May 11, 2020 By Julie Rael, LCSW, CCO Valley Behavioral Health In honor of Mental Health Awareness Month, I would like to continue the discussion around mental health awareness and highlight the various mental and behavioral health needs that individuals deal with. Last week’s blog explored the issue of grief and loss. This week I want to focus on mood disorders and the common discussion points around mood fluctuations that are often referred to as “mood swings”. There are some misconceptions around depression and mood fluctuations that I want to clarify and raise understanding of so that people will know when to seek treatment. Also, I want to provide some insights into what can impact our moods and how we can examine these as a source of information to better inform decisions to improve our mental health. Mood disorders are categorized and diagnosed by most clinicians with The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013. These categories include descriptions, symptoms, and the necessary criteria for a diagnosis of a mood disorder. There are four categories of mood disorders that include dysthymia, major depressive disorder, bipolar disorder, mood disorder due to a general medical condition, and substance-induced mood disorder. There are subtypes of these disorders, but the major difference between the depression and bipolar disorders is that bipolar disorder includes a history of manic or hypomanic episodes whereas major depressive disorder only has depressive episodes. These mood disorders and their subtypes warrant evidenced-based treatments that include medication and therapy. Sometimes individuals tend to forgo the therapy, but I urge those seeking treatment to fully utilize therapy, as it is essential to address concerns that can exacerbate or arise during the patient’s depressive episode as well as help with implementing other interventions in your daily routine to accelerate your recovery. In last week’s blog, it was advised that you seek behavioral health treatment if you notice your low mood occurring for several weeks as this would warrant a concern that you may have a mood disorder that can be addressed with behavioral health treatment. You will also need to seek treatment if you experience interruptions in your sleep patterns where you are not sleeping for three or more days and don’t feel the need to sleep and have an unusual amount of energy, and you or your loved ones notice that you are not are your usual self and are engaging in risky behaviors. It may come as a surprise to some, but fluctuations in our moods and periods of sadness are a normal part of the human experience. These fluctuations are largely influenced by recent events, interactions with others, and daily stressors. As we make our way through our day, we can experience a host of events, thoughts, and perceptions of these and can feel upset one moment and then calm and peaceful the next. The chain of events described above can look different from one individual to the next in the range and intensity of emotions they experience. Some are more demonstrably emotional than others, while others seem more stoic in their response to things. These mood fluctuations don’t qualify as a mood disorder, however, if the intensity and duration of these increase to the point that it impacts one’s quality of life, relationships, and daily functioning, then further clinical considerations need to be explored. If you or a loved one experiences intense and what seems to be an overreaction to certain events, please don’t fall into the common pitfall of self-diagnosing you or them with bipolar disorder. You may have heard some people refer to someone as “bipolar” or having a “bipolar moment”, but this term is very inaccurate and can be harmful as it increases stigma and prevents them from getting the most appropriate treatment. If you are someone that was diagnosed with bipolar disorder, but you have not experienced periods of decreased need for sleep and your mood fluctuations don’t respond well to medications, please seek a second professional opinion on this diagnosis. Remember that to meet the criteria for this diagnosis there needs to be a history of manic episodes. If you do not have a history of manic episodes, then there may be other clinical considerations that a licensed mental and behavioral health clinician can assess. If you have experienced prolonged concerns with your moods or have experienced new concerns, you can begin monitoring and documenting these as you prepare to start treatment. The information that you gather during this monitoring period can help you and your treatment provider identify the root of your concerns quickly, inform treatment recommendations, and accelerate your treatment plan. Below are actionable steps that I discussed in last week’s blog, to help you increase your mental health awareness and help with the monitoring and documentation process. If you are already in treatment and seeing a therapist, these methods can help you prepare ahead of time for your appointments. These methods include: • Keeping a journal. • Spending time in quiet solitude and examining your thoughts during the week. • Checking in with your self regularly and noticing your thoughts and moods throughout the day. • Noticing how various events and your thoughts associated with them impact your experiences and moods. • Observing how you feel emotionally and mentally after an activity or interaction and your associated thoughts. • Considering how you feel around various people and why you may feel that way around them. • Taking note of patterns in your thoughts and moods and how these impact your behaviors and interactions with others. Please know that the methods above are suggestions for monitoring your moods and not a requirement for treatment. You don’t need to worry about following the methods above precisely, and as you get started you will find the methods that may work best for you. Also, remember to ask for questions and guidance at any time in your treatment. Your mental health is important, and your Valley Behavioral Health provider wants you to begin feeling relief from your concerns as soon as possible. Resources American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.