Responding to the reasons why people often do not recover from mood disorders, this book empowers readers by providing the tools needed to work effectively with doctors and health care providers to negotiate the complex pathway to a full and lasting recovery from depression or bipolar disorder. It explains the three main barriers to recovery—not receiving treatment, incorrect diagnosis, and receiving inadequate treatment—and how to overcome these challenges to ensure successful treatment. A practical book for the layperson, it provides flowcharts and useful forms to help readers determine whether they need help and how best to collaborate with their medical team.
|Publisher:||Bull Publishing Company|
|Product dimensions:||6.00(w) x 8.90(h) x 0.90(d)|
About the Author
William R. Marchand, MD, is a board-certified academic psychiatrist and neuroscientist who is currently an assistant professor of psychiatry and an adjunct assistant professor of psychology at the University of Utah. He has years of experience treating mood disorders in clinical settings; researching the neurobiology of mood and anxiety disorders, as well as education of mental health providers and the general public; and using functional neuroimaging methods to investigate the causes of anxiety and affective conditions. He lives in Salt Lake City.
Read an Excerpt
Depression and Bipolar Disorder: Your Guide to Recovery
By William R. Marchand
Bull Publishing CompanyCopyright © 2012 Bull Publishing Company
All rights reserved.
Managing Emotional Distress and Thoughts of Self-Harm
This is the most important chapter in the book. One goal is to help you stay safe if you have thoughts of committing suicide or harming yourself, either now or in the future. This chapter will also help you to manage times of emotional crisis and stress. Please read this chapter now. If you are currently in crisis or have suicidal thoughts, the next section provides options for getting help immediately. If you are not experiencing severe emotional distress right now, please read this chapter and complete the stress and crisis management plan (Form 1.1). We all have times of high stress and can feel overwhelmed by emotion. Ann, whom you met in the Introduction, put it like this: "Depression can feel like getting kicked in the stomach. Sometimes I feel hopeless and helpless." Having a plan prepared ahead of time can help you get through those times. It's like having a fire escape plan in place before a fire. It's hard to come up with a good plan when the building is burning. It will take you only a few minutes to develop a plan.
You might want to read this chapter and develop your stress and crisis management plan with a loved one. Others who know you well may be able to make suggestions for the plan that you might not immediately think of. Please read this chapter and make your plan now.
A number of factors can increase the risk of suicide among those with mood disorders. Some of these risk factors are listed in Table 1.2. Many of these factors are not difficult to understand. For example, it makes intuitive sense that someone who is experiencing both a mood disorder and a serious medical illness might have increased stress and thus an increased risk of thinking about suicide. For other factors, such as having been born in spring or summer, the relationship to suicide risk is not well understood.
In addition to the risk factors listed in Table 1.2, there is evidence of a vulnerability to suicide that is independent of having a mood disorder. What does that mean? Evidence indicates that a trait-related predisposition to suicide exists that has a significant heritable component. A primary candidate for this susceptibility is the trait of impulsivity. In addition to suicide risk, this trait may be associated with risk of nonsuicidal self-injury. Impulsivity means a tendency to do things or make decisions rapidly without thinking through the possible consequences. We all can be impulsive at times, but some people tend to be impulsive more frequently than others. Impulsivity may cause someone who is having thoughts of suicide to be more likely to act on those thoughts than a person who is less impulsive. If you or a loved one with a mood disorder tends to be impulsive, there could be a higher risk of suicide. If so, please complete the stress and crisis management plan (in the next section) now and discuss prevention strategies with your treatment team.
I want to be sure that one thing is clear. Having a mood disorder along with one or more of these risk factors does not mean that any individual will have thoughts of suicide or attempt self-harm. It just means that statistically there is some increase in risk. From a practical standpoint, if you have risk factors, then it is imperative that you do everything in your power to stay safe. Part of that process is seeking professional treatment. However, the following section provides an exercise to guide you in the process of developing a stress and crisis management plan.CHAPTER 2
DMood Disorders and the Diagnostic Process
As the title suggests, this chapter explains what mood disorders are and how these conditions are diagnosed. I have included a lot of information about the diagnostic criteria for mood disorders. My goal is to provide this material as a ready reference for you. For example, if a member of your treatment team says she thinks you have dysthymic disorder, you can quickly look it up. I certainly don't think you need to commit any of this to memory or even read the information that doesn't apply to you. In contrast, the description of how mood disorders are diagnosed is very important. As you will see, an accurate diagnosis requires good communication between you and the person doing the evaluation. Understanding how the diagnostic process works can help you provide the right information.
The term mood refers to one's emotional state, and mood disorders are primarily disorders of emotion. However, mood disorders also cause other symptoms, such as changes in energy level, appetite, and sleep. They can also dramatically affect how we think and even what we think about. But the defining characteristic of a mood disorder is a disturbance of emotional functioning. So, we'll start there.
We all experience a range of emotions every day. Roughly speaking, we can categorize our feelings as generally being either positive or negative. Obvious positive emotions are happiness, hope, and compassion. Negative feelings include anger, disappointment, and embarrassment. Being human means experiencing positive and negative mood states. But what distinguishes a normal mood from a disorder? Broadly speaking, a mood disorder exists when two basic conditions are met: (1) the mood state is abnormal and (2) the symptoms of the mood state are causing significant distress or impairment.
Although actually determining whether someone has a mood disorder is a bit more complicated (much more on that later in this chapter), it is important to start with these two basic criteria. So, what is an abnormal mood state? This is defined as either too much or too little emotion. "Too much" (or "too little") can refer to either intensity or duration. For example, the term depression, as used in the context of psychiatric disorder, means either excessive sadness or sadness that lasts for too long. Both intensity and duration are excessive in persons who have mood disorders. The other basic criterion is that some (or all) of the symptoms are causing significant distress or impairment. Before I move on, it is important to note that mood disorders are sometimes called "affective" disorders. The terms mood disorder and affective disorder are used interchangeably. Affect also refers to one's current experience of emotion. Technically speaking, affect refers to one's immediate emotional state, while mood means a more sustained period of a particular mood. A good analogy is that affect is like weather while mood is like climate.
The most accepted definitions of mood disorders are those listed in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Those definitions are used in this book unless otherwise noted. More about this manual later — for now just know that is the reference for the following discussion.
Mood disorders come in two basic varieties: unipolar and bipolar. Bipolar disorders are sometimes referred to as manic-depressive disorders; however, this terminology is used less frequently nowadays. Unipolar disorders cause abnormalities of mood intensity in only one direction or toward one "pole" of the emotional continuum. The depressive disorders are unipolar because they cause abnormalities only on the depressive end of the emotional range. In contrast, bipolar disorders result in both mood elevations and depressions and are thus "bi"-polar. You may notice that I used the plural word disorders for both conditions. This is because there is more than one disorder in each general category. These disorders are thought to represent a range from more to less severe (for example, from mild to severe depression) expressions of the same basic condition along the continuum. Thus, mood disorders are commonly referred to collectively as "bipolar spectrum" or "unipolar spectrum." That convention is used in this book, and disorders are generally referred to as either bipolar spectrum or unipolar spectrum.
Individuals with depressive disorders experience one or more episodes of depressed mood. Those with bipolar disorders have episodes of both mood depressions and elevations. So, what exactly are mood depressions and elevations anyway? The concept of depressed mood is straightforward. Feeling depressed is simply another way to say that one is sad, down, or blue. This is easy to understand because we all feel sadness as a normal life experience whether we have had a depressive disorder or not. The feeling may be the same, but the intensity and duration are greater for depression than for normal sadness. You may remember Ann from earlier in this book. She is fifty-five and has had depression since she was a child. Ann described the intense sadness of depression as feeling like she has been kicked in the stomach.
Mood elevations are bit trickier to understand because most people who do not have a bipolar disorder don't experience an abnormally elevated mood to any appreciable extent. The closest most people come is likely to be feeling very excited or giddy from time to time. Episodes of elevated mood associated with the bipolar spectrum disorders are referred to as mania or, if a milder form, hypomania. Manic and hypomanic episodes are generally characterized by excessive elation, known as euphoria. However, please be aware that mania and hypomania can cause irritability rather than euphoria. Since the concept of mania may be unfamiliar, some additional reading may be informative. For an authentic and courageous personal account of the experience of living with bipolar disorder, I strongly recommend An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (see Appendix C, Recommended Reading). Dr. Jamison is a Professor of Psychiatry at the Johns Hopkins University School of Medicine. She also has bipolar disorder. She tells a compelling and highly intimate story from the unique perspective of a mental health professional who suffers from a mood disorder.
In addition to causing problems with emotion, mood episodes cause other kinds of symptoms as well. These are outlined in Tables 2.1 and 2.2.
Many depressive episodes don't result in all of the symptoms described in Table 2.1, but a minimum number is required to make the diagnosis (more about this later). There are also other symptoms commonly associated with depression, such as anxiety, that are not listed in Table 2.1. Those symptoms that are listed constitute the "official" criteria in the Diagnostic and Statistical Manual of Mental Disorders.
Symptoms associated with mood elevations are listed in Table 2.2. As with depressive episodes, most people don't experience all of the listed symptoms during each manic or hypomanic episode. However, all mood episodes have a minimum number of symptoms that must be experienced during an episode in order to meet the "official" criteria. Additionally, symptoms must persist for at least a minimum specified time period. These details are covered in the next section. The limitations of the "official criteria" are also discussed later in this book.
The importance of the different categories of information varies greatly with the illness or disease process. For an injured arm, the most important information may be an X-ray to determine whether there is a fracture. For possible diabetes, blood glucose tests may be most important. For mood and all psychiatric disorders, the clinical history is most important.
The ideal diagnostic method is one that is objective (that is, not subject to different interpretations by different people) and definitive (gives a definite yes or no answer). In our example of an arm injury, an X- ray may provide both objective and definitive evidence of a fracture. In fact, it may be so obvious that anyone would be able to make the diagnosis — no medical training required! Unfortunately, many diagnostic tests are not so precise. Still, for most medical conditions some diagnostic tests can be helpful. In contrast, there are currently no objective laboratory diagnostic tests or procedures that can be used to diagnose mood disorders. Therefore, the diagnostic process must be based almost entirely on history. In this case, history means your mood disorder history. That is why it is so critical to provide accurate and detailed information during a diagnostic evaluation to prevent misdiagnosis. In most cases, that requires some preparation, and this is especially true if the history is complicated. Part of this book is about gathering that information and helping you prepare for a diagnostic evaluation.
Before moving on, you need to know that diagnostic tests and a physical examination can be critical components of a diagnostic evaluation and in many cases are necessary (more about this later). However, the purpose is not to diagnose a psychiatric disorder, but rather to rule out other conditions that might be causing the symptoms. For example, hypothyroidism can cause symptoms that are similar to depression, and it may need to be ruled out. A physical exam and laboratory tests may also be useful to monitor treatment in some cases (see Chapter 8). Finally, psychological testing is often an important component of any assessment process.
Now you may be wondering why there are no laboratory diagnostic tests for mood disorders. Why can't we just draw some blood or do a brain scan and say, "Oh, that is definitely bipolar disorder"? The answer has to do with the complexity of the human brain. One great thing about being a member of the human race is our amazing intellectual and language capabilities. Our ability as a species to accomplish so many things is a direct result of our complex brains. However, our brains are so complex that it is very challenging to understand human brain function. It is even more difficult to understand many brain disorders, such as psychiatric conditions. We do know a lot and that information is presented in detail in Chapter 4. But, for now, the key point is that mood disorders are diagnosed based on what you tell your mental health or medical provider. So, it is essential that you get it right.
You now know that the history is the main component of a diagnostic evaluation. But how do we take that information and decide whether it means that you have a disorder and, if so, then which disorder? Mood disorders are defined by a set of criteria. Most criteria are symptoms. A symptom is something you experience, like chest pain or a toothache or sadness. Other criteria can be such things as how long you have experienced the symptoms and how much distress the symptoms cause. We'll take a detailed tour through the diagnostic criteria for mood disorders in a few pages. But first some more background information.
As mentioned above, the diagnostic criteria for psychiatric disorders are defined in a book known as the Diagnostic and Statistical Manual of Mental Disorders or, as it's commonly known, the DSM. The current version is the fourth revision, so it is referred to as the DSM-IV. Another tidbit — this version has a minor text revision, so it is also called the DSM-IV-TR, with "TR" standing for text revision. I refer to the DSM-IV frequently in this book, so it will be helpful for you to know a bit about it. Before we move on, though, it is important to note that there are other classification systems, such as the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The ICD-10, as its commonly known, is a classification system of the World Health Organization. I refer to the DSM in this book because it is most commonly used in the United States.
First of all, the DSM isn't some kind of secret manual available to only psychiatrists and other mental health professionals. It is readily available to the public, and you can find it for sale in many bookstores and online. I'm not recommending that you purchase the DSM; my point is to make you aware that it is readily available. The American Psychiatric Association, the national organization for physicians specializing in psychiatry, publishes the DSM-IV. It outlines the diagnostic criteria for all psychiatric disorders. Additionally, it provides supplementary information about disorders, such as familial pattern or inheritability, other disorders that may be similar, and the prevalence and course of illness. The DSM is written by prominent psychiatrists and other mental health professionals based on the evidence suggesting how psychiatric disorders should be defined. It is updated periodically as new information becomes available. The DSM is the gold standard for defining mood disorders. However, it is important for you to know about its limitations.
Excerpted from Depression and Bipolar Disorder: Your Guide to Recovery by William R. Marchand. Copyright © 2012 Bull Publishing Company. Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Chapter 1 Managing Emotional Distress and Thoughts of Self-Harm,
Chapter 2 Mood Disorders and the Diagnostic Process,
Chapter 3 Do You Have a Mood Disorder?,
Chapter 4 Mood Disorders: Facts and Causes,
Chapter 5 How and Where to Find Help,
Chapter 6 Collaborating with Your Team,
Chapter 7 The Diagnostic Evaluation,
Chapter 8 Medication and Other Biological Treatments,
Chapter 9 Psychotherapy,
Chapter 10 Complementary Approaches to Recovery,
Chapter 11 Starting Treatment,
Chapter 12 Special Considerations for Women,
Chapter 13 Getting Well: The Acute Phase of Treatment,
Chapter 14 Maintenance Treatment and Relapse Prevention,
Appendix A. Resources for Getting Help,
Appendix B. Useful Websites,
Appendix C. Recommended Reading,