Depression has been described in many ways, images such as a looming black cloud, a weighted blanket that creates numbness, or the consistent companionship of a big black dog come to mind. Some clients describe depression as the absence of joy, a constant state of nothingness, nothing motivates them, saddens them, or angers them. Others describe it as a voice in their head that yells at them about how worthless they are or how hopeless life is. Either experience makes life strain nous impacting the way individuals interpret events, people around them, and even themselves.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) informs us that there are many types of depression: Disruptive Mood Dysregulation Disorder, Major Depressive It Disorder, Persistent Depressive Disorder (Dysthymia, and Premenstrual Dysphoric Disorder. All of them share two common features: constant feelings of sadness, emptiness, and or irritability and behavioral and cognitive changes that directly impact the person’s ability to function adequately in life.
Disruptive Mood Dysregulation Disorder can be diagnosed between the ages of 6 and 18 and is characterized as recurrent temper outbursts that are not in accordance with the individual’s age and or situation. These outbursts are present in their interaction with peers, at school or at home and are consistent, they happen at least three times a week. It is important that parents distinguish when there is a temper tantrum or an emotional meltdown that can be signs of a different type of diagnosis.
In general, these children/teens can be described as angry, short-fused and as adults, they have a higher prevalence of the major depressive disorder, bipolar or anxiety disorders. The child institute explains that to help treat DMDD the child, and parent has to participate in therapy in the hopes of gaining skills to regulate anger outbursts and reward positive behavior with adequate attention. If therapy seems to not be enough, medication can be added to the treatment plan to mitigate symptoms.
Major Depressive Disorder is what we traditionally think of when we hear the term depression. For at least two weeks the person experiences either a depressed mood or a loss of interest or pleasure. These two states are consistent for most of the day, nearly every day of the week. Other symptoms are also present for example weight and sleep changes, and a physical sense of being agitated, or slow can also happen. Feelings of worthlessness or guilt without a cause are also commonly present. Of course, walking around with this much turmoil impacts the person’s ability to function and interact socially or professionally becomes daunting.
Dysthymia also known as Persistent Depressive Disorder is when depression is tenacious for at least two years. Low mood and lack of pleasure can not be shaken at all for 24 months. Along with a depressed mood, there are two of the following six symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, difficulty making decisions, and feelings of hopelessness. Its defining characteristic is time, how long the individual has been feeling depressed, and how much that has impacted his or her life.
Premenstrual Dysphoric Disorder (PMDD) is not as well known as Major Depressive Disorder and socially has been harder to accept since it can be camouflaged or minimized due to gender stereotypes. PDD has been thoroughly researched for the last 20 years. PDD is present in only women and its symptoms start before menses improvement is seen within a few days after the start of menses and is minimal or completely absent a week after menses is done. Before the onset of menses, there will be a clear change in effect either by intense mood swings, waves of sadness or tearfulness impossible to control, or an increased sensitivity to rejection. Behaviorally the individual will see a marked rise in interpersonal conflicts because of the weight of having a depressed mood, feeling of hopelessness, or intense self-deprecating thoughts. It is as if a stranger has taken over the person’s body, what they enjoy doing they won’t, there will be a marked lack of energy, appetite, overeating, specific food cravings, hypersomnia or insomnia, sense of being out of control and physical sense of breast tenderness or swelling and bloating. All symptoms will disappear after menses are done and will reappear before the next cycle is about to begin.
The etiology of PMDD is clearly explained in MGH Center for Women’s mental health: Reproductive psychiatry resource and information center. It illustrates that there are five key aspects that create PMDD, creating a feedback cycle where one element impacts another: brain structure and function, genetics, progesterone and metabolites ALL, estrogen, serotonin, and BDNF, and HPA/HPC axis. There are many components that are all intertwined. The interwoven phenomenon of PMDD creates many misdiagnosed attempts. Individuals can be diagnosed with personality disorders, mood disorders, and bipolar disorder but unfortunately, none of these diagnoses explain the cyclical nature of PMDD.
