Depression

In this episode, Wendy discusses bipolar and unipolar depression, holiday depression and the importance of sleep.

Wendy's novel on psychiatric hospitalizations is out on Amazon! It's called "Involuntary Hold." Check it out~ There is a plot twist you won't see coming!



International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

BIPOLAR FOR LIFE

 Episode 6—Depression

The number of adults who report having depression has steadily increased in recent years. A 2023 Gallup Poll shows that a staggering 29% of adults experienced depression at some point in their lives. That’s up from 19.6%, nearly 10 percentage points higher than in 2015. The percentage of Americans who currently have, or are being treated for depression, has also increased to 17.8%, up seven points over the same time period.

Women’s rates of depression during their lifetimes climbed from 26.2% in 2017, to 36.7% in 2023. By comparison, men with depression during their lifetimes saw a smaller increase, from 17.7% in 2017, to 20.4% in 2023.

The World Health Organization has identified depression as the leading cause of disability worldwide.

Welcome to Bipolar for Life, a show dedicated to survival. This podcast examines the day-to-day struggles to endure this life-threatening mental illness. 

I’m your host, Wendy Foard, and I’ve lived with bipolar disorder for 43 years now. It hasn’t always been pretty—I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous visit to rehab. Yet, I’m still here!

Let me say at the outset. That I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly condition through shared experiences and information. 

Please feel free to contact me with any questions, suggestions, or complaints at bipolarforlife@myyahoo.com. I’d love to hear from you! If you get a moment, let me know what you think of the show—Good or bad! Are there any topics you’d like to have more information on? Or, perhaps, you could give me your opinion on the unusual commercials. Just drop me a line! 

Tonight, I’d like to discuss a very important topic, depression. Treatment of bipolar depression is far less investigated than unipolar depression, or major depressive disorder, and is harder to treat. This is because depression medications can increase the risk of manic episodes, rapid cycling, and increased thoughts or plans of suicide for people with bipolar disorder. 

In fact, it’s one way to distinguish major depressive disorder, or clinical depression, from bipolar disorder… If the antidepressants throw you into a manic episode, you’re bipolar. 

According to research, 69% of people with bipolar disorder are initially misdiagnosed with another mental health disorder, most commonly clinical depression, otherwise known as unipolar depression.

Bipolar depression symptoms are similar to major depression. Common symptoms of depression associated with bipolar disorder include:

-withdrawal from people and activities 

-feelings of sadness and hopelessness

-lack of appetite and weight loss

-feeling anxious or guilty without reason

-difficulty concentrating, and

-suicidal thoughts and behaviors.

There is no single characteristic that distinguishes bipolar disorder from other types of depression. However, bipolar disorder is different from major depression, for people with bipolar disorder experience distinct periods of depression and uplifted mood, or mania. Major depressive disorder, or clinical depression, has only one phase; depression.

Symptoms of depression include:

-feeling sad, hopeless or “empty”

-bouts of crying

-irritability and frustration

-Low, or no, interest in activities you usually enjoy

-sleeping too much, or not being able to sleep

-lack of energy

-low appetite or overeating

-anxiety and restlessness

-feeling guilty or worthless

-trouble thinking, concentrating, or making decisions, and remembering things

-unexplained aches and pains, and

-thoughts of death

These symptoms are usually so severe that they disrupt your everyday life. When you are depressed, you tend to have several of these symptoms at one time. The thing that separates bipolar depression from clinical depression is manic episodes, which may include:

-high energy

-a feeling of being unusually important, talented, or powerful

-excessive talking about different topics

-racing thoughts

-jumpiness or irritability 

-impulsive behaviors

-increased appetite for food, sex, or pleasurable activities

-decreased need for sleep.

Typically, people with bipolar disorder have at least one or two cycles of depression and mania per year. However, some people have rapid cycling bipolar disorder, which can cause four or more cycles annually.

Evidence shows that bipolar depressive episodes tend to last longer than the periods of mania or hypomania. Depression can last anywhere from two weeks to several months, it can be a more debilitating state, and may have a greater impact than manic episodes on everyday functioning. 90% of people with bipolar disorder report severe impairment due to depressive episodes. 

While people with bipolar disorder fluctuate between lows and highs in mood, bipolar depression may be experienced more often than manic or hypomanic episodes. It’s actually three times more likely for bipolar patients to experience bipolar depression than mania. 

Medical professionals do not fully understand what causes unipolar and bipolar depression. However, both conditions share similar possible causes. Genetics may play a role in the development of both types of depression.

Studies show that if a person has a first-degree relative with unipolar depression, they are 3 times more likely to develop the condition than the general public.

Studies also show that genetics play a role in bipolar depression. Scientists have made a connection between at least 30 genes and an increased risk of the condition.

According to the medical community, traumatic life events may also play a role in the development of unipolar and bipolar depression. These events can include:

-emotional abuse or maltreatment as a child

-death and loss of a loved one

-childbirth and caregiver burdens

-divorce

-unemployment and financial problems

-interpersonal difficulties

-disability, or 

-conflicts

The alternation between mood episodes (high & low) is what differentiates bipolar depression from unipolar depression. Basically, unipolar depression is another name for major depressive disorder (MDD), also known as clinical depression. For a bipolar diagnosis, a person must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders, volume 5, or DSM-5.

 This means you must have had:

-at least one manic or hypomanic episode

-at least one depressive episode

-cycles that vary from depression to mania, with each state lasting several days or weeks.

According to the DSM-5, which is used by psychiatrists to diagnose mental health conditions, unipolar patients must experience the following to receive a diagnosis of the clinical depression:

-episodes of depression or significant loss of interest, or both

-symptoms for 2 weeks or longer

-a change in the way you previously functioned.

In general terms, both depression and bipolar disorder can be treated with a similar approach involving education, medications, and psychotherapy.

In bipolar disorder, the most common psychotherapy approaches used are:

-Cognitive Behavioral Therapy (CBT)—The goal of CBT is to help you adapt and change your mindset and behaviors by reassessing distorted thought patterns

-Family Focused Therapy (FFT)—Family therapy views a person’s symptoms as taking place in the larger context of the family.

-Interpersonal and Social Rhythm Therapy (IPSRT)—aims to minimize disruptions to your daily routines and rhythms since these changes can lead to disrupted sleep and unstable moods, by identifying current and previous mood patterns.

-Dialectical Behavioral Therapy (DBT)—DBT teaches people to accept their thoughts, feelings, and behaviors with techniques to change them. DBT focuses on the emotional and social aspects of living.

We’ve talked about the mental issues associated with depression, but there are also physical effects from depression as well. Common effects include: 

-chronic pain

-chronic inflammation

-headaches or migraines

-cramps

-constipation or diarrhea

-nausea and vomiting

-chronic fatigue that doesn’t go away after resting

-changes in sleep patterns

-changes in weight

-changes in appetite

-decreased sex drive or pain during sex, and

-increased chance of autoimmune disorders.

That’s an overview of depression and bipolar depression, in general. 

Now, I’d like to talk about a seasonal depression that affects a large number of the populace each year, holiday depression. 

While holidays don’t necessarily exacerbate mental health conditions specifically, they do have a tendency to create more stress. The resulting stress can then trigger or exacerbate mental health conditions such as depression and anxiety. According to the National Alliance of Mental Illness, 64% of people with mental illness say that the holidays make their condition worse.

It is common for people who don’t normally struggle with depression to experience it temporarily during the winter months. This is sometimes referred to as Seasonal Affective Disorder.

Feelings of isolation and loneliness also tend to be heightened during the holidays, especially for those who have recently lost a loved one, or who don’t have a strong network of family and friends.

One of the best things people can do to help alleviate some of the holiday stress is to make sure you engage in appropriate and effective self-care, such as getting enough sleep, eating balanced meals, and having sufficient downtime. 

Here are some of the most common causes for depression during the holidays:

-General stress—this can be due to extra responsibilities, more social interactions, and less time to relax and recharge

-Physical and Mental Fatigue

-Financial Stress

-High Expectations—which are often caused by the exaggerated portrayal of holidays on TV, in movies, the media and on social media

-Travel Stress—from crowded airports to traffic jams, plus the effects of jet lag, there is plenty to worry about during this high-stakes travel time

-Stressful Family Gatherings

-First holiday season after the passing of a loved one

-Loneliness

-Disappointment over not being able to see friends and family

The symptoms of seasonal, or holiday, depression are similar to the symptoms of depression that occur any time. For example:

-tiredness or lack of energy

-change in appetite

-difficulty concentrating or making decisions 

-difficulty working

-general irritability

-change in sleep patterns, and

-self harm

There are many ways to take care of your mental health during the holidays. Some strategies will work better than others, but be sure to try a few to find which works best for you. For example:

-Make sure your expectations are realistic—Ask yourself if you’re expecting too much from yourself, or from someone else. Then, see how those expectations make you feel. Are they helpful or stressful?

-Practice saying “No”—You’re one person, and there is only so much you can do in a given day, or a given holiday. Remind yourself that it’s ok to say “No.”

-Limit external sources of holiday pressure—Maybe take a break from social media if seeing other people’s holiday photos are causing you to engage in self-comparison or causing you stress. 

-Find winter activities to enjoy—by yourself, or with others, that are not associated with the holidays, such as snowboarding, or skiing for example. 

-Don’t slack on self-care—Take time for yourself and be open to experimenting with new self-care strategies. For example, if yoga helps you cope with stress, keep doing that. If spending time with friends helps, connect with them often. 

-Talk to a mental health professional—Talk therapy can help you cope with stress and symptoms of anxiety and depression.

-Don’t wait to talk with someone about your holiday blues—When it comes to stress and mental health matters, sometimes there is a tendency to want to wait and see how things go. But if you’re feeling anxious or depressed, now is the time to talk to someone; sooner rather than later.

Connect with a trusted friend or family member, to share how you’re feeling and lift some of that weight off your shoulders. Since stress and depression are so common during the holidays, you may find that they feel the same way! Just knowing someone else is dealing with the same feelings can make you feel better.

You can also reach out to your regular doctor or a mental health professional. Together, you’ll be able to talk through what you’re experiencing, find ways to reduce your stress, and get you back on your feet again. 

If your feelings of sadness or loneliness during the holidays are accompanied by suicidal thoughts, go immediately to a hospital emergency room, or call 

1-800-273-8255 for the Suicide and Crisis Lifeline or dial 9-8-8. If you don’t feel like talking, you can text H-O-M-E to 741741 to chat via text. Don’t wait to get help!

There is an important component that is critical to our overall health, but especially important when it comes to dealing with depression—sleep.  Most people don’t realize just how critical good sleep is to maintaining mood. 

Sleep deprivations due to depression can present in two ways:

Hypersomnia—which is sleeping too much and having trouble getting out of bed, whereas, 

Insomnia—is having a hard time falling and staying asleep.

With both types of sleep disturbances, any sleep you manage to get with depression isn’t of the best quality. 

 According to the National Sleep Foundation, the relationship between sleep and depressive illnesses is complex. Depression may cause sleep problems, and sleep problems may cause, or contribute, to depressive disorders. This complex relationship can make it difficult to know which came first… sleep issues or depression. 

It can be difficult when you’re busy, and feeling overwhelmed with your daily routine, to prioritize sleep, but experts say, sticking to a solid 7 to 9 hours of sleep per night is essential. 

Approximately 40% of people with insomnia have clinical depression, and up to 80% of patients with depression experience bouts of insomnia. Early waking is closely associated with depression, as well as difficulty falling asleep at night. People with depression may switch back and forth between insomnia and hypersomnia during a single period of depression. 

While we sleep, our amygdala (the brain’s emotional processing center) can regulate and review the day’s events. When you are sleep deprived, the amygdala is overactive and triggers negative emotional responses to stimuli. This causes your mood to tumble, making it harder to cope with daily stress. 

I didn’t want to leave you hanging with no options for better sleep, so I found 6 Tips for Better Sleep with Depression from the American Foundation of Suicide Prevention. *Remember, with all of these tips, consistency is crucial. *

1) Establish a bedtime routine—Establishing a bedtime routine can help you build a structure your body will get used to. Have a set time for getting ready for bed where you focus on basic hygiene (face, teeth, body, etc.), separating from screens, and creating a good sleep environment by turning down the lights and temperature.

Doing the same thing each night will help your body relax enough to fall asleep. You should avoid overstimulation for at least a few hours before going to bed. Try activities that make you feel relaxed, like focusing on breathing, relaxation apps, quiet music, or a book that’s not too mentally absorbing. 

2)Get outside—Spending time outside not only boosts your mental health, but it can also help you sleep at night. One suspected contributing factor to depression is low serotonin levels; the neurotransmitter that regulates mood. 

Time outside can be a simple and effective way to trigger the natural chemicals in the brain that promote high-quality sleep. Studies have shown that sunlight can increase the body’s serotonin production. Exposure to sunlight also aligns the body’s internal clock and circadian rhythms, giving cues for when to be alert and when to sleep.

3)Avoid alcohol—It can be tempting to have a drink to foster relaxation and sleepiness, but alcohol has a harmful effect on sleep. Studies have shown that binge-drinking before bed leads to difficulty falling asleep and staying asleep, while even moderate drinking is enough to disrupt the sleep cycle and shorten the deep REM sleep.

4)Nap carefully—Restless, or inconsistent sleep at night can make it tempting to take a nap during the day, but it is important to keep naps brief. Research has found that the ideal nap length is between 10 and 20 minutes; usually referred to as a “power nap.” Short naps can help regulate emotion, reduce sleepiness, and lead to an overall increase in performance. Naps that last longer than 20 minutes could interfere with your ability to fall asleep at night, while naps that are shorter than 10 minutes are not long enough to gain any benefit from napping.

5)Exercise regularly—Research indicates that those who engage in light, moderate or vigorous exercise, report very good or good sleep quality. Regular exercise has shown to significantly reduce symptoms of depression as well. If you decide to start an exercise routine, consider doing your workout during the first half of the day, as exercising in the evening could interfere with your ability to fall asleep at night. 

6)Talk to a therapist—There are several different kinds of therapy to help cope with depression and change your thought patterns around sleep. Therapies such as CBT, interpersonal psychotherapy, and psychodynamic therapy can help you process some of the feelings and challenges that contribute to depression. Mental health professionals can also suggest concrete behavioral changes to mitigate some of the symptoms of depression and provide coping mechanisms to manage restless, sleepless nights.

If you find yourself sleeping more than 9 hours a night, try setting an alarm, getting yourself up and out of bed, ideally into some sunlight, and get your body moving. 

There are some apps out there that may help you improve your sleep. For example: 

-PILLOW—which is a sleep tracking app, for iOS only

-SLEEP CYCLE—also a sleep tracking app, but for both iOS and Android

-SLEEPIO—is Cognitive Behavioral Therapy for insomnia

-HEADSPACE—is a meditation and mindfulness app which has a free option

-CALM—is also a meditation, mindfulness and master class app. 

I was able to find all these apps in the Google play store, so they are readily available. There are many other apps from which to choose—journaling, to anxiety & panic relief, to white noise. Hell, give them all a try until you find the one that works best for you. 

I think that’s all the time we have to discuss depression tonight. I just wanted to give a general overview of a subject that affects so many people across the U.S. daily, especially at the holidays. Thank you for joining me this evening. I know this is a busy time for us all! 

I’m your host, Wendy Foard, wishing you and yours a happy and depression-free holiday season! Be safe in all your travels, and I’ll see you next time on Bipolar for Life.