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OF mental health care and mentally ill

unipolar depression symptoms

In unipolar depression, the person feels only depressive symptoms. In bipolardepression, the person will experience a range of moods; this will stretch fromfeeling profoundly low in mood to feeling extremely elated. An important point to remember here is that these depths and range of moodsdo not necessarily correspond to a precipitating event in the person’s life, althoughin some cases they can. Bereavement, feeling very sad after a person close to youhas died, is a natural process that moves along at a pace unique to an individual. The important thing is that, eventually, the process comes to an end and the individualaccepts the loss and moves on with their lives. For some people, this process isprotracted and they remain in a very low mood for a very long time.People who have problems with mood disturbance or depression can show acollection of behaviours and ideas that form ‘symptoms’, that is they tend to beconsistent from one person to another. They can be grouped as:

• emotional symptoms

• cognitive symptoms

• motivational symptoms

• somatic symptoms.

In the emotional or ‘feelings’ area, the person may indicate that they arefeeling ‘sad’, ‘low’, ‘helpless’, ‘unhappy’, ‘worried’, ‘useless’ or ‘guilty’. Aperson may find that these feelings alter in severity depending on the timeof day with the most profound feelings happening in the morning with alightening of mood later in the day. Along with these feelings can go aloss of satisfaction with occupations or pursuits that once gave them pleasure.Some people who enjoyed going out avoid doing so, and as a result becomequite isolated. Eventually, this profound low mood will affect some biologicalfunctions, for example eating and enjoying sex; there will be a generalloss or lowering of appetite.

A person who is very low in mood will have recognisable cognitive (howthey think – the process of thinking) symptoms. Such people tend to thinkof themselves in a very negative light and may have quite low self-esteem.They may think that they lack the qualities of a successful person and thatthey are inadequate. They may think that they are significantly less attractive,intelligent or generally talented or lacking in competence than otherpeople. Figure 8.1 provides an example taken from a cognitive behaviouraltherapy session with a depressed client.

From the dialogue in Figure 8.1 it can be determined how low in esteem thepatient is and how he finds it difficult to credit himself with success. The therapist isattempting to engage the client in an objective examination of the false assumptionsthat the client is burdened with in relation to his competence in hanging wallpaper.People who are in this low-mood nexus also believe that their future is one ofhopelessness, and this view is very difficult to dislodge. People in this conditionfeel that their actions will have no positive outcome.

People have different levels of motivation; for example being quite enthusiasticabout going on holiday and the need to prepare for this event. Going back to workon the Monday morning after our holiday will, for most people, not fill us withenthusiasm; however, the important thing is that we do go to work – we haveenough motivation to get us there. People who are in a very low mood find itvery difficult to get any task started. Some depressed people can be found justsitting motionless day after day. In the most severe cases, some people cannot bring themselves to do things that are necessary to maintain life, such as eatingand drinking. For the person who is depressed, every decision is a momentous one,even deciding whether to eat or to get dressed in the morning.

Somatic symptoms (symptoms of the body) are quite marked in severe depression.The most common one is loss of appetite leading to a significant reductionin weight. The person’s sleep pattern is affected and they may complainof fitful sleep and waking up quite early in the morning. There is a markedloss of interest in sexual activity; men may experience erectile difficulties andwomen a lack of sexual arousal . As well as thesesymptoms, the depressed person can become susceptible to infections such asinfluenza.

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