Identifying and Treating the Many Forms of Depression

In this video, Psych Congress Steering Committee Member, Craig Chepke, MD, FAPA, adjunct associate professor of psychiatry, Atrium Health, adjunct assistant professor of psychiatry, UNC School of Medicine, and medical director, Excel Psychiatric Associates, Huntsville, NC, discusses the many forms of depression, including major depressive disorder, bipolar depression, treatment-resistant depression, and seasonal affect depression. Dr Chepke shares his insights on diagnosis and treatment options.

Dr Chepke discusses the different forms of depression and references a recent Harris Poll survey that examined in adults living with bipolar I disorder (BDI) the burden of living with this condition and their experiences with treatment. In the survey conducted on behalf of Alkermes and the Depression and Bipolar Support Alliance (DBSA), 77% of respondents agreed that living with BDI makes them feel isolated and alone. Dr. Chepke provides commentary on how isolation, especially during the COVID-19 pandemic, can lead to depressive symptoms.

Read the transcript:

Dr Craig Chepke:  Hi, my name's Dr. Craig Chepke. I'm the Medical Director of Excel Psychiatric Associates in Huntersville, North Carolina. I'm an adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine and an adjunct associate professor of psychiatry for Atrium Health. I'm also a member of the steering committee for Psych Congress.

One aspect I wanted to highlight about the survey were the 77% of respondents who felt that they were isolated or felt alone because of their bipolar disorder. While the press release doesn't contain more granular information about their reasons as to why the people felt isolated or alone, I'd like to speculate just a little bit.

I think it does tie into the stigma that I just discussed. When people feel that no one can understand them, they tend to withdraw into their own self and their own bubble. That, I think, had to be worsened by the COVID‑19 pandemic in the past few years.

Everyone in the country has felt more isolated at some point or another during the pandemic. Coming and going in waves, depending on where the country is with the different surges that we've had with COVID with the most recent one, obviously, still being in the peak of that.

I think that a lot of people feel that the stigma makes them want to withdraw in and turtle up, as I often say to many of my patients. We can't know, again from the survey, the specific symptomatology of bipolar depression versus bipolar mania, but I'd say probably it would be more the depressive aspect of things that would make people feel more isolated, most likely.

That, I think, is specifically pertinent for this time that we're in currently, being winter. I always like to say that the holiday season is to a psychiatrist what tax season is to an accountant. It's our busiest time of year. That's true because of many different reasons.

There is the cold weather, which can cause people to stay inside more. The holidays, while they may be holly and jolly and bright for some people, for most of my patients, unfortunately, it tends to be the opposite.

There can be certain negative associations. There can be retraumatization from past abuse. Difficult family relationships. A myriad of different reasons. I tend to give the goalposts of from Halloween to St. Patrick's Day is when there's an increase in demand for my services, and I'd say, probably, most psychiatric clinicians around the country.

There's many different types of difficulties that there can be with depression. When we say depression, we often think that everyone's going to know what we're talking about.

There are so many different types of depression. Bipolar depression is very different from major depressive disorder. Both have major depressive episodes, but the major depressive episodes in MDD, major depressive disorder, have never had any sort...

These people have never had any hypomanic or manic episodes, whereas that's the defining characteristic of bipolar disorder, is that they've had both major depressive episodes and, for bipolar I, at least 1 manic episode and for bipolar II at least 1 hypomanic episode.

Some other depressive terminology that's out there...We've heard a lot in the past several years about TRD, treatment-resistant depression. That specifically does refer to a type of major depressive disorder. The way that the nomenclature has evolved, if you hear the term TRD, then we are talking about major depressive disorder and not bipolar depression.

Definitely, there can be people who have very stubborn, difficult to treat the symptoms of bipolar depression, but we wouldn't call those specifically treatment-resistant depression.

Finally, another one is seasonal affective disorder. That ties back into what I just mentioned about there is a seasonal component to certain mood disorders. That one can apply to either major depressive disorder or to bipolar depression. That's because seasonal affective disorder, it's not an actual, specific diagnosis itself.

The way the DSM is constructed, it is a specifier. There are a number of different specifiers in the DSM. There can be a major depressive episode with mixed features, a major depressive episode with postpartum onset, and then there can be some others, too. There's major depressive episode with a seasonal onset.

That major depressive episode could occur either in the context of major depressive disorder or of bipolar depression. Definitely, there's lots of different depressive types of symptomatology floating around there in this time of year, around the holidays, the change of the year.

I can't help but think that that has been exacerbated, again, with the latest surge of Omicron coming at the worst time, when people are...Some people are trying to reach out to be around family or friends during holidays. The recent surge has put a limit on that.