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Scott Webb: Most of us are familiar with high and low mood swings. But if these extreme moods persist for longer periods of time, we may be suffering from a mood disorder. And joining me today to help us understand mood disorders and how they're treated is Dr. Betsy Rosiek. She's a board-certified psychiatrist with the Franciscan Physician Network.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. I think most of us are familiar with being in a good mood or a bad mood, or just different types of moods in general. But what is a mood disorder?

Dr. Betsy Rosiek: A mood disorder, it can take a couple different forms, either an elevated mood, like an abnormally expansive or high mood or a depressed mood. And we all have times of probably highs and lows, like you said. The difference with a mood disorder is that it becomes problematic for somebody's functioning. It can start to impair them socially, occupationally, maybe within their family. So it becomes a disorder when other things are kind of impacted by that change in their mood.

Scott Webb: Yeah, I see what you mean, right? And most of us, whether we're in a good mood or bad mood or highs and lows, you know, we find a way to kind of push through and get things done. But when it is a situation where we can't get those things done, where it's affecting our work, our families, and so on... So as you say, everyone probably gets depressed at times, right? We have those highs and lows. And when we're in those low periods, how does someone know if they actually have a mood disorder?

Dr. Betsy Rosiek: If somebody's having, you know, stressors at work or marital change and that kind of thing, or a move, various things can lead to stress and people feeling depressed. But it becomes a disorder when there's not just a problem with the mood, but all kinds of other symptoms that kind of come together to create some significant problems. And that would be if somebody may be depressed, the timeframe is at least two weeks. And not only are they depressed, but they have other symptoms as well. One of those may be just not interested in things. In fact, you may not feel depressed and you may just feel like, "I don't want do these things anymore. I used to like to go, you know, play tennis with my friends," "I used to enjoy taking the kids to soccer," and you just don't seem to have that anymore. So either feeling depressed or having that lack of interest for two weeks, along with an appetite change. People might eat more or they might eat less. You can have people come in and have unexplained weight loss. And it's just because they haven't felt like cooking, they haven't really been hungry, nothing really tastes good. You may see a change in sleep. We all hit snooze from time to time, but this is you hit snooze two and three times and you've gone to bed early and just you're tired all the time. You might come home from work and instead of getting at your garden, you want take a nap.

The flip of that is some folks with depression can't sleep well at all. They'll go to bed and they'll lie and just can't fall asleep or they'll fall asleep really easily, but then they're up all night. You know, they're up at 1:00, they're up at 2:00, they're up at 3:00. Or people might have what we term terminal insomnia where they can fall asleep and they sleep well, but then at 3:45, they're up for the day and they can't get back to sleep. You can see folks just not have energy, just, you know, more fatigued. Everything's just a push. Some feelings of worthlessness or guilty feelings about things that don't kind of makes sense to feel guilty about, rumination on things, "I didn't..." and "I could have..." and just like, "I'm worthless," so those really pervasive feelings that people can get when they're in clinical major depressive episode.

Another symptom might be a diminished ability to concentrate. Work isn't going as well or you're just more indecisive, kind of can't make decisions. And of course, something that can accompany a major depressive disorder is suicidal thoughts, of course, as well. Thoughts that, "It'd be better if I was dead. My family would just be better off," you know, "I'm not contributing anything," really skewed thinking.

So it becomes a disorder, a major depressive disorder. When you have either a depressed mood or decreased interest for two weeks, and then at least four other of these symptoms with weight changes, sleep changes, energy changes. Worthless feelings, concentration problems, or there can also be what we call psychomotor agitation or retardation, everything's kind of slowed down, people just can move along or people kind of feel antsy. And then the key is also that you're seeing this period of time and these symptoms kind of bleed into work, into family, into social functioning as well.

Scott Webb: Yeah. So, two weeks. Yeah, because I think, you know, all of us have a bad day or a bad night's sleep and we might be in a good mood or a bad mood, or feel a little high or a little low. But as you say, if it extends out over two weeks, begins to bleed into other things, that's when there might be reason for concern. And doctor, I've seen ads on TV that talk about medicines for bipolar depression. What is bipolar disorder and how is it different than major depression?

Dr. Betsy Rosiek: So bipolar disorder, there's a couple of different types of bipolar disorder we now recognize. There's bipolar disorder type I and bipolar disorder type II. And the hallmark of a typical bipolar disorder or type I bipolar disorder is what we call an episode of mania. The other term that is out there a lot is manic depression. Well, manic depression is the kind of layman's term, if you will, for bipolar disorder. When people get that elevated mood, they become almost euphoric. They can have just a lot of increased activity, heightened energy, and that needs to be present for at least a week, pretty much every day and is really noticeable to everybody around this individual.

And along with that definite heightened mood and energy, there needs to be several other symptoms that kind of go along to make that diagnosis. One of those is increased sort of self-esteem or what we call grandiosity, somebody's decided they're gonna run for city council, and they're also going to start this and they're going to conquer all of these things. And there's kind of this real inflated kind of sense of self, a distinct abnormal presentation that individual typically would have. You can see a decreased need for sleep. In fact, with bipolar disorder type I, a classic manic episode that lasts more than a week, folks can go for days or sometimes weeks with no sleep. And what I'll see clinically often is somebody will come on and say to me, "Well, you know, of course I'm irritable. I'm not sleeping. I need to sleep. I have insomnia." They have insomnia because they have bipolar disorder and they're manic. And so you see that go hand in hand that they just don't need to sleep. It's not that they're sleepy, they have a lot of energy.

Somebody who's typically in a manic episode can be very, very talkative, so much so that folks might have a difficult time tracking the conversation. They're speaking very quickly. They'll describe to me sometimes, like they can't kind of keep up with their thoughts and they'll have a subjective sense that their thoughts are just going and going and going, and they're trying to keep up and they'll have what we call flight of ideas. You know, they'll start talking about this subject and then in, oops, it switches to another subject and it goes to something else. They'd be very hyper, very distractable, and just a lot of increased activity. It might be, "By Friday, I'm going to have the tree house built and we're going to have redone the spring room. And by the way, I'm going to start these other things as well."

And then, it becomes problematic also when people become a little loose with their judgment. There can be impulsivity with spending, spending sprees, kind of heightened sexual interest. It might be somebody loses their thoughts and thinks, "I'm going to start this business" or "We're gonna have a business investment." So mania is a really distinct, at least week-long episode of multiple of those symptoms. And sometimes people can become what we call psychotic or hear voices or see things and require hospitalizations in bipolar type I. So the hallmark of that illness are those manic episodes.

Other bipolar disorder, type II, which you're recognizing more commonly, for bipolar type II, you've got to have a depressive episode at some point along the way, and what we call a hypomanic or I could say a little manic episode. So it doesn't last a week. It may last about four days. People can often kind of navigate work and continue with things. They might get into a little struggle maintaining things, but they don't end up hospitalized. They don't end up with hallucinations. But they'll have four days of this kind of elevated mood or irritable mood. They don't need to sleep as much. Maybe instead of their seven hours, they're going on four and that's plenty. You can still see that push to talk and kind of hyperactivity and a lot of activity going on, agitation. But it doesn't tend to be as problematic as a typical bipolar type I who experiences those manic episodes. So when we talk about bipolar depression, we're talking about the other pole of being high, which is being low, and it becomes important to differentiate a major depressive disorder from somebody that has these manic or hypomanic episodes, because the treatment is different.

Scott Webb: Well, there's so much to unpack here and it's so good that we have experts like yourself to help us all sort of sort through these things. And so bipolar I, bipolar II, I'm just trying to keep up with you here. And if someone's listening along with us today and they're checking off a bunch of these boxes and they think that they may have a mood disorder, what's your recommendation?

Dr. Betsy Rosiek: I think the first stop is really to have a conversation with your primary care physician. And, you know, you make those appointments the same as you would if you called and said you've got a fever, "My ear hurts" or "I've got a stomach problem," "I'm not sleeping well or I think I'm depressed." And you talk with your doctor about that. And he or she would go through and kind of weed things out a little bit and see if maybe you need a treatment, which can take several forms and kind of get a treatment plan.

The other good thing about talking with your family physician about that is there's lots of medical illnesses that can mascarade, if you will, as depression or even mania. And it's good to have a physical to make sure there's not an underlying thyroid problem, for instance, or problems with blood sugar, maybe somebody's tired because they're anemic. So having physicals and some work done to rule out other causes for how you're feeling is important. And your doctor would recommend, either, you know, maybe psychotherapy, some counseling if it's some milder episode. But often, you'll have a combination of medications along with therapy, which is really a beneficial combination to help treat these diseases. And if it isn't getting better, you might get a referral to a psychiatrist and we specialize in treating these mood disorders and would encourage people to talk with their family doctor. And if there's a referral needed, to go for that, of course. If anybody ever has any suicidal thoughts, a concern about safety, to go to an emergency room because you can right on the spot have a mental health professional evaluate you and get you started on some kind of treatment plan if needed and not wait, you know, for the next week to see your family doctor, of course.

Scott Webb: Yeah. And you mentioned treatment there and how you can help folks, so how are mood disorders treated and can they really be cured?

Dr. Betsy Rosiek: Sure. Mood disorders are very treatable. And, depending on whether it's I say a bipolar disorder or a depressive disorder, the treatment's going to be different. People might have an episode of major depression once in their life. They have treatment and they don't have another episode, or they may have a second or a third. And when it becomes something that looks more chronic, periodically somebody has these episodes, your doctor might recommend that you just stay on antidepressants, like you stay on your diabetic medication or your heart regimen.

For bipolar disorder, that's a disease that if you have that diagnosis made, you'll manage it for your life. So cured, not cured, but certainly manageable through medications and therapy and sometimes hospitalizations if it's needed as well. But it's really important to treat these symptoms. And if you think you have anything like what we're talking about today, because there's so much difficulty, not only can it create with occupation and socially and so on, but it can also really impact somebody's other physical health as well. We know people aren't as compliant with their medications if they're depressed. We know people don't do quite as well if they've had a heart attack in recovery if they're depressed. And they're not as attuned to following their blood sugar. So, your brain needs to have attention, like all the other organs in your body. And for your overall health, it's good to address these symptoms if you think you have some concerns.

Scott Webb: That's such a great way to put that. You know, our brain sometimes needs some attention as well, needs some help as well. We tend to prioritize the physical things. But the brain, as we're talking about today, whether it's mood disorders or bipolar, needs a little love too, needs a little attention too. And doctor, as we wrap up here, and this has been really helpful, really educational, I'm sure listeners agree, they're nodding their heads right now, let's talk just a little bit about insurance and the coverage for the type of treatment that we're speaking about today.

Dr. Betsy Rosiek: Sure. So insurance is going to vary, of course, from plan to policy, et cetera, but you know, your medication should be covered. There might be deductibles like there are with any medications. Your office visits should be covered. Sometimes there's different plans in terms of the psychotherapy appointments and that kind of thing. You have to check with your insurance provider. But the coverage for treatment of mental health in general has expanded over time. And I would just encourage people to follow along and see what they're able to have in terms of number of sessions with a therapist and that kind of thing. But certainly, medicines and appointments should be covered for the most part.

Scott Webb: Yeah, they should be for the most part. And as you've said today, you know, start with speaking with your primary care provider, your family doctor, whomever. Get a full mental, physical workup, and then go from there and speak with your insurance if you need to. But, you know, we want everyone to take care of themselves, to think about their brains, to treat their brains with care and to be diagnosed, to be treated. Really great conversation today, doctor. Thanks so much. You stay well.

Dr. Betsy Rosiek: Thanks for having me. Have a great day.

Scott Webb: And for more information, visit franciscanhealth.org and search behavioral health. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.