The Blues: Depression, Bipolar, and Suicide in Young Adults

By: Dr. David Hamilton, MD, Associate Medical Director, Center for Clinical Neuroscience at Yellowbrick

We all experience “The Blues”. The demands of work, school, love, family and friends are all competing for our limited emotional and mental resources. This ongoing competition can lead to stress and transient sadness. This is a normal part of healthy mood functioning. “The Blues” is how our brains tell us that the demands on our life are outpacing our ability to manage them. While “The Blues” can lead to clinical depression, they are not depression.

The differences between “The Blues” and depression are characterized by what psychiatrists call neurovegetative and neurocognitive symptoms of depression. Neurovegetative symptoms include: sleep problems (too much or too little); lack of motivation and energy; diminished sex drive, and disrupted appetite (again either eating too much or too little).

Neurocognitive symptoms can include: deep despair or the absence of any feelings at all; feelings of guilt (even guilt about feeling sad), hopelessness about the future, feeling helpless to change anything about one’s life, feelings of worthlessness. Perhaps the most insidious symptom is anhedonia: the inability to experience pleasure. Even the activities or relationships that we normally count on to help us feel better fail to penetrate the despair of depression. Thoughts of ending one’s life begin to seem like a solution when we feel like nothing will lift feelings of sadness or numbness. The presence of five or more of these neurovegetative and neurocognitive symptoms is called a Major Depressive Episode (MDE). The diagnosis most likely associated with a MDE is Major Depressive Disorder (MDD). MDD is a serious medical condition and should be treated by a qualified mental health professional or your physician.

MDD is not the only diagnosis associated with MDEs. Whenever someone presents with a MDE, a careful history should be taken to determine whether they are experiencing unipolar depression (i. e. MDD) or bipolar depression, one of the phases of Bipolar Affective Disorder (BPAD). In BPAD, patients cycle between the two poles of depression and hypomania or mania. Symptoms of mania include: decreased need for sleep, without feeling sleepy the next day; racing thoughts; speaking very quickly; increased risk taking behaviors (examples include promiscuity, increased substance use, reckless gambling, compulsive shopping, etc); feeling like one is bursting with ideas; and markedly increased movement. The less intense and disruptive version of these episodes is hypomania. Mania can include the presence of psychotic symptoms: difficulty knowing what is real, feeling the one has special powers, or having disturbances of perception such as hearing voices or having visions. Distinguishing between MDD and BPAD is essential: the treatments are different, and the treatment for MDD can actually worsen the mood cycling of BPAD if a mood stabilizing medication is not also used.

Both MDD and BPAD are treatable psychiatric conditions, and quite common. Though estimates very, approximately 12% of the population are experiencing MDD and 2% BPAD right now. While antidepressant medications are some of the most prescribed medications, research continues to indicate that the majority of young people experiencing mood disorders, such as MDD and BPAD, are not receiving treatment or adequate treatment. Mood disorders are serious medical conditions that can be fatal. Suicide is currently the second leading cause of death for emerging adults, following only accidents (and it is unknown, of course, how many of these accidents were actually undetected suicides). Signs that a loved one may be contemplating suicide include them giving away possessions, obtaining large amount of medications or drugs of abuse, and saying their “goodbyes.” If you suspect a loved one is having suicidal thoughts, ask them. If you are having suicidal thoughts, seek help immediately. Call the National Suicide Prevention Lifeline: 1-800-273-8255. Call your campus counseling and psychological services. Call 911. Reach out – help is available, and can actually help. Suicide is a permanent solution to a temporary problem. Reach out for help – the world will reach back.