person must be in a major depressive episode and never have had a manic, hypomanic, or mixed episode. The following account illustrates a moderately severe case of MDD. Jennifer Jennifer is a 35-year-old graphic designer who is married and has three young children at home. She has been running a successful, and growing, business out of her home ice, which she has really enjoyed because working from home allows her the time and flexibil- ity to be with her children when they are not in school. Jennifer expe- rienced a major life stressor 6 months ago when her husband of 15 years, Michael, told her that he is leaving her for a younger woman he met at his job. Jennifer was totally blindsided by this news. After an initial period of trying to work things out, Michael moved out of the house. Jennifer continued on with her business and managing of her household for several weeks, but then things started to change. She felt increasingly sad and would have long periods of crying throughout the day several times per week. Whereas she used to enjoy work, time with her children, and going out with her girlfriends, none of that seemed fun anymore. Even “movie nights” at home with the kids, which was one of her favorite times of the week, just wasn't enjoyable to her anymore. Her body felt heavier and heavier and she lacked the energy to keep up appointments, leading her business to decline-she began losing even her most loyal clients. Jennifer also had difficulties managing her household, on several occasions forgetting to pick up her chil- dren from school and not remembering to make dinner for the family. Her eating and sleeping both declined drastically, and she spent hours lying in bed feeling like she had let down her husband, her children, and her friends. In addition to her extreme sadness, Jennifer began to experience extreme anxiety and worry in multiple domains. How would her business succeed? If she lost her business, wouldn't she lose her house? Would she lose her children as well? Who would take care of them? She wanted to address all of these things but felt paralyzed and unable to take action. This led her to feel even more like a failure. She believed she was completely worthless and began contemplating whether everyone wouldn't be better off if she was dead, which increased to explicit and frequent thoughts of suicide. and anxiety disord 2005). The issues su sion and anxiety, w] tion in recent years, DEPRESSION ASF diagnosis of MDD whether this is a firs or a recurrent episod episodes). Depressi 9 months if untreate people with MDD, 2 years, in which ca diagnosed (Boland Chronic major depres childhood family pro childhood (Angst et a Although most a not said to occur unt. for at least 2 months) some future point. TI two types: relapse ar return of symptoms situation that probab ing episode of depr- (Boland & Keller, 200 relapse may common terminated premature but before the underl & Dimidjian, 2009). Recurrence, which of depression, occurs in people who experience Harkness, 2011). The with the number of pric son has comorbid diso experience multiple de symptom-free in betwee depressive symptoms h- et al., 1998). Moreover, toms, or with significant Jennifer's case illustrates that a person with MDD shows not only mood symptoms of sadness but also a yari- (Goodwin ang, 1996). The following case illustrates both phases of bipolar I cient episo are le disorder ns a far n Sped Up and Out of Control Tim is a 25-year-old student and aspiring poet, rapper, and musi- cian. He was just admitted to a psychiatric hospital in an apparent manic episode. Although he has had a fairly stable life in which he 6o ntil 100 Elin and een. erm the recogs Ві (altho wome young years Bipola mately et al., 2 disorde extreme of cases or imm cases, ti by inter illustrat and dep in bipola disorder they are on only Moreove ence sigr personal many as lives with his girlfriend, Tessa, takes classes at the local community college, and works at a coffee shop in town, his behavior has become increasingly erratic. More specifically, his girlfriend reports that Tim has appeared to be “really sped up" the past month, talking faster than usual, expressing some pretty grandiose ideas (e.g., "I'm going to start and finish a PhD in poetry this year,” “I set up a meeting with Kanye West to discuss signing with him," and "I am Tupac rein- carnated!"). Tessa reports that things have gotten much worse dur- ing the past 2 weeks, during which Tim sleeps just 1 to 2 hours per night and spends the rest of his time in the evenings making music, smoking marijuana, and buying expensive items online (he has maxed out their credit cards buying multiple guitars, turntables, a new refrigerator, and a five-star trip to Paris). She also reports that Tim disappeared for the past 4 days (skipping school and work as well), only to return home this morning saying that he "has been liv- ing with another woman he just met.” Tessa says that this is all very out of character for Tim. Since she has known him he has had peri- ods of pretty severe depression during which he becomes extremely sad, stops playing or making music, sleeps most of the day, and xed own eek, ays. but 120 cast - ety barely leaves the house. However, she has never seen him so sped up and out of control and he has become a completely different person these past few weeks. sonal pro depressio which cas DSM-5 also identifies a distinct form of bipolar dis- order called bipolar II disorder, in which the person diagnosec A Successful "Total Failure" Sophie, a junior in coliege, was getting all A's in her classes, working in her spare time as a research assistant in a psychology laboratory, and had a lot of great friends and a 2-year relationship with the guy of her dreams. Things soon changed, however, when her boyfriend unexpectedly told her that he was leaving her for someone else. Fol- lowing her initial shock and rage, she began to have uncontrollable crying spells and doubts about her other relationships and even about her abilities in the classroom and research lab. Decision mak- ing became an ordeal. Her spirits rapidly sank, and she began to spend more and more time in bed, refusing to talk with anyone. Her alcohol consumption increased to the point where she was seldom entirely sober. Within a period of weeks, her grades plummeted due to her inability, or refusal, to attend class or complete any assign- ments. She felt she was a “total failure," even when her friends reminded her of her considerable achievements; indeed, her self- criticism gradually spread to all aspects of her life and her personal history. Finally, her parents intervened and forced her to accept an appointment with a clinical psychologist. Was something "wrong" with Sophie, or was she merely expe- riencing normal human emotions because of her boyfriend having deserted her? The psychologist concluded that she was suffering from a serious mood disorder and initiated treatment. The diagnosis, based on the severity of the symptoms and the degree of impair- ment, was major depressive disorder. Secondarily, she had also developed a serious drinking problem-a condition that frequently co-occurs with major depressive disorder. by intense a euphoria. Sor only time per moods. Howe at certain tim time points. N types of episc often conceive uum, with no cept is accurat have sympton time period. L. ences rapidly ria, and irritat Types of We will first which a perso then move on person experie The most a depressive depressed or ties (or both) toms such as worthlessness The other episode, in w euphoric, or e sional outburs particularly manic person Most of us feel depressed from time to time. Failing an exam, arguing with a friend, not being accepted into one's first choice of college or job, and breaking up with a roman- tic partner are all examples of events that can cause a depressed mood in many people. However, mood disor- ders involve much mood for
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