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Outline - Chapter 3: Mental health problems

• Why do people develop mental health problems?
• Mental health disorders
  • Anxiety
  • Mood
  • Psychosis
  • Impulsivity
• Personality disorders

In this section:

• Major depressive disorder
• Bipolar disorder
• Hypomania
• Depression

Ordinarily, people experience a wide range of moods. They feel more or less in control of their moods. When the sense of control is lost, people experience distress. Those with an elevated mood (mania) can experience expansiveness, racing thoughts, decreased sleep, exaggerated self-esteem and grandiose ideas. People with depressed mood (depression) can have symptoms such as a loss of energy and interest, feelings of guilt and difficulty concentrating.

Major depressive disorder

Prevalence

Between 15 and 20 per cent of women and between 10 and 15 per cent of men will experience a major depressive episode in their lifetime.

Symptoms

A person who is experiencing at least five of the following symptoms meets the criteria for a diagnosis of a major depressive episode:

• Depressed mood: A depressed mood is much different from sadness. In fact, many people with depression say they cannot feel sadness, and many people cannot cry when depressed. Being able to cry again often means the depression is improving.
• Loss of interest or pleasure: At the start of depression or with mild depression, people can still enjoy and be distracted by pleasurable activities. When people are severely depressed, they lose these abilities.
• Weight loss or gain: Many people lose weight when depressed, partly because they lose their appetite. However, some people feel hungrier and may develop a craving for carbohydrate-rich foods. This causes them to gain weight. Depending on the type of depression, a person's metabolism may speed up or slow down. This can also cause weight loss or gain.
• Sleep problems: Sleep problems are common in depression. Many people have insomnia. They have trouble falling asleep, wake up often during the night, or wake up very early in the morning. They do not find sleep to be restful and may wake up feeling exhausted. Others may find that they sleep too much, especially during the day. This is called hypersomnia.
• Physical changes: For some people with depression, their movements, speech and/or thinking slows. In severe cases, they may be unable to move, speak or respond. With other people, the opposite happens. They become agitated and cannot sit still. They may pace, wring their hands or show their agitation in other ways.
• Loss of energy: People with depression find it difficult to complete everyday chores. It takes them much longer to perform tasks at work or home because they lack energy and drive.
• Feelings of worthlessness and guilt: When depressed, people may lack self-confidence. They may not assert themselves and may be overwhelmed by feelings of worthlessness. Many people cannot stop thinking about past events. They obsess about having let others down or having said the wrong things, and they feel guilty. In severe cases, the guilt may cause delusions. (See “Psychotic symptoms,” three bullets below.)
• Inability to concentrate or make decisions: People may not be able to do simple tasks or make decisions on simple matters.
• Suicidal thoughts: People with depression often think that life is not worth living or that they would be better off dead. There is a high risk that they will act on these thoughts. Many people do try to kill themselves when depressed.
• Psychotic symptoms: These may include false beliefs, such as believing they are being punished for past sins. People with psychotic symptoms may believe that they have a terminal illness, such as cancer. They may also hear voices that are not there (auditory hallucinations).

Other symptoms may include:

• oversensitivity and preoccupation with oneself
• negative thinking
• little response to reassurance, support, feedback or sympathy
• less awareness of other's feelings because of one's own internal pain
• feeling a need to control relationships
• inability to function in a normal role.

Course

A first episode of depression can occur anytime in a person's life.

Most people struggle for long periods with the symptoms before seeking mental health intervention. They may have undergone several stressful events, and have tried to manage their mood fluctuations, only seeking help when they experience serious difficulties coping at home, at work or in important relationships.

A person may be diagnosed as having had a “single episode” (meaning that this is the first time he or she has experienced a major depression) or “recurrent episode” (meaning that the person has experienced at least one previous episode of major depression). Different episodes may vary in severity: some episodes may be minor and have less impact on a person's ability to function, while others may be more severe and result in significant disruption to a person's life.

Bipolar disorder

Prevalence

About one to two per cent of the population will develop a bipolar disorder in their lifetime.

Symptoms

There are three major groups of symptoms related to bipolar disorder. These are mania, hypomania and depression.

Mania

If a person's mood is abnormally or persistently high for at least one week, he or she may be in a manic phase of the illness. However, not everyone who enters the manic phase feels euphoric. Some people may feel extremely irritable, behave rudely or become angry, disruptive and aggressive. They can be very impatient with others and make hurtful statements or behave impulsively or even dangerously.

In addition to mood symptoms, people must have at least three of the following symptoms to a significant degree to be diagnosed with bipolar disorder:

• exaggerated self-esteem or grandiosity
• reduced need for sleep
• increased talkativeness
• a flood of ideas or racing thoughts
• speeding up of activities such as talking and thinking, which may be disorganized
• poor judgment
• psychotic symptoms such as delusions (false beliefs) and in some cases hallucinations (mainly hearing voices).

Mania causes people to be emotional and react strongly to situations. For people with poor anger management skills or with low tolerance for frustration, this can lead to violent behaviour.

Hypomania

Hypomania is a milder form of mania with less severe symptoms. However, symptoms can interfere with the person's ability to function. We now recognize that hypomania has more impact on a person's life and relationships than was previously recognized.

Depression

Depressive episode symptoms are described earlier in this chapter, in the “Major Depressive Disorders” section.

Bipolar I disorder

Some people experience mania or depression, or both, in addition to well phases during their illness.

Bipolar II disorder

Some people experience hypomania, depression and phases without symptoms—with no full manic phases.

Course

The manic/hypomanic, depressive and mixed (both manic/hypomanic and depressive) states usually do not occur in a particular order. How often they occur cannot be predicted. For many people, there are years between each episode, whereas others have episodes more often. Over a lifetime, the average person with bipolar illness experiences about 10 episodes of depression and mania/hypomania or mixed states. As the person ages, the episodes of illness come closer together. Untreated mania often lasts for two or three months. Untreated depression usually lasts longer, between four and six months.

One in five people with bipolar disorder have four or more—sometimes many more—episodes a year and have short phases without symptoms. This is called rapid cycling, and is a subtype of bipolar disorder for which people need specific treatment. The cause of rapid cycling isn't known. Sometimes, it may be triggered by antidepressants, but how this happens is not clear. In some cases, stopping the antidepressant may help the person return to a “normal” cycling pattern.

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