The Blues or a Mood Disorder?

Some people get depressed during winter because of seasonal affective disorder (SAD), a problem associated with lack of sunlight. Some people are always anxious, often because their brains lack certain chemicals required for optimal function, including mood regulation. Some people just feel blue, and wonder why.

How do you know when you have a temporary mental droop that’s just part of the normal ebb and flow of emotions, or a more serious disorder that requires medical attention?

The Conversation, a website devoted to the collection, examination and public discussion of a wide range of science topics by academics, recently addressed this question.

Psychiatry typically uses two classification systems to define “clinical” from “normal” states of mental angst – the World Health Organization’s International Classification of Diseases and the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM).

In the U.S., most providers rely on the DSM. We’ve written about the most recent update to the latter reference, and the ongoing controversy that is part and parcel of mental disorder diagnosis. As The Conversation notes, these problems aren’t like broken bones; their boundaries can be fuzzy, and the DSM has been criticized for expanding certain boundaries of clinical states into what many experts consider normal health.

But there have to be standards and guides, and for diagnosing, treatment and insurance coverage purposes, the DSM generally is ours.

Clinical depression is diagnosed by many factors including severity, duration, persistence and recurrence. People with more severe depressive disorders often have symptoms such as suicidal preoccupations and grave impairments such as an inability to concentrate and hold down a job. Generally, the problem lasts more than two weeks.

More specific definitions of depression divide into two types – melancholic and nonmelancholic conditions. The latter is fuzzier, involving responses to certain life events, such as being humiliated by a partner or a personality style that predisposes someone to depression. People with this condition might be anxious worriers, very sensitive to judgment by others or perfectionists to a debilitating degree. They might be extremely shy, or have had a low sense of self-worth since childhood.

Melancholic depression is easier to define as a disease. There might be a strong genetic component (maybe a history of suicide in the family). These people might respond only partially to counseling or psychotherapy, but well to antidepressant drugs, because there’s a strong biochemical component.

People suffering from a melancholic depressive state usually lack energy, experience little pleasure in life, are physically lethargic and tend to feel much worse in the morning.

Biopolar disorders are characterized by swings from high to low moods. In the most extreme cases, the highs are called mania, can include psychosis and require hospitalization. Bi-polar patients might feel invulnerable, talk a lot, have a lot of energy and sleep little. They might be extremely creative, spend money lavishly and/or have high, inappropriate sexual appetites.

Anxiety disorders are distinguished from the anxiety we all feel under certain circumstances (giving a speech, attending a social event where you don’t know anyone) by the fact that the anxiety is so persistent it prevents you from doing things you want to do. You might feel extremely anxious for no logical reason.

Generalized anxiety disorder involves chronic worry without a definitive cause; social phobia involves a fear of talking to or being around others.

There are many different anxiety disorders, and it can be difficult to distinguish when normal anxiety starts to become a problem.

So what do you do if you think you need help with the blues, or some variation of them?

Tell someone – a medical practitioner or someone who knows you well – how you feel. There is no stigma about having these experiences. Even the Affordable Care Act’s (ACA) health insurance reform calls for coverage of mental health issues equal to that of physical problems.

But be aware that a being diagnosed with a mood or anxiety disorder can be a stressful experience itself. One’s reaction generally depends on how well he or she relates to the diagnosis, whether the diagnosis is anticipated and whether or not he or she expects a diagnosis and adequate treatment to improve the condition.

The vast majority of conditions, says The Conversation, can be treated, but finding the right treatment can be frustrating. And insurance coverage can be difficult to get.

Mood disorders deserve attention. If you or a loved one is suffering, seek help. See our Child Safety blog, “Recognizing and Treating Anxiety Disorders.” And if you’re worried about a loved one, see our newsletter about suicide – risk factors, warnings and how to help.