December 23, 2012

Diagnosis: Unipolar Disorder

Unable to attribute.
Occationally I'll put up a post that has nothing to do with market gardening or hobby farming.  Today I want to talk about my personal experience with mental illness to help a dear friend (we call each other "Bro" and "Sis") who has just been diagnosed with Unipolar Disorder.

The "Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) 4th ed." is the reference book used by mental health workers to diagnose mental illness.  (The book itself isn't online but there's a good "Cliff Notes" version at  That link goes to the page on "Great Depression", aka Unipolar disorder.)

There can be overlap with mood disorders, and often a person is diagnosed with co-morbidities (other disorders as well).  For example, I'm Bipolar and I also suffer from Generalized Anxiety Disorder.

Brief Description of Unipolar Disorder


According to the summary of Unipolar Disorder at (International Foundation for Research and Education on Depression), the symptoms include:
  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Trouble sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment.

Author's Comment: With no disrespect intended,  in my experience males are not in touch with their feelings.  A mood disorder is about feelings: anger, sadness, etc.  Coping with a mental illness requires in-depth scrutiny of all your feelings, not just the ones described in the symptoms.  I'll get to this later.


Treatment can either combine both pharmacotherapy [medications] and psychotherapy or utilize one or the other individually.

Psychotherapy is useful in helping the patient understand the factors involved in either creating or exacerbating the depressive symptomotology. Personal factors may include a history of abuse (physical, emotional, and/or sexual), maladaptive coping skills. Environmental factors involved in this disorder include, among others, a poor social support system and difficulties related to finances or employment.

Author's Comment:  Medication will be prescribed. I've never been in treatment without them. 


Major Depressive Disorder [aka Unipolar] has a better prognosis than other mood disorders in that medication and therapy have been very successful in alleviating symptomotology. However, many people with this disorder find that it can be episodic, in that periodic stressors can bring back symptoms. In this case, it is often helpful to have an ongoing relationship with a mental health professional just as you would a physician if you had diabetes or high blood pressure.

My friend hasn't given me the details - says he'll know more after next month.  So I want to help him get off on the right foot with a bit of advice from someone who's been in his shoes.

  • Develop a close relationship with your care provider.  If you aren't comfortable with him/her and can do something about it - shop around.  It's absolutely essential that you develop a good working relationship.  Be sure you find someone who doesn't arbitrarily dismiss your concerns, someone without the "God complex" so many healthcare professionals possess.  Note:  frequently your care will be managed by an ARNP under the supervision of a psychiatrist.  This is fine.
  • Build a support network.  This includes joining online support groups - you'll have to shop around to find one that meets your needs - and in the beginning at least, I recommend going to group meetings.  A good place to find a group in your area is the Depression and Bipolar Support Alliance (   It's also critical that you get your nearest and dearest educated and on board with helping you manage your disorder.  (But be aware that some people just don't want to deal with it.)
  • Be prepared to spend large amounts of time managing your illness.  This includes studying the disorder until you know everything you can find about it. In my experience you can't just sit back and let the provider manage your care - you have to be proactive. You'll also need to spend time scrutinizing your moods and of course, working at getting better. 
  • Learn how to identify your emotions.  If you use this chart and pair it with the below mood diary, you're well on your way.
  • Look for "triggers".  A trigger is just what it sounds like - anything that deepens your depression.  A mood journal is a good way to identify your triggers.  I like this Mood diary.  It's short and sweet.  And if you look around, there are mood charting apps for your phone.
  • Do not believe anyone who thinks that your disorder can be cured by "pulling yourself up by your bootstraps" or is the result of laziness or lack of self-discipline. You have a legitimate illness.  Would those people say the same things to, for example, a cancer patient??  Just ignore them.  Ditto the people who think your illness is somehow contagious...  You'll need to decide if it's worth your time to try to educate these people or just write them off.
  • Take your medications exactly as prescribed.  Psych medications are touchy things; you have to build up a suitable level in your body in order for them to work properly.  When trying a new drug or drug combo, ask the doctor how long you should give them to work.  Take notes about any side effects, no matter how insignificant they are to you.  And make sure you know what serious side effects can crop up.  Some can be life-threatening.
  • Be patient with the "Medication Roller Coaster".  You'll have to try several meds/combinations to find the one that works for you.  The process can take years (but hopefully it won't.)  The roller coaster effect can be distressing and disheartening.  Some meds will make you worse and some won't help at all.  Because everyone's brain chemistry is different, trial-and-error is the only way to find out what works.  The roller coaster can be very hairy, but stay with it - the right drug/combination will eventually be found.
  • Get enough exercise.  Exercise alone is a mood elevator.  You can find a plan that works for you on the internet.  I find just walking for a while every day helps.
  • Avoid as much stress as you can.  Remember that good things can be stressful, too - like a promotion at work.  Hand off stressful chores and responsibilities to your spouse and/or friends if they're willing.  If you hate your job, try to change careers (that's very stressful at first but enjoying your job makes up for it in the long run.)
  • Do things that give you pleasure even if you don't feel like getting started.  Sometimes it's impossible to overcome the lethargy of depression, but if you can possibly make yourself do fun things the better off you'll be.  Sometimes I find that if I can just get moving, I can carry through.
  • Be patient and compassionate with yourself.  Try to avoid regret, guilt and beating yourself up.  AA members call this "stinking thinking", and it's just as true for those of us with mood disorders. They make things worse.
  • Learn to live in the moment.  Worrying about the future and/or thinking about the past is counterproductive.  Pay attention to what you're doing at every- moment - google "mindfulness" and you'll get the idea.  Most of us are so busy that we spend too much time living in the future, or regretting the past.
  • A Word of Caution.  Carefully evaluate what you find on the internet.  Sadly, there's a lot of misinformation out there.  Your provider can help you sort out the chaff.

Living with Unipolar Disorder is a struggle and the above list is just the tip of the iceberg.  But never give up.  Ever.  Even Pandora's Box had something wonderful in it:  Hope.