Specifiers for Mood Disorders

Specifiers allow for a more specific diagnosis, which assists in treatment and
prognosis. A postpartum onset specifier can be applied to a diagnosis of
major depressive disorder or bipolar I or II disorder if the onset is within
four weeks after childbirth. Symptoms include fluctuations in mood and
intense (sometimes delusional) preoccupation with infant well-being. Severe
ruminations or delusional thoughts about the infant are correlated
with increased risk of harm to the infant. The mother may be uninterested
in the infant, afraid of being alone with the infant, or may even try to kill
the child while experiencing auditory hallucinations instructing her to do
so or delusions that the child is possessed. Postpartum mood episodes severely
impair functioning, which differentiates them from the “baby blues” that affects about 70 percent of women within ten days after birth.
Seasonal pattern specifier can be applied to bipolar I or II disorder or major
depressive disorder. Occurrence of major depressive episodes is correlated
with seasonal changes. In the most common variety, depressive episodes
occur in the fall or winter and remit in the spring. The less common
type is characterized by depressive episodes in the summer. Symptoms include
lack of energy, oversleeping, overeating, weight gain, and carbohydrate
craving. Light therapy, which uses bright visible-spectrum light, may
bring relief to patients with a seasonal pattern to their mood disorder.
The rapid cycler specifier can be applied to bipolar I or II disorder. Cycling
is the process of going from depression to mania, or hypomania, and
back or vice versa. Cycles can be as short as a few days or as long as months or
years. Rapid cycling involves the occurrence of four or more mood episodes
during the previous twelve months. In extreme cases, rapid cyclers can
change from depression to mania and back or vice versa in as short as a few
days without a normal mood period between episodes. Seventy to ninety
percent of rapid cyclers are both premenopausal and postmenopausal
women. Rapid cycling is associated with a poorer prognosis.

Sources for Further Study
Copeland, Mary Ellen. The Depression Workbook: A Guide for Living with Depression
and Manic Depression. Oakland, Calif.: New Harbinger, 1992. This
workbook for coping with depression is based on a study of 120 people
with depression and manic depression. The author includes sections on
possible causes of mood disorders and offers advice about building a support
system, finding a health care professional, building self-esteem, and
preventing suicide.
Court, Bryan L., and Gerald E. Nelson. Bipolar Puzzle Solution: A Mental
Health Client’s Perspective. Philadelphia: Taylor & Francis, 1996. The authors
provide answers to questions asked by support group members
about living with manic-depressive illness.
Cronkite, Kathy. On the Edge of Darkness. New York: Dell, 1994. A collection of
celebrity accounts of their personal experiences with depression. The
reader is invited into their experiences of what depression feels like, how
it is treated, and the consequences to the individual and family.
Dowling, Colette. “You Mean I Don’t Have to Feel ThisWay?” New Help for Depression,
Anxiety, and Addiction. New York: Macmillan, 1991. Presents the biological
basis of disorders including bulimia, depression, and panic disorder.
Includes a section on getting help through psychotherapy and
medication.
Gold, Mark S. The Good News About Depression: Breakthrough Medical Treatments
That Can Work for You. New York: Bantam Books, 1995. The author, a
biopsychiatrist, guides the reader through treatments available to people
with depression. He describes conditions that mimic the symptoms of depression.
Healy, David. The Creation of Psychopharmacology. Cambridge, Mass.: Harvard
University Press, 2002. Details the discovery and development of psychiatric
medications (including antidepressants), the extremely profitable
partnership between psychiatrists and the large pharmaceutical companies,
and the frightening consequences for today’s culture and society.
Ingersoll, Barbara D., and Sam Goldstein. Lonely, Sad, and Angry. New York:
Doubleday, 1995. Provides information about depressive disorders in
children and adolescents. Includes guidelines on how to react to a crisis,
what to expect in the future, and how to get family help. There is also a
section on recognizing depression in the classroom.
Moreines, Robert N., and Patricia L. McGuire. Light Up Your Blues: Understanding
and Overcoming Seasonal Affective Disorders.Washington, D.C.: The
PIA Press, 1989. The authors, both biopsychiatrists, describe the symptoms,
causes, and effects of seasonal affective disorder. They also describe
phototherapy.
Nelson, John E., and Andrea Nelson, eds. Sacred Sorrows: Embracing and
Transforming Depression. New York: Jeremy P. Tarcher/Putnam, 1996. This
is an anthology of personal experiences, biological research, psychological
research, and spiritual traditions written by psychiatrists, psychologists,
social workers, novelists, philosophers, and teachers. The book provides
a firsthand experience of depression and a look at theories about
why people become depressed. Some of the essays discuss treatments including
medication, physical exercise, psychotherapy, and raising planetary
awareness.
Radke-Yarrow, Marian. Children of Depressed Mothers. New York: Cambridge
University Press, 1998. Presents a developmental perspective on the children
of depressed mothers. The book reports the results of a longitudinal
study of children and their families.
Thompson, Tracy. The Beast: A Journey Through Depression. New York: Penguin,
1996. A journalist tells the story of how she came to terms with her
depression. Good firsthand discussion of symptoms such as short-term
memory deficits, anxiety, anhedonia, and changes in sleep patterns, sensation,
and perception. Her account includes a frank discussion of feelings
of isolation and thoughts of suicide.
Elizabeth M. McGhee Nelson
See also: Bipolar Disorder; Clinical Depression; Depression; Drug Therapies.