This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Bipolar Disorder NOS (Not Otherwise Specified).

Bipolar Disorder NOS is a part of the bipolar disorder spectrum of mood disorders, which are often also referred to as manic-depressive disorder, manic depression or bipolarism. Bipolar disorder NOS, often referred to as ’sub-threshold’ bipolar disorder, is a kind of ‘catch-all’ diagnosis given to those who, while still showing symptoms of mania and depression, do not fit into any of the formal bipolar diagnostic categories as outlined by the DSM-IV-TR.^[1]

Though the ’sub-threshold’ label might suggest that bipolar disorder NOS is a milder form of bipolar disorder, the condition can still significantly impair and adversely affect the quality of life of the patient.

Symptoms

The symptoms of bipolar disorder NOS can be very broad, and potentially encompass the symptoms of all other forms of bipolar disorder. Therefore, as with other types of bipolar disorder, the symptoms of bipolar disorder NOS may include:

• Mania.
• Hypomania.
• Major depressive disorder.
• Lengthy periods of feeling ‘high’, overly happy or outgoing.
• Irritability, agitation and feeling ‘jumpy’ or ‘wired’.
• Racing thoughts and fast speech.
• Restlessness.
• Insomnia.
• Delusions of grandeur.
• Hypersexuality.
• Impulsive behaviours such as spending sprees or unwise financial choices.
• High-risk behaviours such as careless or dangerous use of drugs or alcohol.

Diagnosis

Bipolar disorder NOS is diagnosed when the symptoms of a bipolar-like disorder are clearly present, but these symptoms do not fit another diagnosis under the DSM-IV-TR.^[1].

The disorder can appear similar to rapid cycling bipolar disorder, and a diagnosis of bipolar disorder NOS may also be given when the sufferer experiences manic or dysphoric mania episodes that appear to be part of a delusional disorder, residual schizophrenia, or a form of psychosis that is difficult to classify.

A diagnosis of bipolar disorder NOS may also be used provisionally, to indicate that while a bipolar disorder seems to be present, there is not yet enough information to make a formal diagnosis of a specific type of bipolar disorder.

Getting Help

Just as with any form of mood disorder, bipolar disorder NOS is a serious medical condition requiring proper medical treatment. If you or someone you know is experiencing a number of the symptoms listed above, it is important that expert medical advice is obtained quickly.

References

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Bipolar II Disorder.

Bipolar II disorder is a part of the bipolar disorder spectrum of mood disorders, which are often also referred to as manic-depressive disorder, manic depression or bipolarism. Bipolar II disorder shares the mood cycles associated with bipolar I disorder, but sufferers of bipolar II experience mania in the form of the milder hypomania, and also have experienced at least one episode of major depressive disorder.

Depressive episodes in bipolar II are more frequent and more intense than episodes of hypomania, and in fact bipolar II may create depression or anxiety so great that the risk of suicide is higher than in those suffering from Bipolar I.^[1]

Symptoms

The symptoms of bipolar II disorder are:

• Hypomania.
• One or more episodes of major depressive disorder.

Diagnosis

Bipolar II disorder can be particularly challenging to diagnose, and the condition is generally underdiagnosed due to hypomanic behaviour being overlooked as a personality trait, or misdiagnosed as an anxiety disorder, sometimes combined with a diagnosis of some form of depression.

This can be dangerous, because if a bipolar II sufferer is prescribed an anti-depressant alone, it can elevate a hypomanic state to a manic one, or even onset periods of rapid cycling bipolar disorder.

In diagnosing bipolar II disorder, the DSM-IV-TR^[2] requires:

• At least one hypomanic episode.
• One or more major depressive episodes.
• No other disorder be responsible for the symptoms.
• The patient has not experienced either mania or dysphoric mania.
• The symptoms cause the sufferer distress, and/or impaired functioning in social, occupational, or other important areas of functioning.

Getting Help

While the hypomanic aspects of bipolar II may be attributed to an energetic personality, the presence of major depressive disorder should act as a warning sign that medical help is needed.

If you or someone you know seems to be suffering from bipolar II disorder, it is important that medical help is sought quickly. The chances of this condition worsening when left untreated are very high, escalating the risk of suicide.

As with bipolar I disorder, bipolar II disorder can be treated. Sufferers who access and maintain treatment can enjoy functional lives.

References

Goldring N, Fieve RR, (1984), Attempted suicide in manic-depressive disorder, American Journal of Psychotherapy

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Bipolar I Disorder.

Bipolar I disorder is a part of the bipolar disorder spectrum of mood disorders, which are often also referred to as manic-depressive disorder, manic depression or bipolarism. Sufferers of bipolar I disorder experience one or more manic episodes, but may or may not experience episodes of major depressive disorder.

The mania or dysphoric mania experienced in bipolar I disorder can be extremely severe and dangerous, while mood swings tend to cause difficulty in work and other relationships, and can interfere in the performance of everyday activities. Sufferers of bipolar I disorder may also experience psychosis in the form of delusions and hallucinations

Bipolar I disorder regularly develops in a person’s late teens or early adult years, with at least half of all cases beginning before age 25.^[1] The disorder can also develop during childhood, or later in life.

Symptoms

The symptoms of bipolar I disorder differ depending upon whether major depressive disorder is also present, in which case some of the symptoms of that disorder can apply. The manic symptoms of bipolar I disorder can include:

• Lengthy periods of feeling ‘high’, overly happy or outgoing.
• Irritability, agitation and feeling ‘jumpy’ or ‘wired’.
• Racing thoughts and fast speech.
• Restlessness.
• Insomnia.
• Delusions of grandeur.
• Hypersexuality.
• Impulsive behaviours such as spending sprees or unwise financial choices.
• High-risk behaviours such as careless or dangerous use of drugs or alcohol.

Diagnosis

A diagnosis of bipolar I disorder usually begins by attempting to rule out other medical causes, or substance abuse which may be causing the symptoms.

Due to some shared symptoms, attempts are often also made to rule out schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other forms of psychosis. Medical tests including blood tests, ultra-sounds of the head and computed axial tomography (CAT) scans are not uncommon.

In the absence of other causes for the symptoms, the DSM-IV-TR^[2] can be used to diagnose bipolar I disorder in a patient who has experienced one or more episodes of mania or dysphoric mania.

Getting Help

While some of the characteristics of bipolar I disorder could just be attributed to an extroverted, outgoing personality, the disorder itself manifests in extremes that are more obvious, and seriously life-affecting.

If you or someone you know seems to be suffering from bipolar I disorder, it is important that medical help is sought quickly. Just as with other mood disorders, the risks of the condition worsening, and the risk of suicide increases the longer the condition goes untreated.

Bipolar I disorder can be treated, and sufferers who access and stick with the treatment can enjoy normal, functional lives.

References

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE, (2005), Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Atypical Depression.

Atypical depression is a type of unipolar disorder, and is a subtype of major depressive disorder and dysthymia, characterised by mood reactivity — being able to experience improvements in mood due to positive events. This contrasts with other forms of depression, where sufferers cannot experience improvements in mood even when good things happen.

Despite its name, atypical depression accounts for up to 40% of people with depression, making it the most common subtype of depression.^[1] Atypical depression also tends to onset earlier in life than other forms of depression, often during the teenage years.

Patients suffering from atypical depression are believed to be more likely to suffer from other psychiatric syndromes such as panic disorder, social phobia, avoidant personality disorder, or body dysmorphic disorder.

Atypical depression may also be linked to thyroid dysregulation, with some studies finding subtle thyroid abnormalities in people with atypical depression, and another study suggesting that patients may benefit from triiodothyronine, a medication used to treat hypothyroidism.^[2]

Symptoms

The main characteristic of atypical depression that distinguishes it from other forms of depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. Other symptoms may include:

• An increase in appetite, often accompanied by significant weight gain.
• Hypersomnia.
• Leaden paralysis (a heavy, leaden feeling in the arms or legs).
• A history of sensitivity to interpersonal rejection resulting in significant occupational or social impairment.

Diagnosis

A diagnosis for atypical depression usually involves blood tests and a medical examination to rule out other causes for the symptoms. Particular attention is often paid to issues concerning thyroid function, due to the possible links between the two conditions.

In diagnosing atypical depression, the DSM-IV-TR^[3] requires that the patient experience:

• Mood reactivity, and
• At least two of the following:
1. Significant weight gain or increase in appetite, or
2. Hypersomnia, or
3. Leaden paralysis, or
4. A long-standing pattern of sensitivity to interpersonal rejection.

Getting Help

Identifying whether you are suffering from atypical depression can be difficult, because many of the symptoms might be considered personality traits, or reactions to difficult times in your life.

Just like major depressive disorder and dysthymia though, atypical depression can develop into a very serious and dangerous form of depression, so if you are experiencing any of the symptoms listed above, you should visit your doctor to discuss how you’re feeling.

References

Nierenberg AA, Alpert JE, Pava J, Rosenbaum JF, Fava M, (1998), Course and Treatment of Atypical Depression, Journal of Clinical Psychiatry

Iosifescu DV, Nierenberg AA, Mischoulon D, Perlis RH, Papakostas GI, Ryan JL, Alpert JE, Fava M, (2005), An Open Study of Triiodothyronine Augmentation of Selective Serotonin Reuptake Inhibitors in Treatment-Resistant Major Depressive Disorder, Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Postpartum Depression (PPD).

Postpartum Depression is a type of unipolar disorder, also called postnatal depression. It occurs most frequently in women, and rarely in men some time within the first year after the birth of a child.

PPD is a form of clinical depression, with symptoms not unlike major depressive disorder. It is most likely to onset within the first few months after childbirth.^[1] Previous research has disagreed on the percentage of woman who will develop PPD, with figures ranging from 5% to 25%, but more recent data suggests the rate to be within the 5-9% range.

One cause of postpartum depression is thought to be the significant changes in a woman’s hormones during and after pregnancy, with another being vitamin deficiencies.^[2] In one study, three major causes of PPD were identified as: formula feeding rather than breastfeeding, a history of depression, and cigarette smoking.^[3]

Symptoms

Due to PPD’s similarity with major depressive disorder, many of the symptoms are common to the two disorders. Symptoms may include:

• Feelings of sadness and hopelessness.
• Low self-esteem.
• Guilt.
• Anhedonia.
• Low levels of energy and exhaustion.
• Increased or decreased appetite.
• Insomnia or hypersomnia.
• Feeling inadequate in taking care of the baby.
• Fears of hurting themselves or the baby.
• Irritability and feelings of anger towards others.
• Decreased sex drive.
• Anxiety or panic attacks.

Less then 20% of women suffering from PPD will seek medical help for the condition, despite the fact that postpartum depression can become serious enough to require hospitalisation. Many women recover due to being involved in a support group, or seeking counseling.^[4]

Diagnosis

Postpartum depression should not be confused with ‘postpartum blues’ or ‘baby blues’, a condition experienced by as many as 80% of new mothers, and characterised primarily by mood swings. These ‘blues’ usually begin a few days after giving birth, and subside within one or two weeks. In cases where ‘the blues’ worsen and continue for longer than a week, postpartum depression may be suspected.

As with seasonal affective disorder, the DSM-IV-TR Diagnostic Criteria does not regard PPD as a separate depressive disorder;^[5] rather the term ‘postpartum’ is used as a specifier to identify a subtype of major depressive disorder or bipolar disorder.

Diagnosis for postpartum depression usually involves blood and other medical tests (to rule out any other causes for the symptoms), as well as some form of depression screening test. When used to diagnose postpartum depression, the DSM-IV-TR considers the postpartum-onset specifier in patients with a depressive onset within four weeks of delivery, and requires:

• A minimum of five symptoms of those listed above, present during the same two week period, and which represent a change from previous functioning.
• One of these symptoms must be either:
1. A highly prevalent depressed mood, or
2. Anhedonia.

Getting Help

Some women feel embarrassed, guilty or ashamed about feeling depressed at a time when they ’should’ be happy. They may even consider themselves unfit parents, but this is simply not true. Postpartum depression can happen to any woman, and it in no way suggests you are a bad mother.

If you feel that your ‘baby blues’ have gone beyond the normal mood swings and one or two week duration, then you need to speak to your doctor or other medical professional about your feelings.

There are many effective treatment options for PPD, and in many cases postpartum depression is entirely preventable with early identification and early treatment.

References

The Boston Women’s Health Book Collective: Our Bodies Ourselves, (2005), New York: Touchstone Books

John L. Beard, et. al, (2005), Journal of Nutrition

Sarah J. Breese McCoy et al, (April 2006), Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature, JAOA

Agency for Health Care Research and Quality, Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Seasonal Affective Disorder (SAD).

SAD is a type of unipolar disorder, often also referred to as winter depression, winter blues, seasonal depression or seasonal mood disorder. It is a depressive disorder which causes people who are typically mentally healthy, to experience depressive symptoms during the winter (and sometimes other seasons), repeatedly and at the same time each year.

A variant of SAD affects people during the summer (and sometimes spring) months, referred to as Reverse Seasonal Affective Disorder (RSAD), or summer-onset depression.^[1]

Seasonal effective disorder is believed to be related to light, one argument for this being the effectiveness of bright light therapy in treating the condition.^[2] SAD is significantly more common in the northern hemisphere where winters are longer and harsher, particularly the Nordic countries and Alaska.

The SAD rate in Alaska is approximately 8.9%, and 24.9% for subsyndromal SAD (‘Sub-SAD’, a minor form of seasonal affective disorder).^[3] In Ireland an estimated 20% of people are affected by SAD, and 10% in the Netherlands^[4], and as with both major depressive disorder and dysthymia, women are more likely to affected by SAD than men.

Surprisingly, in Iceland seasonal affective disorder is significantly less common than in other Nordic countries, and it has been suggested that this may be due to the large amount of fish traditionally eaten by people in Iceland.^[5]

Fish is both high in vitamin D (with another source being sunlight), and also contains docosahexaenoic acid (DHA), which has been shown to help with a variety of neurological dysfunctions.^[6]

Symptoms

The symptoms of seasonal affective disorder can be similar to dysthymia and major depressive disorder, the latter of which many SAD sufferers will also experience during the term of their illness.

Symptoms of the condition can vary depending on the type of SAD being experienced. For winter and autumn seasonal affective disorder, symptoms may include:

• A generally depressed or pessimistic mood.
• Hypersomnia.
• Overeating, and often weight gain caused by a craving for food high in carbohydrates.
• Difficulty concentrating on and completing tasks.
• Loss of energy.
• Withdrawal from friends, family and social activities.

In cases of spring and summer seasonal affective disorder, symptoms may include:

• Anxiety.
• Insomnia.
• Decreased appetite, possibly accompanied by weight loss.
• Irritability.
• Agitation.
• A decreased interest in sex.

In cases of reverse seasonal affective disorder (RSAD), symptoms may include:

• Constantly elevated mood.
• Hyperactivity.
• An increase in social activity.
• A sense of enthusiasm or elation which is out-of-proportion to the situation.

Diagnosis

Seasonal affective disorder is sometimes misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, or other viral infections, so diagnosis often begins with a series of medical tests to rule out these and other conditions that may explain the sufferers symptoms.

According to the DSM-IV-TR^[7], SAD is not regarded as a separate depressive disorder, but rather a ’seasonal pattern specifier’, or subtype of major depressive disorder or bipolar disorder. The seasonal pattern specifier must meet the following criteria for a diagnosis of seasonal affective disorder to be made:

• The presence of depressive episodes at a particular time of year, for at least two years during the same season each year.
• Remissions or mania/hypomania also at a specific time of year.
• No other type of depression, or other medical condition better explains the changes in mood or behaviour.

Getting Help

If you feel you are suffering from seasonal affective disorder, it is important to seek medical help quickly. Seasonal affective disorder, if left unchecked can develop into more-serious depressive disorders, but if identified early the condition has a highly successful treatment rate.

References

Ivry, Sara, Seasonal Depression can Accompany Summer Sun, The New York Times

Lam, RW; Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, Tam EM (2006), The Can-SAD Study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder, American Journal of Psychiatry

Rosen LN, Targum SD, Terman M, Bryan MJ, Hoffman H, Kasper SF, Hamovit JR, Docher JP, Welch B, Rosenthal NE (1990), Prevalence of seasonal affective disorder at four latitudes, Psychiatry Research

Elsevier, Dark Days: Winter Depression

Cott, Jerry; Joseph R. Hibbeln (February 2001), Lack of Seasonal Mood Change in Icelanders (Letter to the Editor), American Psychiatric Association

Horrocks, LA; Yeo, YK (1999) Health benefits of docosahexaenoic acid (DHA), Pharmacological research: the official journal of the Italian Pharmacological Society

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Dysthymia.

Dysthymia is a type of unipolar disorder, also referred to as chronic depression, dysthymic disorder, and sometimes misleadingly as ‘minor depression’, as the effects of dysthymia are not ‘minor’, and can be extremely debilitating.

Unlike major depressive disorder which tends to develop rapidly and dramatically, dysthymia is described as a ‘low grade’ depression. The symptoms of dysthymia tend to infiltrate in such a way that most sufferers of the illness cannot identify when they first became depressed.^[1]

Dysthymia is also a very long-lasting form of depression — persisting for no less than two years by definition of its diagnosis.

Dysthymia is approximately as common as major depressive disorder, though it tends to occur earlier in life, and more than 50% of dysthymia sufferers will eventually have an episode of major depression as well. Like major depression, dysthymia is more common in women than in men.^[1]

Symptoms

Some of the symptoms of dysthymia are shared with major depressive disorder, though dysthymia generally does not cause anhedonia, nor involve psychomotor agitation or psychomotor retardation. Other symptoms may include:

• Feelings of hopelessness.
• Low self-esteem.
• Poor concentration or difficulty making decisions.
• Low levels of energy.
• Increased or decreased appetite.
• Insomnia or hypersomnia.
• Suicidal thoughts.
• Irritability.

Dysthymia sufferers are often able to continue to function in work and social situations, but frequently feel distressed, overburdened and unhappy.

Diagnosis

The chronic but low grade symptoms of dysthymia can make the illness difficult to diagnose. Many sufferers have lived with dysthymia for several years, and simply consider it part of their personality. As a result, the sufferer may not even discuss their feelings and symptoms with their doctor, family or friends. Numerous sufferers of dysthymia are simply never diagnosed, or treated for their illness.

According to the DSM-IV-TR^[2], a diagnosis of dysthymia can be made when:

• The patient experiences a depressed mood for most of the day, for more days than not, for at least two years (in children and adolescents this duration is one year, and the mood can be irritability instead of depression).
• The depression is accompanied by at least two of the symptoms listed above.
• The patient has not been symptom-free for two or more months during the two year period.
• No major depressive episode has occurred during the first 2 years of the disturbance, ascertaining that the condition should not be diagnosed as major depressive disorder instead.

  (Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of major depressive disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode).

• There has never been a Manic Episode, a Mixed Episode, or hypomania, and criteria have never been met for Cyclothymic Disorder.
• The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
• The symptoms may not always result in clinically significant distress or impairment in social, occupational, academic, or other major areas of functioning.^[2]

Getting Help

Perhaps the most important step in getting help for dysthymia is realising and accepting that you may be suffering from the condition. Due to dysthymia’s low grade profile, years of living with the illness may have convinced you that you’re just an unhappy or worthless person — but you’re not.

Chances are that if you feel this way, you need to speak with your doctor, psychologist or psychiatrist about these thoughts and feelings. Once diagnosed, dysthymia can be treated effectively with psychotherapy (counseling), medications such as antidepressants, or a combination of both.

If you believe you know someone who may be suffering from dysthymia, try talking to them about it. Approach the subject tactfully and perhaps provide them with some information on the condition. Remember, they may not know dysthymia even exists, let-alone that the illness may be seriously affecting and reducing the quality of their life.

References

Harvard Mental Health Letter (2005), Dysthymia, Harvard Health Publications

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Major Depressive Disorder.

Major depressive disorder is a type of unipolar disorder, often also referred to as clinical depression, major or severe depression, or unipolar depression. It is probable that when someone is said to ‘have depression’, they suffer from major depressive disorder.

The percentage of people who will experience one or more episodes of major depression during their lives varies by country, from as low as 3% in Japan, to as high as 17% in North America, with a global average occurrence of 8-12%.^[1] The condition is approximately twice as frequent in woman as it is in men, though more men commit suicide as a result of major depression than do women.^[2]

Major depression frequently co-exists with other psychiatric problems, often anxiety (at a rate of around 51%),^[3] the added symptoms of which can delay recovery, and both increase the risks of relapse and suicide.^[4]

Symptoms

Major depression is a serious illness which can negatively impact a sufferers day-to-day functioning, work and family relationships, and general health.

Symptoms of the condition can include:

• Feelings of intense sadness.
• Constant low mood.
• Anhedonia.
• Thoughts and feelings of worthlessness, and overall low self-esteem.
• Feelings of hopelessness, futility and the inability to see any point in activities or life in general.
• Insomnia or hypersomnia.
• A decrease or increase in appetite, with accompanying weight loss or gain.
• Psychomotor agitation or psychomotor retardation.
• Concentration and memory problems.
• Physical symptoms such as fatigue, headaches or digestive problems.^[5]
• Recurring thoughts of death or suicide, either with or without a plan for suicide, or a suicide attempt.
• In severe cases, the manifestation of psychosis.^[6]

People suffering from major depressive disorder often feel that they can never be cured, or return to a normal life. An analogy used by some sufferers is that they feel as if they are sliding deeper and deeper into a black hole, and there’s no way out.

These thoughts can become all-pervasive, worsening the depressive condition, and escalating the risk of suicide.

Diagnosis

A diagnosis of major depressive disorder may be carried out by a general practitioner, psychiatrist or psychologist, and begins by examining the patient’s current circumstances and symptoms, biographical history, and whether or not there is a family history of mood disorders. Attempts are usually made to rule out other medical causes, or substance abuse which may be causing the depression-like symptoms.

There are a number of charts, scales and check-lists for diagnosing major depressive disorder^[7], including the ‘Mental Status Examination’ (MSE) which considers the patients appearance, mood, attitude, behaviour, thought processes and other factors.^[8]

The most common tool for diagnosis however seems to be the DSM-IV-TR.^[6] When used to diagnose major depressive disorder, the DSM-IV-TR requires:

• A minimum of five symptoms of those listed above, present during the same two week period, and which represent a change from previous functioning.
• One of these symptoms must be either:
1. A highly prevalent depressed mood, or
2. Anhedonia.

Getting Help

Getting help for major depression can be extremely difficult, not because help is not available, but because the condition itself can disable the sufferer to the point where actively seeking assistance becomes impossible. Sometimes the depressed person has sunk so far into the ‘black hole’, the only way to begin the climb out is with the care and assistance of family or friends.

If you are suffering from major depressive disorder yourself, and reading this, then there is a good chance you are able to take the first step towards getting the help you need. Contact your doctor or local mental health service, or if that is too daunting or confusing, or you are feeling suicidal, call your country’s emergency services number (911, 000, etc), and let them know you need help. They will help you, and it is ok to ask for help.

If someone you know suffers from or seems likely to be suffering from major depressive disorder, it is imperative that they get help, and they may need you to help them get it. Take the time to navigate the mental health care system on their behalf, and you may literally be saving a life.

References

Andrade L, Caraveo-Anduaga JJ, Berglund P (2003), The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005), Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry

Kessler RC, Nelson C, McGonagle KA (1996), Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey, British Journal of Psychiatry

Hirschfeld RMA (2001), The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care, Primary Care Companion to the Journal of Clinical Psychiatry

Patel V, Abas M, Broadhead J (2001), Depression in developing countries: Lessons from Zimbabwe

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

Sharp LK, Lipsky MS (September 2002), Screening for depression across the lifespan: a review of measures for use in primary care settings, American family physician

Trzepacz, PT; Baker RW (1993), The Psychiatric Mental Status Examination, Oxford University Press

We’ve all felt depressed, down or sad at times in our lives, but usually these feelings are transient, with life returning to normal soon after. Sometimes though, feelings of sadness, hopelessness — or in some cases mania — may worsen and persist for weeks, months or even years, indicating the presence of a depressive disorder, and the need for help.

Depressive disorders are categorised as mood disorders, and there are various types of depression, each with their own symptoms and treatments. In this Depression Symptoms Guide, we’ll examine the characteristics and symptoms of each type of depressive disorder.

Depressive disorders are divided into unipolar disorder and bipolar disorders, based on the way each depressive condition presents. Unipolar disorder indicates the presence of one ‘pole’ of extreme mood, namely that of depression, whereas bipolar disorder identifies two ‘poles’ of extreme mood — those of depression and mania.

The physiological differences between unipolar and bipolar depression are largely unknown (and what little is known is highly contested^[1]) but the variance of either one or two ‘poles’ of extreme mood is accepted in the definitions.

In the Depression Symptoms Guide, we will begin by examining the types of unipolar depression, followed by those in the bipolar spectrum.

Unipolar Depressive Disorders

• Atypical Depression
• Dysthymia
• Major Depressive Disorder
• Postpartum Depression (PPD)
• Seasonal Affective Disorder (SAD)

Bipolar Depressive Disorders

• Bipolar I Disorder
• Bipolar II Disorder
• Bipolar Disorder NOS
• Cyclothymia
• Rapid Cycling Bipolar Disorder

References

Kempton, M.J., Geddes, J.R, Ettinger, U. et al. (2008), Meta-analysis, Database, and Meta-regression of 98 Structural Imaging Studies in Bipolar Disorder, Archives of General Psychiatry

Welcome to A Winter’s Day — I’m glad you’re here to share with me the first post to the website!

Chances are, if you’re reading this then you, or someone you care for suffers from severe depression, bipolar disorder, an anxiety disorder or another related mental illness. Or perhaps you suspect the presence of one or more of these conditions, but just don’t know what to do about it. You may be wondering how to deal with one (or a combination) of these conditions yourself or, if you’re caring for someone with a mental illness, you may be unsure about how best to help them. A Winter’s Day is here to help you.

Suffering from severe depression, bipolar or anxiety can make life extremely difficult, and taking on the role of carer for someone struggling with these conditions can be just as hard. I know all of this from a lifetime of personal experience, and it’s my aim with A Winter’s Day to both help and educate you, to do my best to guide you towards a path of wellness and happiness, one winter’s day at a time.

So Who Am I?

My name is Marc, and for more than twenty years I’ve battled with severe depression, anxiety and bipolar disorder. Though I’m not a medical professional, I’m very familiar with the ins and outs of mental illness. These days I am doing pretty well, but that wasn’t always the case. If you’re interested, go ahead and read the About Me page for the long version of my journey, and the motivation behind A Winter’s Day.

What Can You Expect from A Winter’s Day?

In short, you can expect A Winter’s Day to offer you:

• Help and tips for coping with anxiety, depression, bipolar and mental illness in general;
• Useful research and information about mental illness, and options for treatment;
• A balanced and unbiased view of both ‘traditional’ and ‘alternative’ approaches to treating depression, anxiety and other mental illnesses;
• News and reviews about medications, treatments or products of interest;
• A community of people to chat and share your experiences with via post comments, providing further opportunities to help and be helped by people who may be where you are, where you’ve been, or where you’d like to be in relation to your own mental health.

I enjoy researching and writing, and I plan for A Winter’s Day to become a solid resource for anyone seeking information about depression, anxiety, bipolar, mental illness and health. Just as importantly though, I hope A Winter’s Day grows into a community of people who can help and draw strength from each other, transcending and augmenting my own efforts.

How Can You Get Involved?

At this stage I plan to post two to three times a week, and I’ll be paying close attention to what you want A Winter’s Day to offer you, so please extend your comments, suggestions and feedback — it will be greatly appreciated. You can do this by making use of the ‘leave a comment’ link below, or if you’d prefer to contact me privately, you can use the Contact form.

Another thing you might like to do is subscribe to A Winter’s Day either via RSS, or email. This way you’ll be notified whenever a new post hits the site.

Thanks for reading, and I look forward to seeing you again for the next post on A Winter’s Day!