Adjustment Disorder with Depressed Mood: A General Overview

Adjustment Disorder with Depressed Mood, also known as Situational Depression, is another subtype of depression. Adjustment Disorder with Depressed Mood is where depressive symptoms mainly consist of low mood, tearfulness, and feelings of hopelessness. These depressive symptoms occur in response to a stressor, such as losing a job, financial problems, relationship problems, and losing a loved one, just to name a few.

The depressive symptoms of sadness, tearfulness, and hopelessness present in Adjustment Disorder with Depressed Mood do not meet the criteria for a major depressive episode. However, during the course of an Adjustment Disorder, one may develop more depressive symptoms, in which case the diagnosis of major depressive disorder may be more appropriate, or if manic or mixed episodes were present, then bipolar depression may be more appropriate.

So the depressive symptoms only occur in association with a recent stressor, and the depressive symptoms that are mainly present are low mood, tearfulness, and feelings of hopelessness. Again, if five or more depressive symptoms are present, then this is not an Adjustment Disorder with Depressed Mood, and one needs to look at the other subtypes of depression. In addition, the depressive symptoms from Adjustment Disorder with Depression Mood resolves when the stressor is no longer there, and does not last longer than 6 months from when the stressor ended.

However, if the depressive symptoms continue despite the stressor being removed, then the person may have developed Major Depressive Disorder, and the treatment plan needs to be switched to accommodate the new diagnosis.

The treatment for Adjustment Disorder with Depressed Mood is focused on addressing the stressor, and how to cope with it. Stay tuned for upcoming articles to get help and treatment for Depressive Disorders, such as Adjustment Disorder with Depressed Mood.

photo credit: Aaron Stidwell Face full of tears via photopin (license)

KalmPro Reformulated: Natural Anxiety and Depression Supplement

KalmPro, a natural anxiety and depression supplement, has been reformulated to relieve both anxiety and depression. It was important to include even more ingredients than the original KalmPro formulation, as many people with anxiety also have depression. On the other hand, many people with depression also have anxiety. So the reformulated KalmPro was designed to address both anxiety and depressive symptoms, as both go hand-in-hand. Insomnia, or difficulty sleeping, is also a common problem that goes along with anxiety and depression. So it was important for KalmPro to address insomnia as well.

This is why KalmPro was reformulated, to address the symptoms of anxiety, depression, and insomnia. The original KalmPro formulation only had 5 ingredients to help for anxiety. The new, reformulated KalmPro now has 14 ingredients to help for anxiety, depression, and insomnia. As an added bonus, there are ingredients in KalmPro which also help for improving concentration, as concentration problems also go along with anxiety and depression.

If you look at what is available on the market now, there is only one natural anxiety and depression supplement- KalmPro.

The reformulated KalmPro contains the following ingredients:

  • B Complex Vitamins Research shows that B complex vitamins, which include B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine),  and B7 (biotin),  are effective for reducing anxiety and depressive symptoms (1).
  • Magnesium  Magnesium is known be a treatment for anxiety and can help depression as an augmenting agent. When vitamin B6 is combined with magnesium, it is especially effective for anxiety (2).
  • Rhodiola Extract Multiple studies show that Rhodiola can reduce anxiety symptoms in Generalized Anxiety Disorder (GAD), but recently has also been found to be effective for mild to moderate depression (3, 4).
  • Ashwagandha Several studies show that Ashwagandha can relieve anxiety symptoms by stabilizing the body’s response to stress (5).
  • Chamomile Research shows that Chamomile can reduce anxiety in Generalized Anxiety Disorder (GAD) by enhancing GABA  and serotonin (6).
  • GABA GABA is an inhibitory neurotransmitter in the brain which reduces hyperactive fear circuits, and is effective for phobic anxiety (7).
  • Lemon Balm Lemon Balm enhances GABA and reduces stress-induced corticosteroids to help with anxiety and insomnia (8, 9).
  • Skullcap  Skullcap enhances GABA and is a GABA receptor agonist, which helps to decrease anxiety symptoms (10).
  • Bacopa Bacopa helps to reduce anxiety symptoms and has been known to improve memory and concentration (11).
  • Passion Flower Passionflower is a GABA reuptake inhibitor and enhances GABA, which research shows to be effective for Generalized Anxiety Disorder (GAD) and anxiety before surgery (12, 13).
  • Valerian Valerian enhances GABA activity and is used to treat Obsessive Compulsive Disorder (OCD) (8).
  • L-Theanine L-Theanine is an amino acid found in green tea, and is effective at reducing anxiety. It enhances GABA and serotonin in the brain (8).
  • St. John’s Wort St. John’s Wort is an herbal supplement that is effective for depression, and its effect is similar to antidepressant medications. It modulates the neurotransmitters serotonin, dopamine, noradrenaline, GABA, and glutamate in brain areas that are affected in depression (14).
  • 5-HTP 5-HTP is the precursor to 5-HT, also known as serotonin, which is effective for depression (15).

As you can see, the new and reformulated KalmPro has many natural ingredients that studies show to be effective for anxiety and depression, with an added benefit of helping to improve sleep and concentration. KalmPro is the best natural anxiety and depression supplement, formulated by a psychiatrist.


References

  1. Lewis JE, Tiozzo E, Melillo AB, Leonard S, Chen L, Mendez A, Woolger JM, Konefal J. The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN Psychiatry. 2013 Jan 21;2013:621453. doi: 10.1155/2013/621453. Print 2013. PubMed PMID: 23738221; PubMed Central PMCID: PMC3658370.
  2. Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review.Nutrients. 2017 Apr 26;9(5). pii: E429. doi: 10.3390/nu9050429. Review. PubMed PMID: 28445426; PubMed Central PMCID: PMC5452159.
  3. Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD). J Altern Complement Med. 2008 Mar;14(2):175-80. doi: 10.1089/acm.2007.7117. PubMed PMID: 18307390.
  4. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014 Dec;20(12):901-8. doi: 10.1089/acm.2014.0177. Review. PubMed PMID: 25405876; PubMed Central PMCID: PMC4270108.
  5. Bangratz M, Ait Abdellah S, Berlin A, Blondeau C, Guilbot A, Dubourdeaux M, Lemoine P. A preliminary assessment of a combination of rhodiola and saffron in the management of mild-moderate depression. Neuropsychiatr Dis Treat. 2018 Jul 13;14:1821-1829. doi: 10.2147/NDT.S169575. eCollection 2018. PubMed PMID: 30034237; PubMed Central PMCID: PMC6049049.
  6. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82. doi: 10.1097/JCP.0b013e3181ac935c. PubMed PMID: 19593179; PubMed Central PMCID: PMC3600416.
  7. Abdou AM, Higashiguchi S, Horie K, Kim M, Hatta H, Yokogoshi H. Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. Biofactors. 2006;26(3):201-8. PubMed PMID: 16971751.
  8. “Chapter 14- Natural Supplements for Anxiety Disorders.” Anxiety Protocol. Carandang C. 2014. Healthy Mind Research Corporation.
  9. Yoo DY, Choi JH, Kim W, Yoo KY, Lee CH, Yoon YS, Won MH, Hwang IK. Effects of Melissa officinalis L. (lemon balm) extract on neurogenesis associated with serum corticosterone and GABA in the mouse dentate gyrus. Neurochem Res. 2011 Feb;36(2):250-7. doi: 10.1007/s11064-010-0312-2. Epub 2010 Nov 13. PubMed PMID: 21076869.
  10. Alramadhan E, Hanna MS, Hanna MS, Goldstein TA, Avila SM, Weeks BS. Dietary and botanical anxiolytics. Med Sci Monit. 2012 Apr;18(4):RA40-8. Review. PubMed PMID: 22460105; PubMed Central PMCID: PMC3560823.
  11. Sathyanarayanan V, Thomas T, Einöther SJ, Dobriyal R, Joshi MK, Krishnamachari S. Brahmi for the better? New findings challenging cognition and anti-anxiety effects of Brahmi (Bacopa monniera) in healthy adults. Psychopharmacology (Berl). 2013 May;227(2):299-306. doi: 10.1007/s00213-013-2978-z. Epub 2013 Jan 26. PubMed PMID: 23354535.
  12. “Passionflower.” Retrieved from https://nccih.nih.gov/health/passionflower. National Center for Complementary and Integrative Health (NCCIH). 2014.
  13. Modulation of the γ-aminobutyric acid (GABA) system by Passiflora incarnata L. Appel K, Rose T, Fiebich B, Kammler T, Hoffmann C, Weiss G. Phytother Res. 2011 Jun;25(6):838-43.
  14. Maher AR, Hempel S, Apaydin E, Shanman RM, Booth M, Miles JN, Sorbero ME. St. John’s Wort for Major Depressive Disorder: A Systematic Review. Rand Health Q. 2016 May 9;5(4):12. eCollection 2016 May 9. PubMed PMID: 28083422; PubMed Central PMCID: PMC5158227.
  15. van Praag HM. In search of the mode of action of antidepressants: 5-HTP/tyrosine mixtures in depression. Adv Biochem Psychopharmacol. 1984;39:301-14. PubMed PMID: 6380226.

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Dysthymic Disorder: A General Overview

The 3rd subtype of Depression is Dysthymic Disorder, also known as Dysthymia. Dysthymia is a chronic, smoldering form of Major Depressive Disorder. While not as severe and dramatic as Major Depression, Dysthymia lasts a long time, greater than two years in adults, and greater than one year in adolescents. Dysthymia affects 3% to 6% of people. It is one of the 7 subtypes of Depression.

For Dysthymia, you need to experience depressed mood, and at least two of the following symptoms:

  • Sleep: insomnia or hypersomnia
  • Esteem: low self esteem
  • Hopelessness: feelings of hopelessness
  • Energy: low energy or fatigue
  • Concentration: poor concentration or difficulty making decisions
  • Appetite: poor appetite or overeating

People who have Dysthymia experience these symptoms most of the day, most days of the week. In Dysthymic Disorder, if you feel any periods of normal mood, these do not last for more than two months, and there are no major depressive episodes.

You’ll notice that there is a difference for the symptoms of Dysthymia versus a major depressive episode. For Dysthymia, you will use the mnemonic SEHECA, versus the mnemonic SIGECAPS for a Depressive Episode. In Dysthymia, you will see more soft symptoms such as low self-esteem, feelings of hopelessness, and accompanying neurovegetative symptoms with insomnia, low energy, poor concentration, and poor appetite. Major Depressive Disorder (MDD) is more dramatic, and it is easier to pick out the Depressive Episode symptoms such as suicidal ideations, anhedonia, feelings of guilt, and psychomotor agitation/retardation.

The difference is that Dysthymic Disorder is more subtle and exhibits the soft symptoms of SEHECA, while MDD is more dramatic and the depressive symptoms of SIGECAPS are more defined and therefore easier to identify.

Doctors often overlook the diagnosis of Dysthymic Disorder, as they are well-trained to pick out the dramatic neurovegetative symptoms of Major Depressive Disorder, while overlooking the more subtle and covert symptoms of Dysthymic Disorder. Using the mnemonic SEHECA can help to uncover and diagnose Dysthymic Disorder.

The treatments for MDD, which include psychotherapy and antidepressant medications, also work for Dysthymic Disorder. Please review the rest of Depression Boss to learn about the identification and treatment of Dysthymic Disorder and other Depression subtypes.

References:

Sansone, R. A., & Sansone, L. A. (2009). Dysthymic Disorder: Forlorn and Overlooked? Psychiatry (Edgmont)6(5), 46–51.

Bipolar Depression: A General Overview

Bipolar Depression is the depressive phase of Bipolar Disorder, where there is cycling between mania, depression, and sometimes mixed episodes. This is in contrast to Unipolar Depression (Major Depressive Disorder), where there is only depressive episodes, with no manic episodes. Bipolar Depression is just one of the 7 subtypes of Depression, as discussed in a previous article entitled “What is Depression?”

Alas, it can be difficult to tell the difference between Bipolar Depression and Unipolar Depression. You can still use the SIGECAPS mnemonic to determine the presence of a depressive episode, but there are some differences in the presentation of a Bipolar Depression versus a Unipolar Depression:

Bipolar Depression: increased need for sleep (hypersomnia), rejection hypersensitivity (increased sensitivity to rejection), increased appetite, weight gain, and leaden paralysis

Unipolar Depression: multiple early morning awakenings (insomnia), decreased appetite, weight loss, and agitation.

The other main difference between Unipolar and Bipolar Depression is the history of manic episodes in Bipolar Disorder. As with SIGECAPS for a depressive episode, you can use the mnemonic DIGFAST for a manic episode. In addition to expansive, elevated moods, a manic episode needs at least 2 more of the following symptoms:

  • Distractibility (inability to focus)
  • Insomnia (decreased need for sleep)
  • Grandiosity (grandiose delusions)
  • Flight of ideas (racing thoughts)
  • Activity (hyperactivity)
  • Speech (pressured speech)
  • Thoughtlessness (reckless and impulsive behaviors)

So in Bipolar Disorder, there is cycling between manic episodes, depressive episodes, and sometimes mixed episodes (mix of manic and depressive symptoms). And when not in any of those episodes, then there is euthymia, or normal moods. Contrast this with Unipolar Depression, where there is only cycling between depressive episodes and euthymia, with no manic episodes.

It’s important to tell the difference between Bipolar Depression and Unipolar Depression, as the treatment plan for each differs dramatically, and the wrong treatment can lead to worsening of the illness and mood episodes.

photo credit: Risager Valencia via photopin (license)

Major Depressive Disorder: A General Overview

Major Depressive Disorder is the prototypical depressive disorder. When you talk about depression, many people are thinking about Major Depressive Disorder. It is also known as Major Depression and Clinical Depression. Major Depression is just one of the 7 types of depression.

Prevalence

Major Depressive Disorder affects about 7% of adults and 13% of teenagers, making it a common mental illness. It also affects a person’s functioning at home, work, and school. Major Depression also disrupts relationships and self-care. In other words, Major Depressive Disorder can be devastating and life-altering. In some cases, Major Depression can lead to completed suicide, and is a serious consequence of this mental disorder.

Major Depressive Episode

To meet the criteria for Major Depressive Disorder, you must have a Major Depressive Episode lasting for at least 2 weeks. In addition, you must have poor functioning at work, school, relationships, and self-care.

To meet the criteria for a Major Depressive Episode, the episode lasts most of the day and most days of the week, and the episode must include either depressed mood or anhedonia (loss of pleasure and interest in things). In addition, the episode must have at least 5 of the following 9 symptoms for at least 2 weeks:

  • Depressed mood
  • Problems Sleeping (multiple early morning awakenings)
  • Loss of Interest (anhedonia)
  • Feelings of Guilt or hopelessless
  • Low Energy
  • Poor Concentration
  • Poor Appetite
  • Psychomotor agitation (revved-up) or retardation (slowed-down)
  • Suicidal thoughts

SIGECAPS

The easy way to memorize the symptoms of depression is to use to the following mnemonic:

SIGECAPS

  • S: stands for sleep
  • I: stands for interest
  • G: stands for guilt or hopelessness
  • E: stands for energy
  • C: stands for concentration
  • A: stands for appetite
  • P: stands for psychomotor agitation or retardation
  • S: stands for suicidal thoughts

So when you have to consider a Major Depressive Episode, use the mnemonic SIGECAPS, where you have at least 5 of the 9 symptoms. In addition, one of the symptoms must include either depressed mood or anhedonia.

Treatment

The treatment for Major Depressive Disorder begins with psychotherapy. Specifically, interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are the most-researched treatment approaches for mild to moderate depression. For mild to moderate depression that does not respond to psychotherapy, then antidepressant medication treatment may be necessary. These include treatment with SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin Norepinephrine Reuptake Inhibitors).

For severe depression, psychotherapy is often not effective initially. This is because the severe depressive symptoms prevent active participation in therapy due to social isolation, low energy, poor concentration, and poor decision-making. Therefore, antidepressant medication is the treatment of choice for severe depression. Once the antidepressant medication reduces the depressive symptoms, then psychotherapy may be added to help further decrease the symptoms and improve functioning.

So how do you determine the severity of a Major Depressive Episode, and how do you measure it? The answer will be published in an upcoming article on Depression Boss.

photo credit: Send me adrift. Empty via photopin (license)

What Is Depression?

Depression is another term for Depressive Disorders, which are brain disorders based on abnormal brain circuit functioning, maladaptive thinking and behaviors, maladaptive coping to stressors, and mood dysregulation.

Depressive Disorders

Depressive Disorders include the following DSM-IV diagnoses:

All these Depressive Disorders are characterized by the presence of a depressive episode. A depressive episode is highlighted by either depressed mood or lack of interest in pleasurable things (anhedonia). In addition to depressed mood or anhedonia, you also need to have 4 more symptoms of the following to meet the criteria for a depressive episode:

  • Problems sleeping and multiple early morning awakenings
  • Feelings of guilt or hopelessness
  • Low energy level
  • Poor concentration
  • Poor appetite
  • Being revved-up or slowed-down
  • Thoughts of suicide or self-harm

Major Depressive Disorder

The prototypical Depressive Disorder is Major Depressive Disorder (Major Depression). It is characterized by the presence of a depressive episode for at least 2 weeks, and disrupts a person’s normal functioning at home and work, and disrupts relationships, jobs, and self-care. Mild to moderate cases require psychotherapy with a therapist, and moderate to severe cases often require antidepressant medication treatment, then psychotherapy once the depressive symptoms are under control.

Bipolar Depression

Bipolar Disorder is characterized by mood swings, where the sufferer alternates between manic episodes, depressive episodes, or mixed episodes. When a person with bipolar disorder is in a depressive episode, it is difficult to distinguish it from depression associated with Major Depression (or Unipolar Depression). Some caveats: Bipolar Depression tends to be on the opposite spectrum of the manic episode, where a person with Bipolar Depression tends to experience more sleeping (hypersomnia), increased appetite, weight gain, extreme low energy, extreme moodiness to stressors, and rejection hypersensitivity. These symptoms of Bipolar Depression look like what is called Atypical Depression. Treatment of Bipolar Depression requires addressing the manic or mixed episode which will come or has previously occurred. Treatment with mood stabilizers is the standard of treatment, and antidepressants can make the mood swings more unstable.

Dysthymic Disorder

Dysthymic Disorder is basically a depressive episode that lasts for at least 2 years, and is more chronic but less severe than Major Depression. Treatment is similar to the treatment for Major Depression.

Adjustment Disorder with Depressed Mood

People with Adjustment Disorder with Depressed Mood, also known as Situational Depression, experience a depressive episode in response to a known stressor, such as the loss of a loved one, or the breakup of a relationship. The depressive episode only occurs in association with a stressor, and the depressive episode resolves when the stressor is no longer there. Treatment is focused on addressing the stressor, and/or how to cope with it. However, if the depressive symptoms continue despite the stressor being removed, then the person may have developed Major Depressive Disorder.

Substance-Induced Depression

Drugs of abuse, such as cannabis, alcohol, and cocaine, can cause a depressive episode. In addition, prescription drugs and chemicals, such as isotretinoin (Accutane), can cause depression. The depressive episode continues until the offending drug is removed- then the depressive episode lifts. Treatment is focused on addressing the drug abuse or removing the offending substance. However, with continued drug use, the sufferer may go on to develop a Major Depressive Disorder.

Depression Secondary to a General Medical Condition

A general medical condition, such as hypothyroidism, can cause a depressive episode. Treatment is geared towards addressing the underlying general medical disorder, and the depression lifts as a result.

Grief and Bereavement

Grief and bereavement can present as a depressive episode, after the loss of a loved-one. Treatment is focused on supporting the sufferer through their grief process. If depressive symptoms worsen, or if they continue way past the date of the loss, then Major Depression may develop.

Summary

So as you can see, depression is not so simple- it includes multiple depressive disorders as discussed above. When you have depression, look for which type you have listed above.

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