes in school performance
• Expressing  hopelessness, helplessness or worthlessness
• Questioning one’s existence

Diagnosis

There is no specific method for diagnosing self-harm disorder. Its signs usually are discovered by family or friends. A health care provider also may notice signs during a medical exam or when treatment is sought for a wound infection or medical condition resulting from self-harm.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) lists self-harm as a symptom of other disorders. Individuals who self- harm may also have other mental conditions, including: depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia and other personality disorders.

Treatment

A mental health professional with experience in self-harm can evaluate the individual to determine if there is another condition. 

Cognitive-behavior therapy can be used to help identify and analyze dysfunctional emotions, behaviors and thoughts, and replace them with more positive ways of dealing with life. 

CHI Health Psychiatric Associates, with offices in Omaha and surrounding areas, has highly-trained mental health providers who can address the needs of those who suffer from self-harm.