Mood swings?

Depression is one of the so-called affective disorders, which are characterized by a persistent impairment in the brain's ability to regulate emotions and mood . The main affective disorders include depressive disorders (major depression, dysthymia, and unspecified depression) and bipolar disorder.

Depression is the most frequent manifestation of affective disorders and encompasses a series of symptoms that affect:

• Mood: is sad or irritable.
• Motivation: lack of interest and energy. Inability to enjoy things that previously brought pleasure.
• The thought process: is pessimistic, restricted, indecisive.
• The body: changes in appetite and sleep.
• Self-perception: uselessness, guilt, hopelessness.

Therefore, a series of symptoms must be present for clinicians to establish a diagnosis. The symptoms, as specified in the diagnostic manuals used by clinicians, are as follows:

1. Depressed mood or sadness most of the time (for which there seems to be no reason); in children and adolescents the mood may be irritable.
2. Significant decrease in interest or pleasure in all or almost all activities.
3. Significant weight loss or gain.
4. Significant changes in sleep patterns (inability to fall asleep, stay awake, or get up in the morning).
5. Psychomotor agitation or retardation almost every day.
6. Lack of energy and a feeling of constant tiredness.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Decreased ability to think or concentrate, or to make decisions.
9. Recurrent thoughts of death, recurring suicidal ideation without a specific plan. Suicide attempt or a specific plan to carry it out.

To make a diagnosis of depression, at least five of these symptoms must be present, and at least one of them must be symptom 1 or 2. These symptoms must be present for most of the day and for several days (at least two weeks).

I'm very sad. Do I have depression?

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Sadness

It is very important to keep all these criteria in mind, since sometimes a child or adolescent may express that they are sad, but they get up, get dressed, go to school, do their homework, play with their friends and complete their tasks, and their appetite and sleep are preserved, so we cannot speak of depression.

Sadness itself is a necessary emotion, and it's important to give it space and listen to it, as it can offer clues about losses or needs the child may have. Everyone experiences mood swings, and occasional sadness is a normal emotion. The normal stresses of life can lead children or teenagers to feel sad from time to time. Events such as an argument with a friend, a breakup, a poor test result, not being chosen for a sport, a friend moving out of town, or the death of a loved one can result in feelings of sadness, pain, disappointment, or grief. These reactions are usually brief and fade with time and affection.

In contrast, depression is more than just feeling melancholic, sad, or moody from time to time. Depression is an intense mood that lasts for weeks, months, or even longer . To make a diagnosis of depression, the symptoms must cause clinically significant distress or impairment in social, academic, or other important areas of functioning.

One of the main characteristics of depression is the appearance of a symptom called anhedonia, which is characterized by a loss of the ability to experience pleasure and is one of the most disconcerting symptoms for children and adolescents with depression. They often express that they are "bored," or that "I don't have fun when I'm with my friends anymore," or "I used to like playing sports, but I don't enjoy it anymore." This symptom generates significant distress and underlies their abandonment of activities and feelings of hopelessness.

Depression also includes other symptoms such as dysphoria, which can manifest in children as irritability , and be observable by others since it affects the child's behavior (for example, running away, crying, opposition, protests, tics, isolation, hyperactivity, immobility, aggression, etc.).

Other symptoms are not observable and are only accessible through verbal information (e.g., discouragement, lack of interest, feelings of failure, guilt, etc.).

It's important to keep in mind that there isn't just one type of depression. Sometimes depression occurs suddenly, with an acute onset and an acute resolution, which can be followed by possible future episodes with a similar course. This would be called major depression.

Sometimes depression appears more slowly and persistently, lasting for months or even years, without clear periods of worsening or improvement, as if we were constantly feeling a little sad. This form of depression is called dysthymia.

Finally, some depressive episodes could be the first sign of bipolar disorder. These could be described as affective episodes that show two sides, with depressive episodes alternating periodically with manic or hypomanic episodes. Manic episodes are the complete opposite of depression and are characterized by excessive euphoria, feelings of superiority over others or grandiose ideas (for example, being the richest person in the world, the most handsome, the most intelligent, etc.), increased energy with numerous plans and projects, increased creativity, a decreased need for sleep for days without feeling tired, an increased libido that can lead to behaviors such as promiscuity or increased masturbation, a decreased perception of risk, with very risky behaviors, feeling as if one is on top of the world.

Bipolar disorder: what it is and how to live with it

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When manic episodes occur, we would be dealing with what is called bipolar disorder or manic-depressive illness, requiring some changes in the therapeutic approach.

This is an original article from the 12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them".