For most women, having a baby is a very exciting, joyous, and often anxious time. But for women with peripartum (formerly postpartum), depression can become very distressing and difficult. Peripartum depression refers to depression occurring during pregnancy or after childbirth. The use of the term peripartum recognizes that depression associated with having a baby often begins during pregnancy.
Peripartum depression is a serious but treatable medical illness involving feelings of extreme sadness, indifference, and anxiety, as well as changes in energy, sleep, and appetite. It carries risks for the mother and child. An estimated one in seven women experiences peripartum depression.
Seasonal affective disorder* is a form of depression also known as SAD, seasonal depression or winter depression. In the Diagnostic Manual of Mental Disorders (DSM-5), this disorder is identified as a type of depression – Major Depressive Disorder with Seasonal Pattern.
People with SAD experience mood changes and symptoms similar to depression. The symptoms usually occur during the fall and winter months when there is less sunlight and usually improve with the arrival of spring. The most difficult months for people with SAD in the United States tend to be January and February. While it is much less common, some people experience SAD in the summer.
SAD is more than just “winter blues.” The symptoms can be distressing and overwhelming and can interfere with daily functioning. However, it can be treated. About 5% of adults in the U.S. experience SAD, and it typically lasts about 40% of the year. It is more common among women than men.
SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. As seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. SAD is more common in people living far from the equator, where there are fewer daylight hours in the winter.
Bipolar disorder is a brain disorder that causes changes in a person’s mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.
People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behaviour change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.
Bipolar disorder is a category that includes three different diagnoses: bipolar I, bipolar II, and cyclothymic disorder.
A person with persistent depressive disorder (previously referred to as dysthymic disorder) has a depressed mood for most of the day, for more days than not, for at least two years. In children and adolescents, the mood can be irritable or depressed and must continue for at least one year.
In addition to depressed mood, symptoms include:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Persistent depressive disorder often begins in childhood, adolescence, or early adulthood and affects an estimated 0.5% of adults in the United States every year. Individuals with persistent depressive disorder often describe their mood as sad or “down in the dumps.” Because these symptoms have become a part of the individual’s day-to-day experience, they may not seek help, just assuming that “I’ve always been this way.”
The symptoms cause significant distress or difficulty in work, social activities, or other important areas of functioning. While the impact of persistent depressive disorder on work, relationships, and daily life can vary widely, its effects can be as great as or greater than those of major depressive disorder.
A major depressive episode may precede the onset of persistent depressive disorder but may also arise during (and be superimposed on) a previous diagnosis of persistent depressive disorder.
PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. A woman with PMDD has severe symptoms of depression, irritability, and tension about a week before menstruation begins.
Common symptoms include mood swings, irritability or anger, depressed mood, and marked anxiety or tension. Other symptoms may include decreased interest in usual activities, difficulty concentrating, lack of energy or easy fatigue, changes in appetite with specific food cravings, trouble sleeping or sleeping too much, or a sense of being overwhelmed or out of control. Physical symptoms may include breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
These symptoms begin a week to 10 days before the start of menstruation and improve or stop around the onset of menses. The symptoms lead to significant distress and problems with regular functioning or social interactions.
For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work or social functioning. Premenstrual dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating women every year.
PMDD can be treated with antidepressants, birth control pills, or nutritional supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise, and practising relaxation techniques, can help.
Premenstrual syndrome (PMS) is similar to PMDD in that symptoms occur seven to 10 days before a woman’s period begins. However, PMS involves fewer and less severe symptoms than PMDD.
Disruptive mood dysregulation disorder is a condition that occurs in children and youth ages 6 to 18. It involves chronic and severe irritability, resulting in severe and frequent temper outbursts. The temper outbursts can be verbal or can involve behaviour such as physical aggression toward people or property. These outbursts are significantly out of proportion to the situation and are not consistent with the child’s developmental age. They must occur frequently (three or more times per week on average) and typically in response to frustration. In between the outbursts, the child’s mood is persistently irritable or angry most of the day, nearly every day. This mood is noticeable in others, such as parents, teachers, and peers.
In order for a diagnosis of disruptive mood dysregulation disorder to be made, symptoms must be present for at least one year in at least two settings (such as at home, at school, or with peers), and the condition must begin before age 10. Disruptive mood dysregulation disorder is much more common in males than females. It may occur along with other disorders, including major depression, attention deficit/hyperactivity, anxiety, and conduct disorders.
Disruptive mood dysregulation disorder can have a significant impact on the child’s ability to function and a significant impact on the family. Chronic, severe irritability and temper outbursts can disrupt family life, make it difficult for the child/youth to make or keep friendships, and cause difficulties at school.
Treatment typically involves psychotherapy (cognitive behaviour therapy) and medications.
FAQs
Everyone experiences a range of emotions over days and weeks, typically varying based on events and circumstances. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally, these feelings ebb and flow. They respond to input and changes. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be cheered, comforted, or consoled. People who recover from depression often welcome the ability to feel normal sadness again, to have a “bad day,” as opposed to a leaden weight on their minds and souls every single day.
Of people diagnosed with major depressive disorder who are treated and recover, at least half are likely to experience a recurrent episode sometime in the future. It may come soon after or not for many years. It may or may not be triggered by a life event. After several episodes of major depression, a psychiatrist may suggest long-term treatment.
A wide variety of treatments have been proven effective in treating depression. Some involve talking and behavioural change. Others involve taking medications. Some techniques focus on neuromodulation, which incorporates electrical, magnetic, or other forms of energy to stimulate brain pathways. Examples of neuromodulation include electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), and experimental deep-brain stimulation (DBS).
The choice of therapy should be guided by the nature and severity of depression, past responses to treatment, and the patient’s and family’s beliefs and preferences. Whatever approach is selected, the patient should be a willing and active participant, engaging in psychotherapy or regularly taking the medication, for example.
Total openness is important. It would be best if you talked to your doctor about all of your symptoms, important milestones in your life, and any history of abuse or trauma. Also, tell your doctor about the history of depression or other emotional symptoms in yourself or family members, your medical history, medications you are taking — prescribed or over-the-counter, how depression has affected your daily life, and whether you ever think about suicide.
If your symptoms are mild, do not impair your work or home life, or adversely affect your health, and you do not think about suicide or self-harm, you could wait a week or two before visiting a professional to see if the symptoms may improve on their own. But more serious symptoms need immediate attention.
Virtually all medicines can cause side effects. Typically, unwanted effects increase when the dose rises. Side effects usually vary from one drug to another and are especially variable between different medication classes. If you have previously taken medicine and done well or poorly or had bothersome side effects, be sure to tell the doctor what happened.This should affect your choice of prescription. If you have never taken an antidepressant, discuss with your doctor which groups have which side effects. Let your doctor know which side effects you particularly wish to avoid, such as sedation or sexual disruption.
In the evolving U.S. healthcare system, the cost of treatment is a consideration for most people. At the same time, untreated depression can be costly itself, often compromising a person’s ability to function at home or work. Speak to your health insurance company to learn about your benefits and co-pays. Insurers sometimes refer only to specific psychotherapists and limit the number of sessions. Co-pays vary. When cost is an issue, ask for generic medications rather than brand-name drugs. Most classes of antidepressants are available in generic formulations. Neuromodulation treatment can be expensive, and insurance coverage varies widely.