Dr. Roger McIntyre, Head of the Mood Disorders Psychopharmacology Unit within UHN’s Centre for Mental Health, answers some common questions to get a better understanding of mood disorders – which comprise many of the diseases considered a mental illness – and how to manage them.
Q: What is a mood disorder?
A: A mood disorder is a group of brain diseases where the main issue is a persistent disturbance in an individual’s mood, thinking (e.g. concentration), and how they function. This disturbance can manifest itself as either a depressive disorder or a bipolar disorder; with the first relating to one of many different forms of depression, and the second which is an unstable mood that cycles between a high mood (mania) and a low mood (depression).
Mood disorders, particularly depression, are the most common reason that people can’t fulfill their roles in life. It’s estimated that up to 15 per cent of Canadians are affected by a depressive or bipolar disorder at some time in their life.
The key difference between having a mood disorder and having a “bad day” is that the disturbance in mood and thinking as well as the problems with functioning in a person who has a mood disorder persists for many weeks and months.
Q: What is the difference between being sad and being depressed?
A: People often assume that you have to feel sad or cry all the time in order to be depressed but being depressed isn’t only about being sad – it’s about a lack of interest and when the ability to fulfill your roles in life become difficult. I have seen many patients who don’t think they’re depressed because they don’t feel “sad.” They’re definitely not happy, and recognize something is wrong, but don’t recognize being depressed. So my hope is that by having a national conversation about mental illness, we can shift that assumption that being depressed means being sad.
It’s normal to be upset over the bumps and bruises of life, but when that starts to affect your ability to work, sustain healthy relationships, function in society, and a sense of apathy starts to take hold, that is as much of a red flag for depression.
Q: Why is it important to recognize that you might be depressed?
A: If you can have your mood disorder detected and diagnosed early, there is a better chance of having a positive outcome. There are many existing therapies that can effectively manage mood disorders, and integrating medication with other therapy such as cognitive therapy or mindful meditation works well.
Mood disorders are very progressive, meaning they get worse and are harder to treat, a person’s chance of recovery and resuming normal life decreases the longer their disorder is left untreated. We still have a lot of work to do to cure mental illness, but we have made progress in that today’s available treatments are much better, safer, easier to take and have shown to make improvements in combination with other therapies.
Q: Why has it been so challenging to cure mood disorders and what hope is there for patients?
A: Although we’ve made progress in managing mood disorders and providing genuine help to patients, not all the treatments that we have work for everyone. Currently, only 20 per cent to one-quarter of patients with a mood disorder respond sufficiently to medication to get better and stay better – that’s not a lot of people. Also, though we’ve come a long way in treating the symptoms of mood disorders, these medications don’t do much to modify the actual disease; as we have seen with patients who stop taking their medication because they feel better and then relapse.
We owe it to our patients to do better than only manage their disease, but I am optimistic that we are finding new avenues of research. For example, over the past decade, the field of psychiatry has determined that brain inflammation and brain metabolism each play a role in mood disorders. In my own work, we are currently looking at different treatments – for example, drugs to treat diabetes – that target both these abnormalities with the goal that they would also relieve the mood disorder.