In DSM 5, mood disorders are now being re-classified as Depressive Disorders & Bipolar and Related Disorders.
- Depressive Disorders:
The feeling of ‘sadness, emptiness or hopelessness’ is described as depressive mood.
A feeling of ‘hopeless’ alone is enough to meet the criterion for depressive mood.
‘Hopelessness’ is considered as a risk factor for suicide.
Generally speaking, Depression is a more familiar and common term people used when their feelings are characterized by having low mood, losing concentration, sleeping many hours still feeling tired, feeling unmotivated and lack of energy, losing appetite, losing interest in once pleasurable activities, and having tendency to think negatively.
1.a Major Depressive Disorder, Single and Recurrent Episodes
The presence of a depressed mood that includes some or all of the symptoms aforementioned and that it persists for at least two or more weeks. Episodes may be isolated or recurrent and are categorized as mild, moderate, or severe.
Case Example: Kyle, twenty-five years old, has been on social assistance for six months since his unemployment insurance benefits ran out. He came across as an individual who some people may label him as a ‘welfare bum’. When Kyle met with his counsellor, he was immediately identified having symptoms of depression which are reflected from his behaviours of not being motivated, getting up until noon, showing no interests of anything included visiting his friends and family, and having complaints about losing appetite, not sleeping at night and feeling tired easily, etc.
1.b Persistent Depressive Disorders (classified as Dysthymia in DSM 4)
Symptoms similar to those characterized for depressive mood but to a less degree of intensity, and patients often maintain this low level of depressive mood for two or more years. It involves a low or irritable mood, a decrease in pleasure, loss of energy, persistently feeling sad and unmotivated. Sleeping is an issue, either sleep too much or having trouble sleeping.
Case Example: Mary works for a mid-size unionized trading company as one of the secretaries. She often calls in sick a few times a month. She and her department manager have had many discussions around her absenteeism. Mary sought counselling as part of her performance review. She stated that her manager was offering her a position in which she will work with another junior secretary as each other’s back-up to ensure her absenteeism will not affect the office’s daily functions. Mary indicated that she does not see the arrangement is necessary, because she is performing alright even though she constantly feels a low level of energy, sad and easily irritable for nearly three years. She also indicated that she has trouble sleeping and does not see anything that will make her feel good.
1.c Postpartum Depression (In the current DSM 5, it is classified as Bipolar or Depression with Peripartum Onset)
Diagnosis is given when the depressive episodes occurs before or after the birth of the person’s child.
Peripartum Onset refers to depressive episodes begin prior to delivery.
Symptoms of Postpartum Depression are as follows:
Depressed mood or severe mood swings, excessive crying, difficulty bonding with your baby, intense irritability and anger, inability to sleep or sleeping too much, withdrawing from family and friends, overwhelming fatigue or loss of energy, loss of appetite or eating much more than usual, reduced interest and pleasure in activities you used to enjoy, fear that you are not a good mother, feelings of worthlessness, shame, guilt or inadequacy, thoughts of harming yourself or of giving up your child, recurrent thoughts of death or suicide, diminished ability to think clearly, concentrate or make decisions, and severe anxiety and panic attacks.
Case Example: Joan is a high achiever who holds a full time job as an IT consultant, and she also works as a fund raiser for a non-profit organization on her spare time. Joan recently gave birth to her first child. A week or two after the delivery of her daughter, she started to feel losing patience and energy to care for her baby. Joan also began feeling sad and irritable for no reasons. She at times having thoughts of harming herself or giving her baby up for adoption. Joan’s husband and extended family are very concerned, but they thought she may overcome these difficulties since she is always a very strong person. Unfortunately, Joan one day broke down and cried hysterically. At that point, Joan’s family realized that she needed medical attention.
Note: there is a difference between having postpartum depression and having symptoms of ‘baby blue’.
People having ‘baby blue’ will show some signs of postpartum depression but these symptoms may only last for a few days to a week or two after the baby is born.
They generally do not have thoughts of self-harm or harming the baby, withdrawing from family and friends, or fear of not being a good mother and of doubting own worthiness.
- Bipolar and Related Disorders
Bipolar disorders are characterized by dramatic and unpredictable mood swings, and it often manifested with episodes of depression and mania. There are two types.
Bipolar I Disorder:
A person with Bipolar 1 has manic episodes which are characterized by extremely abnormal mood and an increasingly abnormal level of activity and energy. Mania may include psychotic symptoms, such as delusions or hallucinations. When a person is going through a mania episode, his/her daily functioning is significantly impaired.
Case Example: David left his office and went straight to the airport to board on a plane to New York City instead of going home as usual. It was not a flight he planned for. His family filed for a missing person after 24 hours of not seeing him shown up at home. Five days later, police phoned David’s family informing that David was found living in a hotel in the central district of New York City.
Bipolar II Disorder
People with Bipolar II has hypomanic episodes in which a person has a sustained mood that is elevated (heightened), expansive (grand, superior) or irritable. This mood has to be noticeably different from his or her normal mood when not depressed. Hypomania does not have psychotic symptoms. When a person is going through a hypomania episode, he/she may still be able to carry out his/her daily functions with only a certain degree of interference.
Case Example: Susan one day started singing in front of her colleagues during a lunch break. She sang for a few minutes, walked away and returned to her desk to work. Her behaviour was considered as very unusually, because she is known as a very shy and private person in her office. Several similar episodes occurred in the following few days. Thereafter, Susan started to experience symptoms of depression.
A person with bipolar II may experience hallucinations or delusions during depressive episodes without the diagnosis changing to bipolar I. Bipolar II disorder is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported.
DISCLAIMER: Description of each of the mental issue is intended for a quick reference only. You are advised not to use it for self-diagnosis. If you have concerns about your mental health conditions, you are advised to seek medical advice from your family doctor or from a psychiatrist. If you already have a confirmed diagnosis of a mental health issue and you are considering counselling as an alternative treatment, you are encouraged not to stop taking medications without discussing and consulting with your family doctor or psychiatrist. Please also mention to your medical professionals about seeking counselling if you can.