Understanding the Third Stage of Depression

Depression affects people differently but it is believed that people experience depression at stages similar to how people experience grief. Learn about persistent depressive disorder (PDD), bipolar disorder (manic depression), seasonal affective disorder (SAD), pe

Understanding the Third Stage of Depression

Depression is a mental health disorder that can affect people in different ways. It is often described as a set of symptoms, but it can also be seen as a set of stages, similar to how people experience grief. The third stage of depression is often characterized by persistent depressive disorder, bipolar disorder, seasonal affective disorder, peripartum depression, and cyclothymic disorder. Persistent depressive disorder (PDD) is a type of depression that lasts for at least two years.

Symptoms may vary from person to person, but this type of depression is typically “persistent” in nature. People with PDD may experience a depressed mood or loss of interest in activities for most days over a two-week period. Traditional antidepressants are not always recommended as first-line treatments for PDD because there is no evidence that these drugs are more useful than a placebo (a sugar pill) for treating depression in people with this condition. Bipolar disorder, also known as manic depression, is characterized by mood episodes that range from high-energy extremes with a high mood to low depressive periods.

When in the low phase, people with bipolar disorder will have symptoms of major depression. Some traditional antidepressants may increase the risk of causing a high phase of the disease or speed up the frequency of having more episodes over time, so they are not always recommended as first-line treatments for bipolar depression. Seasonal affective disorder (SAD) is a period of major depression that occurs most often during the winter months when days get shorter and you get less and less sunlight. It usually disappears in spring and summer.

Peripartum depression affects women during pregnancy or after giving birth, and the severity of depression can often be quite severe. About 1 in 10 men also experience depression in the peripartum period. Antidepressant medications may help in a similar way to treating major depression that is not related to childbirth. Cyclothymic disorder is often described as a milder form of bipolar disorder. The person experiences chronic fluctuating moods for at least two years, including periods of hypomania (a mild to moderate level of mania) and periods of depressive symptoms, with very short periods (no more than two months) of normal between.

The duration of symptoms is shorter, less severe and not as regular and therefore does not fit the criteria for bipolar disorder or major depression. The goal of treatment in the acute phase is to induce remission. For patients with severe major depression, evidence supports drug therapy alone or combination of pharmacotherapy and psychotherapy. For patients with mild to moderate major depression, initial treatment modalities may include drug therapy alone, psychotherapy alone, or the combination of medical treatment and psychotherapy. Patients with mild or moderate depression may use antidepressant medications as an initial treatment modality. Clinical features that may suggest that antidepressant medication is preferred over other modalities are a positive response to previous antidepressant treatment, significant disturbances in sleep and appetite, severity of symptoms, or anticipation by the physician that maintenance therapy will be necessary.

The patient's preference for antidepressant medication alone should be taken into account. Most primary care physicians can medically treat these patients in their office, as long as they continue to monitor the patient's symptoms closely. The frequency of monitoring in the acute phase of drug therapy is from once a week to several times a week. Psychotherapy alone can be considered as an initial treatment modality for patients with mild to moderate depressive disorder. Clinical features suggesting the use of psychotherapy are the presence of psychosocial stressors, interpersonal difficulties, intrapsychic conflicts and personality disorders. In addition, the patient's preference for psychotherapy alone should be taken into account, as well as the woman's desire to become pregnant, be pregnant or breastfeed. Most primary care physicians will refer these patients to a professional psychotherapist for management.

The frequency of monitoring in the acute phase of psychotherapy is from once a week to several times a week. If you're experiencing ups and downs, it's helpful to make it clear to the doctor or healthcare professional who treats you so they can accurately diagnose any condition you may have.

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