Bad days can be signal of more serious mental health issues

November 10, 2003|by Christine L. Moats

According to Mike Shea, administrative director of Behavioral Health Services of Washington County Hospital, most people pay little attention to their own mental health but are quick to notice changes in others. It is not unusual for people to fail to recognize they have had several bad days and have become more irritable with others, withdrawn, or have begun experiencing sleep and appetite changes. These can be early warning signs of more serious issues impacting mental health.

The National Institute for Mental Health (NIMH) reports depression to be the most common form of mental illness in the United States. NIMH estimates one out of five people will experience clinical depression in their lifetime. According to a study conducted in 1996 by the World Bank and World Health Organization, depression is second only to heart disease in health impact worldwide. Richard O'Connor, author of "Active Treatment of Depression," wrote, "In the United States in 1990, the cost of treatment of depression, increased mortality, and loss of productivity was estimated at $44 billion a year, higher than any disease but heart disease, greater than the effect of cancer, AIDS, lung disease, MS, or any other single entity."


The Diagnostic and Statistical Manual of Mental Disorders, a guidebook for mental health diagnosis, reports a person needs to demonstrate five or more of the following symptoms during the same two-week period that represents a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day, as indicated by feelings of sadness or emptiness, or observation of others as being tearful or depressed.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Weight gain, significant weight loss when not dieting, or a change in appetite (increase or decrease) every day.

4. Insomnia (can't sleep) or hypersomnia (too much sleep).

5. Psychomotor agitation (restlessness) or retardation (slowed body movement) nearly every day.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt or a specific plan for committing suicide.

10. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

When these symptoms continue longer than two consecutive weeks, it is considered major depression.

"Experiencing a variety of these symptoms for an extended period of time is the major factor," noted Shea. "The ability to consistently model the healthy characteristics of mental health will diminish the longer and more frequent these negative symptoms are present."

Seek professional assistance when these traits are present greater than two weeks, or sooner if suicidal thoughts are present.

Next Monday's column will focus on what to expect from treatment and where help can be found.

- Sources: National Institute for Mental Health; "Active Treatment of Depression" (2001); "The Diagnostic and Statistical Manual of Mental Disorders."

Christine L. Moats is a wellness coordinator at Washington County Hospital.

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