Getting Help for Psychological Concerns - Major Depression, Bipolar Disorder

This post will discuss: considerations when deciding whether to seek professional help; using MDD, and bipolar disorder types 1 and 2 as examples, doing preliminary research, types of mental health professional, vetting & selecting (especially as this process relates to trust). 


When or if should you seek professional help? 

The answer is very personal. For many people, they can navigate life after having experienced trauma without feeling a need for professional help if trauma affected them mildly. Conversely, other persons without support systems or other means to overcome the effects of trauma are likely to be more severely impacted by the same types of trauma and have a greater need for professional help. 

If you are unsure, the answer can best be determined based on symptoms as they relate to the list of 4 points below to any condition. 

If you are only aware of a feeling of malaise without being able to positively name it, simply being aware of and able to articulate it will suffice for a very competent health care provider who can recognize patterns and help you to expressly identify your symptoms and the condition with which they are associated. Such an approach is akin to starting from scratch. 

Alternatively, if you have not yet been diagnosed but have done research and have suspicions about certain conditions, research its official definition and associated list of symptoms in the Diagnostic & Statistical Manual (DSM) used by mental health professionals. Note those symptoms that you observe in yourself. It is useful to consider clear examples. As you will notice from the DSM, conditions apply only if you have the 'A criteria' (ie those criteria that you must definitely have in order for the condition to apply at all) and meet the minimum number of symptoms. In other words, if these criteria are not met, there is no need to proceed further with the particular condition.

In this information age, many mental health clients do preliminary research and then present their suspicions to the professional (who is comfortable with this trend in only some cases). Such clients essentially explain and defend why they think one diagnosis over another fits their circumstances. However, in order to do this, clients must be prepared to go deep down rabbit holes because misdiagnoses are easy, even for seasoned professionals. A case in point is evident in the misdiagnosis of major depression when bipolarity is more appropriate. This issue arises because, in some cases, major depression as a symptom of one type of bipolarity. Since many people overlook symptoms of 'happy' hypomania as positive recovery from depression, they miss the fact that these changes are only one dimension of a mood disorder. Consequently, misdiagnoses like this are common (especially in cases of type 2 bipolarity). In short, much care and broad introspection is required, often in collaboration with professionals and or close relations.

Low mood is an emotional state characterized by sadness (or feeling down), anxiety, tiredness, low self-esteem. (When someone suffers low mood without depression, the low mood usually lifts within a few days).

Example(s)
  • Major depressive disorder (MDD). The DSM-5 posits that someone can be said to be experiencing major depressive disorder if they observe 5 or more of the list of symptoms of depression (below) that deviate from previous functioning.

    • The 'A' criteria, (ie must-be-included among the minimum of 5)  occurring: within a single 2-week period; not attributable to substances (like drugs that slow the nervous system or coming off of stimulants) or other medical conditions

  • loss of interest.
have never been experienced along with manic or hypomanic episodes (associated with bipolar disorder) or cause significant distress or impairment to one's ability to function socially, occupationally or otherwise
Do not shy away from tailoring the formal wording of symptoms so that they are more meaningful to you. For instance, for depression, the term 'hopelessness' is often listed. However, make it your own. You might feel 'overwhelmed' that you feel stuck without options for overcoming circumstances.

Here is a test for MDD with the full list of criteria. 

 

Since MDD symptoms occur in Bipolar Disorder 2, they are discussed below. 


  • Bipolar Disorder Types 1 and 2. Bipolarity is a chronic mood disorder that, in addition to depressive episodes, is also characterized by another extreme; episodes that are manic (in the case of type 1) or hypomanic (in the case of type 2). To differentiate bipolarity from depression, depression is often called 'UNI-polar' depression because unipolar depression is characterized by only the depressive episode while bipolarity is characterized by both extremes of the mood spectrum.     (The term 'chronic' relates to the fact that the condition is not a one-off occurrence but ongoing series of circumstances.)
The 'A' Criteria of mania in bipolarity 1 is a mood that is elevated, expansive or irritable that is also abnormal and persistent. This mood involves increased goal-directed activity lasting for over 1 week and is present most of the day, nearly every day of the week. If hospitalization is required, any duration applies. There should be at least one manic episode.

The 'A' Criteria of hypomania in bipolarity 2 is similar to mania, except that the mood: lasts for less time, specifically 4 - 7 days; is not so severe to cause hospitalization; has no psychotic features. There should be at least 1 hypomanic episode AND 1 episode of MDD.

In summary, a key difference between bipolar 1 and 2 is the fact that type 1 experiences higher highs while type 2 experiences lower lows. For instance, while BP 1 requires at least one manic episode (and NO required episode of MDD), BP2 require BOTH hypomania and MDD. 

The B criteria involves 3 or more of the classic symptoms: no sign of impairment to one's function socially or occupationally. 

  • inflated self-esteem or grandiosity 
  • reduced need for sleep 
  • more talkative than usual 
  • racing thoughts 
  • easily distracted (by unimportant or irrelevant external stimuli) 
  • increased goal-oriented activity such as socially, work/school, sexually, etc -- or -- psychomotor agitation (?). 
  • excessive involvement in pleasurable activities that have the potential for painful consequences, like imprudent business decisions, sexual indiscretion, unrestrained shopping, etc 

See  mnemonics at 13:13 of the video below that can be used to remember all of these criteria.

Unlike BP1 which also experiences depressive episodes, BP2 involves MDD that is as follows.
  • more chronically (ie recurrent), even to an extent that exceeds what unipolar depression involves (MDD by nature is chronic, ie ongoing in cycles, with or without triggers or bipolarity)  -- and --
  • more persistently (ie longer lasting episodes). 

 

C criteria requires the manic episode to: 
  • cause dysfunction (socially and or occupationally) 
  • requires hospitalization for treatment to prevent harm or treat    -- or -- 
  • occurs with delusions and hallucinations (psychotic features)

 

C criteria associated with nearly daily major depressive disorder (MDD) episodes that: 
  • cause dysfunction (socially and or occupationally). There is usually a greater lad in occupational recovery after episodes.  
  • I believe that, while hypomania does not hospitalize sufferers, hospitalization is more likely as a result of suicide attempts brought on by the MDD. 

 

Symptoms of Major Depressive Disorder (MDD) in Bipolar 2 are as follows. The minimum number required for the diagnosis is 5.

  • (Criteria 'A') Depressed mood. 

  • (Criteria 'A') Significant loss of interest or feeling of no pleasure in all or most activities 
  • weight loss when not dieting, weight gain or abnormal increase / decrease in appetite 
  • sleep disruptions: either insomnia or oversleeping 
  • restlessness or slowed behavior 
  • loss of energy. This might present itself in the form of psychomotor retardation (ie the slowing down of thoughts, emotional responses, gestural behaviors and physical movements). For instance, even activities that involve slow movements like yoga might feel too demanding. Activities (writing, household chores, etc) that one was otherwise able to perform with relative ease can feel considerably harder and more time to perform than before. In the most severe cases of depression (which might begin to transcend MDD), people can show vegetative symptoms, being unable to even manage self-care (showering, dental care, etc), can not work or function otherwise, self isolate severely to the extent that their windows are always drawn and they have no contact with the outside world, remain bed-ridden, continue eating food already in their mouths, unable to care properly for other responsibilities like caring for pets or others. Severest forms of depression may even worsen overall health because individuals do not take medications or other necessary steps towards maintaining health concerns. The severest forms may demarcate some limits of MDD.  
  • feelings of hopelessness 
  • feelings of inappropriate guilt 
  • decreased ability to think or concentrate 
  • indecisiveness 
  • thinking about, planning or attempting suicide




If you have already been diagnosed, you will already have the 'definition' and only need to consult the list of associated symptoms.

To clearly state your list, give each symptom its full assessment on each of the following points. So after identifying one symptom, complete the subsequent points (intensity, frequency, level of disruption) for that symptom before advancing to the subsequent symptom. 

Notice the symptoms you observe

  1. number of symptoms. Write a list of symptoms you observe. Continue with the following steps one symptom at a time, Example(s)
    • 5 of manic or hypomanic symptoms, including both of the 2 'A' criteria. 
      • 'A' criteria - agitation like psychomotor agitation that is self-harming (like nail biting, tics). I also get bursts of energy that result in my being able to perform considerably more work-related tasks than normal.
      • reduced sleep ... 
      • etc
    • 5+ of MDD symptoms within a 2-week period, including 'A' criteria: 1) 'A' - depressed mood; 2) 'A' - loss of interest in music, dancing, beach, dreams and other things I usually enjoy; 3) lost _ pounds even without dieting, and so on ....
  2. intensity of symptoms. Example(s)
    • Re mania or hypomania; while I experience this, I do not experience it so intensely that requires external intervention. For instance, I can remain guarded and in control of the positive grandiose feelings or 'happiness'. While I struggle with the symptoms, I do not put myself or others in the hospital or draw more attention to myself than people finding me 'weird'. In short, I can hide it from the public.  
    • Re MDD; The symptoms are persistent, ie they are 'long lasting' in that they last for several weeks on end. I no longer dance. When I go out, I can not contain tears, even during usually enjoyable activities, etc 
  3. frequency of symptoms.  Example(s). 
    • daily (versus one-off instance).
  4. their level of disruption in your life. Can these symptoms persist indefinitely or even get worse if you do not seek help? Example(s)
    • Is your depression a one-off experience ... or is it chronic (ie recurrent) trouble sleeping that does not appear possible to resolve on its own
    • You are unable to work or have normal relationships. See criteria C for manic episodes. 


What type of professional help do you need?
Psychologists (aka therapists) can help with behavioral concerns. Therapy is designed to help you work through the process of changing your mindset around challenges. Examples include the following.
  • resolving trauma experiences.
  • Compulsions
  • Avoidance behaviors associated with social anxiety
  • Relationship issues. 
Doctors can help with the effects of trauma or associated behaviors. Examples include the following.
  • Medication may help you to sleep,

Vetting & Selecting
Regarding selecting on the basis of the hard skills of a professional, you can start by selecting among the types of professional to meet your specific needs. If you are uncertain, a psychologist is usually the best choice. Psychologists can refer to psychiatrists if you need medical treatments that they are not qualified to prescribe.

Establish whether your professional specializes in your area and or has had successful experience. Not all psychologists or psychiatrists are trained or focused equally. For instance, unlike someone suffering mild depression, another person suffering DP2, along with other conditions like anxiety issues (like post traumatic stress disorder, dissociative episodes and so on) will benefit more from professionals with professionals that are specifically specialized in trauma.

Furthermore, professionals that specialize in a particular area can specialize in different approaches to therapy. Professionals may offer pharmacology (ie involving medication) and  or psychotherapy (aka talk therapy). Within those approaches, they may specialize further. For instance, some professionals specialize in certain techniques like cognitive-behavior therapy (CBT) and exposure therapy.

Deep trust is key. Outside of the trust you give by showing up because of the other person's hard skills, professionals should also win your trust when you interact with them. After all, you need to confide in them and trust their judgement to help you transform your life. Signs that you can trust usually manifest in several ways.
  • Does the professional listen deeply? Does the exchange achieve deep levels of understanding? Are you able to complete thoughts without being interrupted or cut short with hasty and incorrect assumptions about what you mean?
  • Is he or she validating or invalidating of your experiences? Validating does not mean that they agree with everything you say. Rather, it refers to their ability to recognize how real your pain and challenges are to you, within your circumstances. Red flags include them saying that certain types of ailments are 'all in your head'. Beware that there are certain mental health challenges that are so rare that some professionals simply have either little or no knowledge. Some even have difficulty believing in their existence. Returning to an earlier point regarding hard skills, this is why selecting professionals who specialize in out of the ordinary challenges is particularly important.
  • Does the professional interact with you without any biases that can interfere how they deal with you? This is particularly important if you have characteristics that can generate prejudices like sexual orientation, socioeconomic background, racial background and so on. This might be a strong possibility when professionals are assigned by sociocultural organizations (like religions), communities with distinctive characteristics and so on. Review any website or other public description on the professional's target client. Otherwise, seek referrals. Beware; if you get this wrong, you can leave more traumatized than when you arrived! Needless to say, you should also be mindful of and therefore honor your own biases. 
  • How does the person make you feel in his or her presence?
Many adults prefer collaborative professional help.


Admin. 
  • Ensure that there is linguistic compatibility. For instance, speaking the same language and in comprehensible and non-distracting accents is ideal.



CONTENT RELATED TO GETTING HELP FOR PSYCHOLOGICAL CONCERNS

= Definitions =
Psychomotor agitation refers to a set of signs and symptoms that stem from mental tension and anxiety. It often accompanies major depressive disorder, obsessive compulsive disorder (OCD) and sometimes the manic phase of bipolar disorder. (The state can also be a result of substance abuse or involuntary muscular activity in the elderly). The signs are unintentional and purposeless motions. Symptoms are emotional distress and restlessness. Typical manifestations include pacing the floor, uncontrolled tongue movement, excessive blinking, pulling off clothes and putting them on again. In more severe cases, the motions are harmful to the individual such as repetitive motions that eventually hurt or injure the individual. Examples include chewing off or picking off one's skin from some part of the body.    
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