Sadness and depression: when do you cross the line?

Sadness or depression?

Nowadays the word ‘depression’ has been so fully absorbed into our daily language that it is often incorrectly used to describe normal sadness.

Sometimes it may occur that intense sadness makes us wonder whether it is a normal and transitory feeling or there is more about what is perceived as sorrow, such as real depression. In this instance, it is important to be aware of it and in case the boundary is crossed, seek appropriate help as depression is an actual disease which should be dealt with as soon as possible.

Let’s have a look then at the differences between sadness and depression.

The differences between sadness and depression

Sadness is an emotion that we often experience in our everyday life and that is usually categorised as a ‘negative’ and ‘unwanted’ feeling. Sadness is generally caused by missing out on our aims or goals which seem no longer achievable. Depending on how important the goal is and its specific meaning to us, we may experience a more or less intense feeling of sadness. For example, the intensity of the sense of sadness will be very different if applied to an unsuccessful application for a temporary and maybe not-so-wanted job as opposed to the instance of not getting our dream-life position.

Usually sadness is linked to specific events or thoughts, is time-limited and doesn’t prevent us from experiencing positive feelings if happy and joyous events occur. Furthermore, it doesn’t have a significant influence on our biological rhythms and daily functioning.

On the contrary, depression brings consistent and identifiable changes and symptoms in our habits and lasts for longer. First of all, a wake-up call related to a depressive episode occurs if the symptoms and low mood persist for at least a period of two weeks, in which they manifest most of the time and most of the days.

The core symptoms are severely low mood and lack of interest in the activities that used to stir up a positive response within ourselves, such as a sense of interest and engagement. When depressed, we are no longer interested in and motivated to undertake activities or hobbies as they no longer bring us any sense of pleasure. We may also feel like we have no energy for them at all. We may not care at all about going out, hanging out with friends, spending time with our partner (engaging in sexual activity as well), going to work, playing our favourite sport, etc. It may even occur that we neglect self-caring tasks. Low mood and a lack of interest will make us perceive the world as emotionally dull and grey, as though colours no longer exist.

As mentioned above, depression brings changes in our biological rhythms as well.

Different types of change in sleep habits, appetite and motor activity are reported. As a matter of fact, sleep problems or a tendency to sleep in can be observed as well as significantly increased or reduced appetite (and therefore weight gain or weight loss) and retardation or agitation related to motor activity.
Cognitively speaking, we may suffer from concentration problems, have trouble making decisions and often feel guilty, unworthy and hopeless about the future. In particular, the future may be perceived as an infinite extension of a worthless today. Several cognitive biases tend to maintain this hopelessness-related point of view.

As you can see, depression manifests in different ways with different symptoms, but the common denominator is a significant change in the functioning of the person, intense, strong and long-lasting symptoms and a significant impact on everyday life.

What to do

If you have the feeling that your low mood may not be linked to momentary sadness, keep an eye on it and if you recognise yourself in the aforementioned symptoms, consult a specialist. A psychotherapist, and in mild or severe cases a psychiatrist, can help you understand and tackle the issue.

Irritable bowel syndrome: can psychotherapy help?

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, affecting around 11% of the general population, that tends to be chronic and is certainly bothersome. Even if usually no inflammation or tissues alteration is present, IBS may be a very disturbing and distressing condition, that significantly worsens a person’s quality.

Irritable Bowel Symptoms

People suffering from IBS may experience a great variety of symptoms:

  • abdominal pain: its intensity is usually mild and not severe, it may follow food ingestion and stop after evacuation
  • cramping and/or bloating
  • constipation or diarrhea
  • gas and/or mucus.

The risk factors of IBS are: being woman, being under 45, having a familiar history of IBS and having a mental health problem.

The causes of IBS are still unknown, but it is very likely that several concomitant factors may play a role.

Furthermore, stress seems to have an impact in worsening the syndrome. In particular, the stress condition caused by suffering from IBS may itself create a vicious cycle, fostering IBS symptoms and consequently creating more anxiety. Moreover, it seems that up to 70-90% of people suffering from IBS may experience psychological difficulties, more likely mood or anxiety disorders.

What is neuroscience telling us?

The tight relationship between our brain and our bowel is not a novelty, but in the last decade neuroscience has given us amazingly interesting new information about it.

It seems that our brain and our guts are in constant communication, both influencing each other through top-down and bottom-up processes. But we are not talking only about digestion-related information: our guts have been defined by scientist M. Gershon like a real “second brain”.

Our “second brain” contains indeed around 100 millions of neurons that are responsible for digestion but also for making us experience the so called “gut feelings”, such as “butterflies” in the stomach. Furthermore, it seems that those feelings can have an influence on our mental states even if no conscious thought or decision-making can be undertaken by our second brain. In particular it seems that some specific macrobiota in our guts may impact the functions of our central nervous system; in mice, an impact on anxiety and stress-related behaviours has been found.

Can psychotherapy help?

If you suffer from IBS and you believe you are suffering from anxiety and stress, you may consider taking care of this to avoid a worsening of your IBS.

Research has showed high comorbidities of anxiety and mood disorders in IBS patients, the problematic vicious cycle that anxiety may create and the consequent risk of perceiving a poor quality of life.

Psychotherapy may help you with the aforementioned psychological issues, as our mind and our bowel are so deeply interconnected.

Furthermore, research has showed promising results on the efficacy of psychotherapy, in particular cognitive behavioural therapy and therapies involving relaxation techniques, in improving IBS symptoms, anxiety and the patient’s quality of life.

Suggested links

Irritable Bowel Syndrom Network UK

Bibliography

Al-Asmakh, M; Anuar; Zadjali, F; Rafter, J;  Pettersson, S. “Gut microbial communities modulating brain development and function”. Gut Microbes 2012 Jul-Aug;3(4):366-73. Epub 2012 Jun 29.
Blanchard, E; Lackner, JM; Sanders, K; Krasner, S; Keefer, L; Payne, A; Gudleski, GD; Katz, L; Rowell, D; Sykes, M; Kuhn, E;  Gusmano, R; Carosella, AM; Firth, R;  Dulgar-Tulloch, L. “A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome”. Behavioural Research and Therapy, April 2007, vol 45(4):663-648.
Garakani, A; Win, T; Virk, S; Gupta, S; Kaplan, D; Masand, PS. “Comorbidity of Irritable Bowel Syndrome in Psychiatric Patients: A Review”. Am J Ther. 2003 Jan-Feb;10(1):61-7.
Kuo, B; Bhasin, M; Jacquart, J; Scult, MA; Slipp, L; Riklin, El, Lepoutre, V; Comosa, N; Norton, BA; Dassatti, A; Rosenblum, J; Thurler, AH; Surjanhata, BC; Hasheminejad, NN; Kagan, L; Slawsby, E; Rao, SR; Mackin, EA; Fricchione, GL; Benson, H, Libermann, TA; Korzenik, J; Denninger, JW. “Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease” PLoS One. 2015 Apr 30;10(4):e0123861. doi: 10.1371/journal.pone.0123861. eCollection 2015.

Bereavement: Maria’s experience

Bereavement

Bereavement is an extremely touching experience, difficult to articulate in words. The normal reaction to losing a beloved person implies a mix of feelings that can vary from deep sadness to guilt, anger or emptiness. Usually the person experiences the tendency of spending some time by himself/herself in order to cry for the loss, remember the memories, realise what has happened and “adjust” his/her life with the absence of the departed one.

The five stages of grief

Even if psychologists support the theory of the Five Stages of Grief theorised by Elizabeth Kubler Ross, everyone has its own specific pattern of reaction. Usually we need a variable amount of time in order to cope with a loss and it is proportional to the intimate meaning and role that the departed person represented to us.

Often, the very first reaction to some shocking sad news is denial. Many times people remember that their first thoughts were: Are you serious? What are you talking about? That is not possible! Denial is a primitive and protective reaction and it can manifest in different forms: for someone denial can last only few minutes, for others it can last few hours or even days; the person can feel shocked, stunned, turned upside down without realising what is going on and without feeling the relative emotions yet. Denial can then be followed by angerWhy is this happening to me? Why him/her? It is not fair! Why did he/she leave? Anger is a protective reaction as well; our anger can be addressed to different objects or persons, even the beloved one.

After anger, the person usually enters the bargaining stage, when he/she starts to look for explanations and faults about what happened. The universal and most known stage is then the depressive one, when sadness and regrets are dominant. On the contrary, the last stage is characterised by acceptance: realising and accepting the death of the loved person is the first step to go back to reality.

Not everybody is able to reach the acceptance stage: it can happen, for many different reasons, that a person gets stuck in one of the previous stages and needs a little help to elaborate the loss.

What to do

If we have trouble in elaborating bereavement, time is not healing our wounds and we have the feeling of being trapped by intense and sometimes contradictory emotions, psychotherapy can be a useful tool to get past this.

This is for example what happened to one of my first patients and how therapy worked for her.

Maria’s experience

She was a lovely and smart lady over 80 years old, who I will call Maria here; she lost her husband a few years earlier and she was stuck in the depressive stage. Actually Maria didn’t just lose her husband, she had lost her unique, special and long-lasting love after 60 years of marriage, the person she totally relied on for almost all of her life. And she was not able even to think about her life without this precious man by her side. Maria was very depressed and felt lost; no antidepressant was helping her so she decided to start psychotherapy.

Psychotherapy supported her while going through almost all the stages of loss. Indeed she was not alone while she was crying all her tears, expressing all her anger towards her condition and her dead husband who left her alone, while passing through guilt and every regret and remorse. In the end psychotherapy helped her searching and strengthening her personal dispositions that could help her in coping with that difficult period. Little by little, Maria started reorganising her life, finding new ways, new goals and new meanings. After two years of therapy, Maria decided that it was time to end psychotherapy: she realised that she will always be missing her husband, that she could never forget him, but that she could focus on her nephews, her family and friends to feel better. And in that moment she felt that she could do it by herself.

This is a good example of how a psychotherapist can indeed help you express and understand your feelings, realise what is keeping you stuck in a particular stage of grief and prevent you from coping with your loss.

Why change can be so scary?

“There is nothing permanent except change”, Heraclitus

Change: a six-letter word that can enclose and raise so many different feelings and meanings in each of us.

For some change may imply new thrilling experiences when they can test themselves, explore unknown territories and create better ways of living. On the contrary for others changing may be a mandatory and unavoidable step, at times not wanted and burdened with suffering, but possible to deal with. Moreover, for other people change is really scary and may imply the total breakdown of what is “well known” and bring them in a terrific spot of unknown and uncertainty. In these cases, tightly grasping to the past may be a solution.

Why is change so important?

As Heraclitus quoted back in 400 A.C., change is probably the only permanent thing in life.
Darwin explained this concept very well in his Evolutionary Theory: changing allows organisms to better adapt themselves to their environments. Moreover, the better the organism is able to adapt, the higher the likelihood of survival.

If change is natural, why can it be so scary?

Change can refer to thousands of different situations with extremely different features. Obviously the potential scariness will depend on many characteristics, such as how much it was expected, wanted and foreseen, if positive or negative consequences will result from it (their extent and how definitive they are), the amount of secondary changes that it may imply, how much we feel able to deal with it, etc.

Try to think about some of the following important changes that can happen in a lifetime and try to relate them to the aforementioned features: finishing school and starting to work, a marriage or a divorce, a betrayal, changing job, changing city, becoming a mother, the loss of a loved one, going into retirement … the list is potentially infinite.

Each of these changes may assume different meanings to each of us depending on our personal history, current lifestyle, our goals and our intimate beliefs. But a common denominator is that our self-esteem will influence how we will manage these changes: the more we feel that we are able to cope with the related changes and difficulties, the less scary the change will be.

And what if we feel that we are not strong enough, independent enough or lovable enough to succeed in getting through an important change?

In these cases change can be faced in different ways.

Someone could go through it with an intense pain, anxiety or sadness managed with its own specific coping mechanisms. For example someone could find relief by increasing their control over everyday life, or by being extremely dependent on the partner/parents/friend.

On the contrary other people may be so scared about a potential change that he/she may try to stay ahead in the game and work hard to avoid it in the first place.

Instead other people may react to change misrepresenting it, not taking into account its consequences, minimising it or pretending it’s not happening. But denial and keeping our eyes closed will not eventually change things; on the contrary this solution may disconnect you from reality, that sooner or later will intensely materialise.

Usually our typical pattern of reaction to new information is consolidated in the attachment relationship with our parents; but with clinical work it can be changed.

If you recognise yourself in having issues at adapting and accepting important changes in your life, you may try to think about the dynamics written above.

What is scaring you? What are the feared consequences? What are your intimate beliefs about yourself dealing with this change?

Sometimes it may be hard to go through this alone by ourselves. Psychotherapy can help you realise what is preventing you to adapt to how your life is turning out. Moreover, it can help you achieve more flexibility and strengthen your self-esteem.

Being aware of what is happening is, as a matter of fact, the first step to change.

How to cope with bipolar disorder

Bipolar Disorder

As the former quote says, mood swings are the core feature of people with bipolar disorder.

As a matter of fact, events can trigger the mood swings, making the person feel the related excitement or sadness in such a deep way.

Bipolar disorder is an affective disorder that implies strong mood swings, from mania or hypomania to deep depression, alternating with periods of time with mood in a normale range.

There are two types of bipolar disorders:

  • Type I: periods of intense activation and excessive mood elevation alternates with periods of deep depression. During mood elevation, the person doesn’t need to sleep as much as usual, acts in a different way from how he normally does, has an extreme self-confidence that could bring him to get involved into potentially dangerous situations (excessive speed driving, gambling, not safe and/or promiscuous sexual activity, …). This elevation is so intense that it gets very difficult to handle and potentially dangerous for the person himself or the people who surround him, requiring then a hospitalisation. Sometimes mixed states can be present: the person can experience symptoms of mania and depression at the same time.
  • Type II: periods of time with hypomania alternate with periods of depression. Hypomania means having a less intense mood elevation, that never requires a hospitalisation. Even if the mood swings are less intense, their impact and consequences are anyway impressive.

Bipolar disorder treatment?

Bipolar disorder can be managed with an appropriate pharmacotherapy with mood stabilisers prescribed by a specialised psychiatrist, that will help you in controlling these swing and that should be very regularly taken.

Cognitive Behavioural psychotherapy is a parallel tool that is highly recommended by NICE guidelines (National Institute of Health and Care Excellence) in the treatment of bipolar disorder.

As a matter of fact, psychotherapy can be very helpful to better cope with the consequences of the swings and to adjust your lifestyle to prevent mood changes and to better cope with them. The best ways to prevent mood changes are indeed pharmacotherapy and adopting a very stable and healthy lifestyle.

As Sun Tzu said, “keep your friends close, but your enemies closer”. Cognitive Behavioural Psychotherapy can help you in getting to know bipolar disorder, in having a better awareness of it and in early recognising when the mood is changing so that you will be better prepared to deal with it before it gets worse.

Bipolar disorder can be a heavy burden; but with a good specialised help, you can arrange the best solution for you to cope with it.

Related articles:

“Life on a swing: sharing life with the bipolar disorder” by Ilaria Tedeschi.

Suggested links:

www.bipolaruk.org.uk

http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/bipolardisorder.aspx

http://www.isbd.org

Attachment: that special bond in our intimate relationships

Attachment: what it is

Attachment belongs to the motivational systems of the human being and it is always active in our lifetime.

It defines how we relate to the people we get in a deep relation with, involving intimate beliefs about our loveliness and other people’s affective availability, and consequently the expectations we have about these relations.

In early years, the first person who allows us to experience attachment for the first time is usually our mother. This relationship will have an intense influence on developing the first beliefs and general rules about interpersonal relations.

Types of attachment

In early years, as in adult life, we can discriminate between secure and not-secure attachments.

Different types of attachment are not be considered as separate categories but as elements of the same continuum, with different shades and characteristics.

Adults with a secure-style tend to develop long-lasting and healthy relationships based on mutual trust; the partner represents a secure base to leave in order to explore the environment and to rely on with hope and trust.

People with an ambivalent-style have usually experienced in infancy an unpredictable mother, who intermittently responded and not responded to the kid emotional needs. Those kids developed a feeling of not constant loveliness. When adults, they will probably experience the same unpredictability in relationships, where sometimes they will feel an intense love from the partner and other times and intense rejection.

On the other hand, adults with an avoidant-style were once kids with distant and dismissing mothers; they learned to inhibit their emotional needs in order to prevent rejection. They will become adults who will not experience an intense emotional involvement in relationships and who will stay at a safety distance from intimacy.

Attachment in lifetime

Attachment styles tend to consolidate during the first years of life.

But recent theories suggest that each life stage can represent for attachment an opportunity to change; furthermore, particular life events or psychotherapy processes can allow a change from a un-secure attachment towards a more secure one.

 

Photo credits @Rachel Kramer

The effects of stress in pregnancy

Pregnancy can be a stress trigger in women, as it is a moment of several physiological, psychological and social changes. Due to the intensity of these changes, it’s normal for women to experiment stress in little doses.

What are the symptoms of stress in pregnancy?

Stress implies an intense physiological activation while trying to adapt to significant environmental events (stressors).

Hans Selye, theorising the General Adaptation Syndrome, recognises three different stages of response to a stressor:

  1. Alarm: we react to stressors through an activation of our sympathetic system, increasing the heart beat, blood pressure, breathing activity, endocrine secretions, perspiration, bodily temperature and muscle tension.
  2. Resistance: our body is coping to face the stressor and the alarm symptoms disappear.
  3. Exhaustion: if stressors persist there can be a burn-out of our defences, with symptoms like fatigue, sleep disorders and decrease of immune system. Stress is not pathological per se, as in small doses it helps us to better concentrate and to have a better performance.

Can stress during pregnancy have effects on the baby born?

Some researches highlighted that an intense and prolonged stress could negatively affect pregnancy, possibly leading to a higher risk of pre-term birth and a lower weight of the baby. Specifically, stress could be not directly responsible for those consequences: it could lead indeed the mother to adopt unhealthy behaviours to better cope with it, such as the use of tobacco, alcohol, …

An intense and prolonged stress could possibly have an impact on the foetus motor skills, with a decreased number of movement assessed with ultrasounds. Moreover, other researches found a higher presence of childhood infective diseases, and consequently a higher use of antibiotics, in babies of mothers stressed during pregnancy.

Some scientists observed that baby girls exposed to high levels of cortisol during the first weeks of gestation had a bigger amygdala’s volume. Amygdala is a part of the brain responsible for emotions processing. This could suggest the chance of a higher risk of developing lifespan affective disorders, such as anxiety, depression, or others. The foetus exposure to high levels of cortisol during gestation could then represent a risk factor for later psychological problems.

Last but not least, intense stress/anxiety in new mothers could interfere in bonding and creating a safe attachment with their babies, making it more difficult to respond to the babies’ emotional needs.

Which tools can be used to reduce stress in pregnancy?

After considering the possible consequences of stress, it is very important to recognise when stress becomes too intense and to try to cope with it at our best.

There are several effective tools than can be used to better cope with stress and anxiety, such as relaxation techniques (progressive muscle relaxation, biofeedback or slow breathing technique), meditation (yoga, mindfulness) and psychotherapy. Furthermore, do not underestimate the importance of a constant physical exercise, healthy eating and regular sleep-wake cycles.

Is there a link between stress in pregnancy and the baby’s gender?

A research carried out at Oxford University suggests that the mothers’ work and problems “choose”  the baby born gender.

They found indeed that women stressed during pregnancy are more likely to conceive baby girls. In their sample indeed, women with high levels of cortisol had 75% of chance of not conceiving a baby boy.

These interesting results have to be considered as preliminary, as the high levels of cortisol could suggest not only the presence of stress but also the possible presence of other aspects or life-styles that could affect the baby’s gender.

To read the original article, click here.