Depression & Bipolar Disorder

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We all experience changes in our mood. Sometimes we feel energetic, full of ideas, or irritable, and other times we feel sad or down. But these moods usually don’t last long, and we can go about our daily lives. Depression and bipolar disorder are two mental illnesses that change the way people feel and make it hard for them to go about their daily routine.

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Depression is a mental illness that affects a person’s mood—the way a person feels. Mood impacts the way people think about themselves, relate to others, and interact with the world around them. This is more than a ‘bad day’ or ‘feeling blue.’ Without supports like treatment, depression can last for a long time. Signs of depression include feeling sad, worthless, hopeless, guilty, or anxious a lot of the time. Some feel irritable or angry. People lose interest in things they used to enjoy and may withdraw from others. Depression can make it hard to focus on tasks and remember information. It can be hard to concentrate, learn new things, or make decisions. Depression can change the way people eat and sleep, and many people experience physical health problems. Age and sex can also impact how people experience depression. Males often experience anger or irritability rather than sadness, which can make depression harder for others to see. Young people and older adults may experience lasting changes in mood that are mistakenly dismissed as a normal part of growing up or of aging.

Bipolar disorder is another mental illness that affects mood. With bipolar disorder, people experience episodes of depression and episodes of mania. An episode of depression in bipolar disorder is the same as other types of depression. Mania is an unusually high mood for the person. People may feel like their thoughts are racing and may feel hyperactive. They may feel unrealistically confident, happy, or very powerful. Many people don’t sleep much when they experience mania. They may act without thinking and do risky things they wouldn’t normally do. People usually experience periods of wellness between episodes of depression or mania. Episodes of depression or mania generally last for a period of time, though a small number of people may experience episodes that change quickly. The frequency and type of episode can also vary greatly. For example, some people experience many episodes of depression with only a few episodes of mania. Others experience long periods of wellness with only a few episodes of depression or mania during their lifetime.

Depression and bipolar disorder can affect anyone. They are likely caused by many different factors that work together, including family history, biology, the environment, life experiences, personality, and physical health problems. Mood disorders are conditions that cause people to feel intense, prolonged emotions that negatively affect their mental well-being, physical health, relationships and behaviour. Almost 10 per cent of Canadians experience a mood disorder at some point in their lives. While we can all have brief episodes of “highs” and “lows”, we generally do not experience extreme, extended swings in our emotions. An internal sense of control tends to moderate big mood swings and stabilize our ups and downs.

A combination of factors can make a person more susceptible to depression. These include a physical illness; certain medications; stress; biochemical imbalances in the brain, hormones or immune system; and a pre-disposition towards a negative view of life. A family history also seems to contribute towards the likelihood of someone developing a clinical depression.

It is not known what causes bipolar disorder although research indicates that a genetic predisposition may contribute to the condition since it tends to run in families. Substance abuse (alcohol and drugs) and stress may also contribute to its development.

A major depressive disorder – usually just called “depression” – is different than the “blues”. Someone experiencing depression is grappling with feelings of severe despair over an extended period of time. Almost every aspect of their life can be affected, including their emotions, physical health, relationships and work. For people with depression, it does not feel like there is a “light at the end of the tunnel” – there is just a long, dark tunnel.

Symptoms of Depression

If you (or someone you know) have some of the following signs for more than several weeks, you may be experiencing a depressive illness. Symptoms include:

  • Loss of interest and a lack of pleasure in activities, including sex;
  • Withdrawal from social situations;
  • Ongoing feelings of sadness, anxiety, worthlessness, hopelessness, guilt;
  • Changes in appetite, or an unexplained fluctuation in weight;
  • Lack of energy, complaints of fatigue;
  • Sleep disturbances (insomnia or excessive sleeping);
  • Loss of focus, decreased concentration, forgetfulness;
  • Complaints of physical ill health with no identifiable cause;
  • Thoughts of suicide.

Some people have a mood disorder known as dysthymia. Dysthymia is a long-term condition which causes a mild, ongoing depression that can last for at least two years. Someone experiencing dysthymia tends to have symptoms that are less severe than that of someone with a major depressive illness, however they still have trouble coping with their day-to-day functions because of their disorder. At the other extreme, some people can experience what is known as a psychotic depression, where delusions or hallucinations occur in addition to the symptoms listed above.

Depression in Disguise

Sometimes people who are depressed don’t show signs that are considered “typical”. For example, men may have extended periods of irritability or anger rather than sadness. These symptoms don’t come across as depression, making diagnosis more difficult. Children who are depressed may complain of sickness, avoid school or be extremely reluctant to leave a parent. They may come across as angry, uncooperative or anti-social. Unfortunately it can be difficult to separate a child’s clinical depression from a “phase” and parents might consider the behaviour to be “normal”. On the flip side, society often regards depression in older adults as “normal”; this cannot be further from the truth. It is not normal for older adults to have ongoing feelings of grief and hopelessness.

In addition to feelings of depression, someone with bipolar disorder also has episodes of mania. When people are experiencing manic periods, they exhibit symptoms that include:

  • Extreme optimism, euphoria and feelings of grandeur;
  • Rapid, racing thoughts and hyperactivity;
  • A decreased need for sleep;
  • Increased irritability;
  • Impulsiveness and possibly reckless behavior.

Depression and bipolar disorder can be very challenging. Many people blame themselves for their feelings or wonder why they can’t just ‘get over it.’ Some feel like they have to live with difficult feelings because they worry about what others will think if they ask for help. The symptoms of the illnesses themselves can make it hard to seek help. Depression and bipolar disorder are real illnesses, and they deserve care and support. People can and do recover. Just like any other disease, mental illness responds better to early identification and treatment. Depression, in particular, responds very well to treatment.

Don’t let the stigma of mental illness – yours or that of others – prevent you from getting the help that is required. You would not hesitate to go to your doctor for a broken leg; seeking help for depression is no different. If you or someone you know is showing signs of depression or bipolar disorder, talk with your family doctor. People can take the following steps to help prevent the recurrence of a mood disorder or at least, minimize its impact:

  • Counselling and support – A type of counselling called Cognitive-behavioural Therapy (CBT) is common for mood disorders. It teaches you how your thoughts, feelings, and behaviours work together. It also teaches important skills like solving problems, managing stress, realistic thinking, and relaxation. CBT is often the first treatment to try if you experience mild or moderate problems with depression.
  • Support Groups – Support groups are also very important. Depression and bipolar disorder can isolate people from others, and isolation can add to mood problems. Support groups are a safe place to share your experiences, learn from others, and connect with people who understand what you’re going through.
  • Well-being – Taking care of your well-being is especially important if you’re working through recovery, but this can be easy to overlook. Regular exercise can boost your mood and help you manage stress. Eating well and learning or maintaining healthy sleep habits are also very helpful. It’s always important to spend time on activities you enjoy, find relaxation strategies that work for you, and spend time with loved ones. Avoid drinking caffeinated beverages as they tend to increase anxiety, and minimize alcohol intake as it is a depressant.
  • Medication – Antidepressants are the main kind of medication used to treat depression. There are many different classes and types of antidepressants, and they each work a little differently. However, antidepressants may not be the best option for bipolar disorder. Instead, bipolar disorder may be treated with mood stabilizers. While medication can help with some symptoms, they can’t get rid of the thinking patterns or beliefs that can drive mood problems. Most people use a combination of medication and counselling.
  • Other options – If depression is very serious or lasts for a long time, doctors may recommend Electroconvulsive Therapy (ECT). ECT can be very helpful, especially when other treatments haven’t worked. There are other options such as light therapy for certain kinds of depression, but it’s best to talk with your care team before you try something new.
  • Relapse prevention – A big part of recovery is learning to recognize relapse. A relapse is when symptoms come back. Seeking help as early as possible can do a lot to reduce problems or challenges. Relapse prevention plans—prepared when you’re well—often map out early warning signs, list treatment strategies that have worked in the past, and assign tasks to key people who can support you in your recovery. Your plan may be a formal arrangement with your care team or an informal plan with loved ones.

When someone you love is diagnosed with depression or bipolar disorder, you may wonder how you can really help. You can offer emotional support or practical support to help make the journey less daunting. You can also help a loved one watch for signs of relapse or other difficulties, which is an important part in maintaining wellness. People who experience an episode of depression may have thoughts of ending their life. This is a sign that a loved one needs extra support. If you believe that a loved one is in danger, don’t hesitate to call 911 or your local crisis line. Here are some tips for supporting someone you love:

  • Learn more about the illness and listen to your loved one so you have a better understanding of their experiences.
  • Someone who experiences an episode of depression may want to spend time alone or act out in frustration, and this can hurt other people’s feelings. These are just symptoms—it isn’t about you.
  • Ask your loved one how you can help. Think about practical help with day-to-day tasks, too.
  • Make sure your expectations are realistic. Recovery takes time and effort. It means a lot when you recognize your loved one’s work towards wellness, regardless of the outcome.
  • Set your own boundaries, and talk about behaviour you aren’t willing to deal with.
  • Seek support for yourself and think about joining a support group for loved ones. If family members are affected by a loved one’s illness, consider family counselling.

Reach Out for Help

Whether you or someone you care about is experiencing a mood disorder such as depression or bipolar disorder, the future does not have to be bleak. Don’t let fear or embarrassment stop you – find out more about the help that is available in your community. You are not alone. You can also contact the Canadian Mental Health Association – Calgary Region for more information at (403) 297-1700 or email: info@cmha.calgary.ab.ca.