When we talk of mood we are referring to a state of mind or predominant emotion. Most of us have experienced that our moods can change; we may be in a carefree, happy mood when on holiday and when many things have gone wrong we may be irritable or unhappy. This is normal. When we talk of a mood disorder, we are talking about mood changes which are beyond the normal and which affect our ability to function either in our work or studies, or in our relationships.
Mood disorders are divided into two groups: those where we only have a depressed mood and those where we have both a depressed mood and an elevated or very good mood (manic or hypomanic). We will describe the different types of disorders, after discussing some general points which are common to all mood disorders.
Mood Disorders Are Not Chosen
Mood disorders are illnesses. We cannot just snap out of them. You have not done anything to cause a mood disorder. Well-meaning friends and relatives who indicate that you have not tried hard enough or tell you that they do not “believe” in depression, have simply not had the experience of a serious mood disorder.
You may have done unbelievably stupid things during a manic episode; again this is not because you are an irresponsible person. You have done these things because of an illness.
Although you have not caused a mood disorder, you are responsible for managing it properly. Mood disorders often recur. This makes it essential that you learn to manage it. We will indicate some methods for managing mood disorders in this information leaflet; you will learn others in the groups and in consultations with your psychiatrist and psychologist.
What Causes Mood Disorders?
A useful way of looking at the development of mood disorders is to accept that people may inherit the genetic predisposition for a mood disorder (they are born with the possibility of developing a mood disorder), and they start to develop symptoms once they are exposed to extreme stress in life. This stress can be caused by numerous factors, including illness, death, trauma, problems in relationships, financial strain and so on. You will be assisted in trying to understand what has contributed to your having developed a mood disorder.
Diagnosing a Mood Disorder
You will be asked a number of questions about yourself, your life and your symptoms. Be as honest as you possibly can. Psychiatrists and psychologists have probably heard most of it before and cannot be shocked. They will also not be critical of you – judging people does not help solve anything. What you say is confidential and will not be disclosed to anyone without your permission. Withholding information such as drug use, serious problems in relationships, legal problems and so on, can make it more difficult to understand what you are dealing with and at times can influence decisions concerning your treatment.
It is quite common to have other disorders (for example the anxiety disorders) as well as a mood disorder.
The diagnosis which is made, the implications of the diagnosis and your treatment options will be discussed with you.
Major Depressive Disorder
In a major depressive episode, you could be very sad, feel despondent and without hope. It is also possible to be irritable. You may find that you have lost interest in things you used to enjoy and everything is too much effort. Your sleep pattern may be disturbed, as may your appetite. You may feel guilty, feel bad about yourself and find it hard to concentrate. Making decisions can become very difficult. You may have thoughts of suicide or death; you may have plans for committing suicide. You may also find that you are very restless and that you cannot settle down to do anything.
This is long-lasting, low-grade depression. It may feel that it is part of your personality, that you are always more melancholic or gloomy than others. There are also symptoms such as poor appetite or overeating, sleeping too much or sleeping too little, tiredness, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness such as in a major depressive disorder.
Bipolar Mood Disorder
In a manic episode, people have an elevated mood, in other words they feel really good, although some people are more irritable. When someone is manic, they have endless energy and hardly need to sleep. People may experience that their thoughts are racing and that they may speak as though they have to say things very quickly. It can be hard to follow them. Often people are distractible and cannot focus on things. Judgement can be affected and people can do things that are abnormal for them, for example, spend money they do not have. They may believe that they are unique and have grandiose ideas, in other words, believe they are chosen, are going to do things no one else has ever done, and so on. When extreme, people can become psychotic; in other words they lose contact with reality.
Hypomania is a milder form of mania. Functioning is not as badly affected as in mania. In actual fact, people may be more productive than usual. They are optimistic, creative and need less sleep. However, they may still demonstrate poor judgement or become irritable. People who are hypomanic feel good and people may not recognise it as a possible problem.
In a mixed state, the symptoms of mania and depression occur at the same time. For example, you can be tearful during a manic episode or have racing thoughts when depressed.
Bipolar I and Bipolar II
You may hear people referring to bipolar one and two. In bipolar one you experience manic episodes and major depressive episodes which alternate.
In bipolar two, the major depressive episodes are still present, but you have hypomanic episodes.
A much milder form of bipolar mood disorder, cyclothymia often goes undiagnosed. In cyclothymia, the person may experience periods of hypomania and periods of a mild depression.
The Impact of Mood Disorders
Mood disorders have an immense impact on every aspect of our lives. They affect us on a biological level; they affect our emotions and our thoughts, the way we view the world and ourselves in it; they affect our ability to form and keep relationships, how we respond to our families and friends; they affect our ability to work; they affect our lifestyle choices and they affect our spiritual relationship. Mood disorders are serious and should not be left untreated, especially as effective treatments are available.
Treatment of Mood Disorders
Mood disorders can be treated and most people respond well to treatment. Depending on the nature of the illness you have, you may be offered medication, psychotherapy or electro-convulsive therapy (ECT). One way of understanding the treatment is to recognise that we think of a mood disorder as affecting the bio-psycho-social-spiritual elements of a person’s life. We try and address all these aspects. Medication and ECT address the biological aspects of the illness, as does diet and exercise. However, these elements overlap and diet and exercise can also be used to address the social aspects of the illness as eating or exercising with someone can be a pleasurable activity. We address your relationships, both at work and with friends and family. You may be referred to a psychologist to work on the psychological elements of the illness; we also address some of the psychological aspects of the illnesses in the groups. Spiritual counselling is also available.
These options will be discussed with you; you need to know what the particular treatment is expected to do, what problems are associated with it, and whether there are alternatives. You also need a good idea of how successful the proposed treatment is in treating other people with mood disorders similar to yours. The person treating you will be happy to answer questions; please ask them and make sure you understand exactly what is meant.
Depression has a biological component; in other words the functioning of your body is affected by depression. You may, therefore, be prescribed medication. Please make sure that you understand what to expect from the medication you are prescribed. Many of these medications do not give the desired effects immediately and you need to know if this is something you should expect. Medication often has side effects. Most of these are not a problem after a few days or weeks, but if they are really a problem you need to discuss them with your psychiatrist. Medication affects people differently and you need to give your psychiatrist feedback on your experiences.
Please do not just stop medication; it can make your treatment more difficult and it is dangerous to just stop some medications. Some medications have a minimum period for which they have to be taken. Please speak to your psychiatrist and make sure you know for what period you have to take your medication. Make regular follow-up appointments after you are discharged.
Be careful of alcohol and medication – they do not mix well;
Please, no recreational drugs – they really do not mix with medication;
Check with your psychiatrist before you take any natural or traditional remedy;
And using your friend’s medication or giving them yours is a really bad idea.
Electro convulsive therapy (ECT)
ECT is sometimes used when you do not respond to other forms of treatment or when a rapid response is needed, for example when you are a serious danger to yourself. There are many scary stories about ECT, but it is often very effective and can be lifesaving. It can restore your quality of life. There are side-effects; the most common one is short-term memory loss. Your psychiatrist will discuss the benefits and dangers or disadvantages with you in detail if it is recommended for you.
There are a number of approaches that work very well with some of the mood disorders.
You will be assisted to analyse what has contributed to you developing a mood disorder, as well as factors which may be maintaining symptoms. You will be taught skills to address these issues. This can include being taught different ways of thinking, ways of managing problems in relationships, problem-solving skills and so on. Your psychologist will discuss your options regarding what forms of psychotherapy are indicated for you. You will be given indications of how most people with your type of mood disorder respond to the particular approach.
You will also learn more about your illness and how to recognise the development of symptoms before they become a problem, what you can do to try and prevent problems from developing in future.
Moderate physical exercise helps enormously in helping you feel better. It also helps to maintain feeling better. And it has no bad side effects! A sure way to worsen depression is to withdraw from physical activity when you begin to feel bad. You do not have to run a marathon, but try and do some activity such as walking most days. If you are not used to exercise, do not start with anything too strenuous.
Remember to try and eat healthily. Especially when depressed, it is tempting to binge on carbohydrates (for example, bread), but it is not a good idea. Try and stick to a normal good diet of vegetables, fruit, lean protein and complex carbohydrates.
You may also have to make other changes in your life. You may have to renegotiate your working hours and may have to learn how to not take on more than you can comfortably manage.
You may have to make decisions concerning work or relationships that may be adding or causing your mood disorder. You will discuss the timing of these decisions with your psychologist or psychiatrist as it is often not a good idea to make major, life-changing decisions while you still have active symptoms.
The Role of Friends and Family
It is often helpful to tell trusted friends and family that you have been diagnosed with a mood disorder. You will need support once you leave hospital and it is helpful if there are people who can give support. You can share this leaflet with them, so that they can better understand the diagnosis you have been given. You will also have to explain what you need with regards to support. You may be able to find a support group that you and your family can attend. Contact The South African Depression and Anxiety Group (www.sadag.org) for groups in your area.
Note to Family and Friends
A family member or friend who suffers from a mood disorder places enormous demands on people close to them. You may also feel that very little attention is given to you who bears the brunt of your family member or friend’s illness. It is important that you speak to the treating professionals concerning the diagnosis and what to expect. The person with the mood disorder is primarily responsible for managing it; you can assist, you can be supportive, but it is not your responsibility. You cannot make them feel better. You have also not caused the mood disorder. No one has.
When the person you care about has active symptoms, it is good if you show concern. But do not “baby” them. In a family, you may have to take over some duties for a while.
They may say or do things which upset or hurt you. Try and recognise that they have said it because of an illness. You will probably still have to tell them in a calm way, that you do not like what they have said or done.
Take threats of suicide seriously. You will have the emergency numbers of the treating psychiatrist and psychologist. Phone them if you are concerned.
When the person is not experiencing active symptoms, you also have an important role. You can help them be aware when symptoms start.
You can also encourage your friend or family member to exercise, eat healthily, to take their medication as prescribed and attend psychotherapy.
This leaflet gives a brief introduction to mood disorders. You may have many questions after reading it. Please speak to the relevant treating professionals. It is important that you understand your illness and what it means.
Most mood disorders respond well to treatment. Do not be too hard on yourself and accept help from others. Stick to treatment and acknowledge it takes courage to admit you have a problem and to address it.
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