Understanding Mood Disorders

About 21 million Americans, or 9.5 percent of the U.S. population, have a mood disorder. Mood disorders include major depressive disorder, dysthymia, bipolar disorder, mood disorders due to a medical condition and substance-induced mood disorder. Major depressive disorder is the most common mood disorder, affecting 16 million Americans, which is about 7 percent of the population.

There is a great need for people with mood problems to seek help and get treatment. People with untreated mood disorders have trouble with activities of daily living: They may not get out of bed, shower, get dressed or go to work. They may often be absent from work or quit working altogether because they can’t leave the house. Their anxiety leads them to withdraw, and they have trouble being around other people. Unstable moods cause them to withdraw from friends, and their friends may drop them because they are unstable. They might reach for substances to self-medicate. People with untreated mood disorders may develop thoughts of wishing they would die or of killing themselves.

How Mood Disorders Are Treated

The good news is mood disorders can be treated successfully with therapy and medication. There are many different medications available, which can improve quality of life. Choosing the right medication depends on the particular mood disorder. Antidepressants and mood stabilizing agents are most successful in helping people with different kinds of mood disorders. In some cases, anti-psychotics are utilized to increase the power of an anti-depressant, relieve severe anxiety, or balance and enhance the mood.

Treatment also includes learning how to balance mood. One of these approaches is cognitive behavioral therapy (CBT), a proven way to improve mood by reframing one’s thoughts. This type of therapy teaches a person how their actions affect their thoughts and moods. For example, a person with depression might take things too personally and think everything around them is the result of something they said or did. CBT helps reframe thinking. Changing one’s thinking can improve mood, even when the circumstances surrounding the problem can’t be changed.

The Importance of Diet and Exercise

A healthy diet and getting exercise are good supporting treatments for those with mood disorders, but also important to all of us and our mental health. How often we eat has a great impact on mental health. Many people skip meals and only eat once a day. They do this because they are busy, don’t want to prepare meals, have trouble with planning ahead and are hoping to lose weight. They often feel they are not hungry during the day, so they only eat at night. This way of life does not promote weight loss or foster good mental health.

Eating regularly gives the brain what it needs to function well. The brain is laden with nerve cells called neurons, and it is the most energy demanding organ, using over 50 percent of all the energy in the body. Optimal brain function is associated with optimal glucose levels. This is not to say that people should eat candy bars to keep their brains working well. Our brains need a constant supply of glucose mainly from vegetables, fruits and grains in order to keep it working well. The frontal lobe of the brain is very sensitive to dropping glucose levels. When people skip meals, they can’t think or concentrate.

Foods don’t contain cortisol, but what you eat impacts how much cortisol is released. Cortisol is released by the adrenal glands, causing blood levels to rise. If you want to keep your cortisol levels down, eat foods low on the glycemic index about every five hours. Eating foods that are high on the glycemic index (refined carbohydrates like white bread, etc.) activates cortisol, which results in decreased serotonin and dopamine levels. This in turn leads to a depressed mood.

Exercise is one of the most effective ways to improve mental health. People who exercise enjoy a greater sense of well-being. Exercise improves mental clarity, boosts energy and helps people sleep better at night. Jogging for 15 minutes per day or an hour of walking can reduce symptoms of depression by about 25 percent. Additionally, strength training effectively reduces symptoms of depression, including sad mood, whether people train five days a week or just two.

What to Do When You’re Concerned about Yourself or a Loved One

A primary care provider is the first person you should see when any health concern arises, including your mental health. About 80 percent of depressed people seek treatment in primary care, and the majority of people with mood disorders first see their primary care provider for diagnosis and treatment. Your provider must be knowledgeable of the differences between different types of mood disorders as the treatment is different for each. Mistaking bipolar disorder for major depressive disorder can lead to the wrong treatment. First-line treatment with antidepressants can worsen symptoms in the case of bipolar disorder. Specialists have advanced education in specific areas of medicine. If you need a psychiatric provider, your primary care provider will likely refer you to one. In some cases, your insurance may not require a referral, and you can contact a psychiatric provider on your own.

As for concerns about a friend or loved one, contrary to popular belief, giving unsolicited advice to others only serves to build resistance. When we give advice, we send the message, “You’re not smart enough to figure this out.” We think we’re helping, when in fact we are putting ourselves on a pedestal and putting our friend or loved one beneath us. Giving unsolicited advice puts distance between you and your friend or loved one and is a road block to communication. Listening carefully is the best course of action for it fosters a true connection and helps your friend feel valued. Listen, not for the purpose of advising, but to help your loved one feel heard and understood. Let the person talk, and avoid changing the subject. Avoid making jokes about mental illness, as this only puts distance between you and your friend.

Avoid telling your loved one how great your day was, as it takes the focus off of them and makes it sound like a competition. Good listening includes summarizing what your friend is saying and reflecting back what you believe are their feelings surrounding the issue. It’s also okay to set boundaries and tell your friend you can’t talk right now because you’re feeling overwhelmed. Let your loved one find their own solution, as people change when they are ready.

Of course if your friend or loved one is having suicidal thoughts, this is a different story. The first thing to do is find out if your friend is thinking of acting on their suicidal thoughts. It’s important to ask them if they have a weapon and plan to use it. Also ask what their plan is, and if they have the means to complete their plan. It’s okay to ask them with plain language, “Are you thinking of killing yourself?” Asking them if they’ve previously tried to hurt themselves or kill themselves is the right thing to do. If your friend or loved one is having thoughts of suicide with an action plan or you learn they have attempted suicide, call 911 or take them to the nearest emergency room.

Many Americans suffer from some kind of mood disorder. It’s important to know there is help available. Make an appointment with your primary care provider if you are concerned about your mental health. Mental health specialists are readily available, and your provider can make a referral when necessary.

Ann Padilla is a board-certified psychiatric mental health nurse practitioner with Overlake's Outpatient Psychiatry clinic.