IMAGE: Genevieve Pizzale
A host of disorders, from depression to Post Traumatic Stress Disorder, fall under the umbrella of mental health. Knowing what defines each one and how to treat and address it is essential for keeping symptoms at bay.
Though the prevalence of mental illness is well known (one in two Canadians have or have had a mental illness by the time they reach 40), less is understood about the different disorders the term covers and the best ways to address and treat each one.
“We often talk about mental health problems and how common they are, but something that may get lost in the discussion is how treatable most of them are,” says Dr. David Gratzer associate chief of inpatient care and practice innovation at The Centre for Addiction and Mental Health. The first step for addressing any disorder is seeking help and getting a diagnosis, which will help with finding support and crafting a mental health plan, which may include medication or talking therapies.
There are also many options available that can help soothe or alleviate symptoms, depending on the disorder. We spoke with Dr. Gratzer to get a better grasp on some of the most common disorders and available treatment options.
But note: There are plenty of nuances within each diagnosis and treatment plans will not be the same for everyone. “If you or a family member are struggling to the point of these problems affecting your day-to-day functioning, it’s worth having a conversation with your primary care provider,” says Dr. Gratzer. While you and your primary care provider will be able to map out your best options, nonconventional treatments—including yoga, exercise, meditation, acupuncture and naturopathy—can be an effective complement to other therapies. Still, we recommend you speak to your medical doctor as a first step in your mental health treatment journey.
Clinical depression or major depressive disorder (MDD) is defined as having a low mood for longer than two weeks. “This is different than saying that you’re having a bad day,” says Dr. Gratzer. “These are people who are struggling to the point that it affects their functionality—whether that be at home, at work or in relationships.” In addition to feelings of sadness, emptiness and irritability, people with depression can also experience physical symptoms like sleep problems, changes in appetite and trouble concentrating.
What causes it: A person’s brain chemistry, family history of depression, personality and stress can all influence this complex and extremely common mood disorder. Sometimes depression can be caused by (or is a reaction to) another illness such as cancer or hyperthyroidism.
How it’s typically managed: Psychotherapy and medication can be used individually or in combination to treat depression. Clinical depression can be a lifelong illness but is manageable with the right treatment plan.
To learn more about depression visit depressionhurts.ca, camh.ca or Mood Disorders Society of Canada at mdsc.ca.
Bipolar affective disorder (formally known as manic-depressive disorder) is a recurring disorder wherein a person experiences dramatic mood swings that involve a high state (mania) and a low state (depression). “The Hollywood depiction of people with bipolar disorder is of people who are really happy then really sad, which is not really what we see,” says Dr. Gratzer. “In the real world, people who are experiencing a period of mania can be really excited, go several days without sleeping well and engage in uncharacteristic and reckless behaviour like driving radically.”
What causes it: There is no known cause for bipolar disorder, but researchers believe a strong genetic connection is at play. Stress can trigger an episode in someone who has bipolar disorder.
How it’s typically managed: Given the myriad of symptoms involved, bipolar disorder is difficult to diagnose and doctors must first rule out a number of other illnesses.
Psychotherapy and medications such as mood stabilizers and antidepressants are the mainstay treatment options.
To learn more about Bipolar Disorder visit Mood Disorders Society of Canada at mdsc.ca or CAMH at camh.ca.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is characterized as excessive anxiety and worry occurring the majority of days over a period of at least six months. Though everyone experiences stress from time to time, someone with an anxiety disorder can experience anxiety so great that it’s difficult to manage daily tasks and cope with everyday life from work to studies to relationships. “The anxiety essentially takes on a life on its own and leaves a person not only symptomatic, but also not functional,” explains Dr. Gratzer. Beyond the feelings of worry and dread, someone with anxiety may also experience physical symptoms like exhaustion, difficulty concentrating, muscle tension and sleep problems.
What causes it: An individual’s biology, psychology and stressful and traumatic life events can cause GAD, the most common mental health problem in women.
How it’s typically managed: Research has shown the most effective therapy is cognitive-behavioural therapy (CBT), a form of psychotherapy that focuses on identifying, questioning and changing negative thoughts, feelings and behaviours. Medications can be used as well as relaxation training, meditation and stress management.
For support and more information on anxiety disorders visit anxietycanada.com, the Canadian Network for Mood and Anxiety Treatments at canmat.org or Mood Disorders Society of Canada at mdsc.ca.
Panic disorders are a type of anxiety disorder that involve repeated and unexpected panic attacks. A panic attack is “over-the-top anxiety that can feel like you’re having a heart attack,” says Dr. Gratzer. “Someone may feel that there’s impending doom, which is accompanied by physical symptoms like a racing heart, shortness of breath and sometimes nausea or vomiting.” Panic disorders can also include marked behaviour changes, namely an avoidance of places and situations where a person experienced past anxiety symptoms.
What causes it: Like other anxiety disorders, panic disorders are influenced by biological, environmental and psychological factors. Having a panic attack doesn’t necessarily mean you have a panic disorder; however, being constantly worried about and fearful of another attack indicates there could be a problem.
How it’s typically managed: There can be overlap between anxiety and mood disorders, so treatment options can vary person to person. Again, CBT is an effective treatment on its own or in combination with medications or psychological treatments.
For support and more information on anxiety disorders visit anxietycanada.com or Mood Disorders Society of Canada at mdsc.ca.
Schizophrenia is a complex mental illness that affects nearly 300,000 Canadians. It can affect how a person thinks and acts, and onset usually occurs in late adolescence or early adulthood. Dr. Gratzer characterizes schizophrenia as “when a person’s mind plays tricks on them—hearing voices when no one else is around or seeing things that others don’t see.”
What causes it: Like many other mental health problems, schizophrenia is believed to be caused by a combination of biological and environmental factors, with a higher risk for the illness if a family member has been diagnosed with it.
How it’s typically managed: Treatments include medications like antipsychotics or mood stabilizers, talking therapies and in some cases, brain stimulation therapies can help too.
More information and support services are available at camh.ca and schizophrenia.ca.
Persistent Depressive Disorder
Persistent Depressive Disorder (PDD) describes moderate symptoms of depression (such as loss of interest, low self-esteem, poor appetite or overeating) and chronically low mood over a long period of time. “The old version is called Dysthymic disorder and can be understood as a low-grade depression, but nevertheless it is just as serious and debilitating,” says Dr. Gratzer. “People might still be able to go to work and manage daily tasks, but they chronically feel low.”
What causes it: There’s no test you can take to determine if you have PDD and no single cause. A family history of depression, your own biology and your environment can all be contributing factors.
How it’s typically managed: Treatment options for PDD include psychotherapy and medication. Some people may have both PDD and MDD, in which case this is referred to as double depression and is treated with similar measures.
Support services can be found at depressionhurts.ca, camh.ca or Mood Disorders Society of Canada at mdsc.ca.
Post-traumatic Stress Disorder
Historically considered a part of anxiety disorders, Post-traumatic Stress Disorder (PTSD) is now classified under trauma and stress-related disorders. PTSD is a natural emotional response to a dangerous and unsettling experience, but for some people, the thoughts of these instances can negatively impact their lives long after the traumatic event has taken place. “A myriad of symptoms can occur, from flashbacks to nightmares, after a person has a near-death experience,” says Dr. Gratzer. Other symptoms can include avoidance of places and people that are reminders of a traumatic event, loss of interest in activities they used to enjoy, getting angry easily and an inability to have loving feelings or feel pleasure.
What causes it: Not everyone who experiences a traumatic event develops PTSD, but risk factors can include past traumas, history of substance abuse or other mental health problems and guilt or shame about the event.
How it’s typically managed: Recovery from PTSD is different for every person, and research shows that having a support system following a traumatic incident is important for recovery. Counselling and therapy are commonly part of treatment plans and in some cases, doctors can prescribe medications that help with PTSD symptoms like sleep problems and depression.
PTSD Association of Canada ptsdassociation.com and CAMH are great resources for those with PTSD as well as their loved ones.
Borderline Personality Disorder
Among several types of personality disorders—such as histrionic, narcissistic and antisocial personality disorder—Borderline Personality Disorder (BPD) is the most common and is described as a pattern of behaviour that is drastically different from the expectations of a person’s individual culture that causes them significant distress and impairment. “In other words, a personality disorder can be understood as a disorder of relationships,” says Dr. Gratzer. Someone will have great difficulty handling thoughts and emotions and dealing with relationships and have an inability to understand or change the behaviour that’s causing them problems. Reconciling personal behaviour and thoughts with societal norms and expectations are at the heart of Borderline Personality Disorder. “Some of the common features of BDP include poor sense of self, volatility in mood and chronic suicidal thoughts,” says Dr. Gratzer.
What causes it: BDP has a genetic influence in addition to biological, social and environmental factors. Some studies have found that the brain areas that control emotional regulation, impulsivity and aggression are overactive in someone with BDP.
How it’s typically managed: Now that BPD is better recognized and diagnosed, specialized treatment plans can significantly improve the life of someone with BDP. Treatments include individually tailored psychosocial therapies like Dialectic Behaviour Therapy, a form of therapy that integrates mindfulness and places equal importance on making positive changes to behaviours and management but also accepting validating initial thoughts and experiences.
CAMH is a great resource for support and information and also offers psychoeducational support groups for friends and families to learn more about this disorder and how they can best help their loved one.
Like PTSD, Obsessive-Compulsive Disorder (OCD) used to be classified as an anxiety disorder but now has a category of its own. The obsessions in OCD refer to repeated intrusive thoughts, and common coping mechanisms for these obsessive thoughts can manifest as a certain ritual or “compulsion.” Obsessions could be fear of dirt, germs and diseases, or repeated doubting (such as constantly second-guessing whether you locked the door or turned off the oven), and compulsions can include incessant cleaning, checking, hoarding and arranging. These obsessions and compulsions are not only time-consuming but also can cause a great deal of distress at work and in relationships.
What causes it: OCD is thought to affect one in 40 people and can be influenced by genetic, psychological and environmental factors. Research on potential biological causes are ongoing, but there may be a link between OCD and certain brain chemicals like serotonin.
How it’s typically managed: While treatments vary, cognitive behavioural therapy and antidepressants are commonly used in conjunction to treat this disorder.
Visit The Canadian Institute for Obsessive-Compulsive Disorders ictoc.org and camh.ca for more information and support networks.