Mood Disorders and Suicide 197
features—hallucinations (e.g., in which a patient can feel that his
or her body is decaying) or delusions (e.g., in which the patient
believes that he or she is evil and living in hell).
Symptoms may also form a pattern over time. In contrast to recur-rent depression, in which symptoms of an MDE disappear and then
reemerge at a later time, chronic depression is the pattern in which the
symptoms meet the criteria for an MDE continuously for over 2 years.
In some cases, such as that of Marie Osmond in Case 6.2, depression
emerges within 4 weeks of giving birth, designated as postpartum on-
set. However, the DSM-IV-TR cutoff of 4 weeks for postpartum onset
may be too restrictive; 6 months to 1 year after giving birth may be
a more useful diagnostic cutoff (Wisner et al., 2004), although some
women develop symptoms as soon as 5 days after delivery (Adewuya,
- or even before the birth (Evans et al., 2001). Those most at risk
for postpartum depression are women who have had recurrent depres-
sion before giving birth (Forty et al., 2006).
Although postpartum depression can arise after
giving birth, for many women, “postpartum”
depression may actually begin during pregnancy,
particularly the latter half, and persist after the
birth (Evans et al., 2001).Laura Dwight/Photo EditCASE 6.2 • FROM THE INSIDE: Postpartum Onset of Depression
After the birth of her seventh child, Marie Osmond developed postpartum depression:
I’m collapsed in a pile of shoes on my closet fl oor.... I sit with my knees pulled up to my
chest. I barely move. It’s not that I want to be still. I am numb. I can tell I’m crying, but it’s not
like tears I’ve shed before. My eyes feel as though they have moved deep into the back of my
head. There is only hollow space in front of them. Dark, hollow space. I am as empty as the
clothing hanging above me. Despite my outward appearance, I feel like a lifeless form.
I can hear the breathing of my sleeping newborn son in his bassinet next to the bed. My
ten-year-old daughter, Rachael, opens the bedroom door and whispers, “Mom?” into the
room, trying not to wake the baby. Not seeing me, she leaves. She doesn’t even consider look-
ing in the closet on the fl oor. Her mother would never be there. She’s right. This person sitting
on the closet fl oor is nothing like her mother. I can’t believe I’m here myself. I’m convinced
that I’m losing my mind. This is not me.
I feel like I’m playing hide-and-seek from my own life, except that I just want to hide and
never be found. I want to escape my body. I don’t recognize it anymore. I have lost any re-
semblance to my former self. I can’t laugh, enjoy food, sleep, concentrate on work, or even
carry on a conversation. I don’t know how to go on feeling like this: the emptiness, the end-
less loneliness. Who am I? I can’t go on.
(Osmond, Wilkie, & Moore, 2001)Sometimes recurrent depression follows a seasonal pattern, occurring at a par-ticular time of year. Referred to as seasonal affective disorder (SAD), this disorder
manifests itself in two patterns:
- Winter depression is characterized by recurrent depressive episodes, hypersom-
nia, increased appetite (particularly for carbohydrates), weight gain, and ir-
ritability. These symptoms begin in autumn and continue through the winter
months. The symptoms either disappear or are much less severe in the summer.
Surveys fi nd that approximately 4–6% of the general population experiences a
winter depression, and the average age of onset is 23 years. The disorder is four
times more common in women than in men (American Psychiatric Association,
2000). Winter depression often can be treated effectively with phototherapy (also
calledlight-boxtherapy), in which full-spectrum lights are used as a treatment
(Golden et al., 2005).- Summer depression, which is less common, tends to appear in late spring. Symp-
toms often include poor appetite and weight loss, less sleep, and psychomotor
changes (American Psychiatric Association, 2000). Treatment for summer depres-
sion usually includes antidepressant medication.Seasonal affective disorder (SAD)
Recurrent depression that follows a seasonal
pattern.Phototherapy
Treatment for depression that uses full-
spectrum lights; also called light-box therapy.