Long ago, before I was even diagnosed with depression (my first psychologist had said I was “highly neurotic”), I was a transcriptionist at an insurance company in Iowa. The woman who sat in front of me would sometimes become upset about something that happened and start to talk about quitting. This frightened me because she was the senior transcriptionist and I was a raw beginner who needed her help frequently.
I would try to calm her down but she would rant about everything that was wrong in our department, all of it true because it was not well run. I’d grow more and more unhappy listening to her until she went back to work leaving me feeling bad for some time.
Eventually, I noticed that after she unloaded her anger onto me, she was cheerful. She had successfully transferred all the negativity to someone else and could continue her day in a better frame of mind. This was the first time I recognized toxicity in another person.
This woman wasn’t entirely toxic. She could be gracious and helpful, and in fact, when I had surgery on my arm a few years later, she was the only one of my co-workers to offer assistance with my household chores (she did ALL my accumulated laundry). And once I knew not to absorb her negativity, we had few problems working together. But I’d begun to learn a valuable lesson: there are toxic people in the world.
Who are the severely toxic people?
They are the ones who complain all the time. They are the ones who always blame you. They may always turn things around so things you felt they had done wrong are suddenly your fault. They overreact to bad events.
They drain your energy. It may be that they get you to spend a lot of time and emotional strength trying to cheer them up. They may bombard you with their negativity so that you have to spend energy trying to fend it off. Perhaps their constant pessimism infects you, or they always make you angry. They may be leeches who feed themselves by making you give them your positivity.
People with mental illnesses such as bipolar disorder, major depression or even depressive tendencies are particularly susceptible to toxic people. We are more easily triggered than others. When manic or hypomanic, we may be less sensitive to depressive triggers – or we may not. During mixed or depressive episodes, or when we’re more or less stable, we are more likely to have a somewhat weaker grip on emotional stability than most people, making it easier for a toxic person to affect our moods. That’s not to say that people who do not have mental illnesses can’t be affected by the toxicity of others. But we are more vulnerable.
Toxic People in Your Life
Do you know someone who always makes you feel depressed, angry or just plain tired? Think about this person. Is he or she a complainer, or someone who always expects things to go wrong, or someone who constantly finds fault with you? Does he or she always seem more cheerful after ranting to you? If any one or more of these is the case, you likely have a toxic person on your hands.
If you have an easy way to get this person entirely out of your life, you’ll be better off instantly. Of course, often it is not so easy, when the toxic person is a co-worker or family member or even a long-time friend. If it’s a co-worker, is there a good excuse like “I’m right under an air vent that’s chilling me” to get your desk moved? Perhaps you can say, “You really ought to talk to the supervisor/manager about this” and calmly return to doing your work.
With family members and friends, it may be more difficult. A seriously toxic friend may require that you gradually decrease the time you spend with this person over a period of months so it isn’t particularly noticeable. When the toxic person is a family member, it may be possible to get the person into therapy, which is often needed to solve the underlying issue behind the negativity. If not, you need to train yourself to “tune out” when the complaining, fault-finding and energy-draining behavior starts.
Toxic Situations
I had a supervisor who used to bring me a pile of two days’ worth of work and tell me she wanted it done by 2:00 p.m. I’d look it over, tell her it was impossible, and the fight was on. Sometimes we screamed at each other so loudly that people down at the other end of the floor would stand up to see what was going on. This happened again and again.
When I spoke to a social worker about it, she asked what I was doing to set the supervisor off, as opposed to what the supervisor was doing to set me off. Well, I was always telling her the truth – that there was no way I could get the work done that quickly. But after discussing the situation for some time, we had devised a plan.
The next time my supervisor brought me an impossible stack and said she wanted it done by 2:00 p.m., I said, “I’ll try.”
And that solved the problem. Never mind that the work wasn’t done by the deadline. The important thing was that I had not said “impossible.” My supervisor and I never fought over work again.
This supervisor actually wasn’t a toxic person, but in this case, the situation was poisonous. In cases like this, the solution may be at your fingertips.
Ultimately, the answer is that you can’t change the other person’s behavior, but you can change your own. If someone you know always triggers depression, anger or tiredness in you, examine how you react when the negativity starts and see if changing your reaction helps. If your reaction doesn’t contribute to the problem, or you can’t make such a change, find a way to lessen this person’s presence in your life. It will be good for your health.
Major depression is when five or more symptoms of depression are present for at least 2 weeks. These symptoms include feeling sad, hopeless, worthless, or pessimistic. In addition, people with major depression often have behavior changes, such as new eating and sleeping patterns. Major depression increases a person’s risk of suicide.
Depression – major; Unipolar depression; Major depressive disorder
The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person’s life.
Some types of depression seem to run in families, but depression can also occur in people who have no family history of the illness. Stressful life changes or events can trigger depression in some people. Usually, a combination of factors is involved.
Each year, more than 18 million Americans — men and women of all ages, races, and economic levels — have depression. It occurs more often in women.
Women are especially vulnerable to depression after giving birth. This is a result of the hormonal and physical changes. While new mothers commonly experience temporary “blues,” depression that lasts longer than 2-3 weeks is not normal and requires treatment.
Major depression can occur in children and teenagers, and they can also benefit from treatment.
Trouble sleeping or excessive sleeping
A dramatic change in appetite, often with weight gain or loss
Fatigue and lack of energy
Feelings of worthlessness, self-hate, and inappropriate guilt
Extreme difficulty concentrating
Agitation, restlessness, and irritability
Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such sex)
Feelings of hopelessness and helplessness
Thoughts of death or suicide
Depression can appear as anger and discouragement rather than feelings of hopelessness and helplessness. If depression is very severe, it may be accompanied by psychotic symptoms, such as hallucinations and delusions. These are usually consistent with the depressed mood, and may focus on themes of guilt, personal inadequacy, or disease.
Major depression is diagnosed if the person reports having five or more depressive symptoms for at least 2 weeks. Beck’s Depression Scale Inventory or other screening tests for depression can be helpful in diagnosing depression.
Medical causes that can cause symptoms of depression should also be ruled out before making the diagnosis of depression.
Depression can be treated in a variety of ways, particularly with medications and counseling. Most people benefit from a combination of the two. Some studies have shown that antidepressant drug therapy combined with psychotherapy appears to have better results than either therapy alone.
Medications include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. While antidepressant medications can be very effective, some may not be appropriate for everyone. For example, in September, 2004 the FDA began considering a warning that some antidepressants may increase the risk of suicidal tendencies in children. In 2007, the FDA proposed that all antidepressant medicines should warn of the risk of suicidal behavior in young adults ages 18 – 24 years.
Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. For persons with psychotic symptoms, such as delusions or hallucinations, antipsychotic medications may be needed.
Electroconvulsive therapy (ECT) is a treatment that causes a seizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don’t respond to other treatments.
Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain functioning in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may be effective in relieving depression.
As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements. It is important to maintain a healthy lifestyle. Eat well-balanced meals, avoid alcohol and drugs (which make depression worse and may interfere with medications), get regular exercise and sleep, and seek supportive interpersonal relationships.
Many consumers try herbal products for depression. St. John’s wort has a long history of use in Germany and has gained popularity as an herbal antidepressant in the United States. Most of the German studies indicated that St. John’s wort was comparable to some antidepressants. However, a large study conducted by the National Center for Complementary and Alternative Medicine found that St. John’s wort was NOT effective for treating major depression.
Because herbal products can have side effects, always tell your doctor if you are using them.
For more information and resources, see depression support group.
The outcome is usually good with treatment. Although most depressive episodes can be effectively treated with either medication, psychotherapy, or both, depression is a recurring problem for many people. For people who have experienced repeated episodes of depression, maintenance treatment may be needed to prevent future recurrences.
Suicide (up to 15% of people with major depressive disorder die by suicide)
Increased risk of alcohol- and drug-related problems
Increased risk of tobacco dependence
Increased risk of problems with physical health and premature death due to medical illness
Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.
Call your doctor right away if:
You hear voices that are not there.
You have frequent crying spells with little or no provocation.
You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks.
You think that one of your current medications may be making you feel depressed. DO NOT change or stop any medications without consulting your doctor.
You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.
Some episodes of depression can be avoided by:
Learning how to relax and manage stress
Avoiding alcohol, drugs, and caffeine
Exercising regularly
Maintaining good sleep habits
Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.
For elderly or others who feel socially isolated or lonely, try volunteering or getting involved in group activities.
Medications and psychiatric counseling may prevent recurrences. Some episodes of depression are not preventable.
Bipolar disorder is a psychiatric condition characterized by severe disturbances in mood. People suffering from bipolar disorder, a term which has replaced the outdated ‘manic depression‘, go through episodes of mania (exaggerated highs) and depression (debilitating lows) that they cannot control. Although doctors do not know the exact cause, it is believed that chemical, genetic and environmental factors all play a part. For the most part, bipolar disorder is caused by an imbalance of chemicals in the brain. If certain neurotransmitters are not properly balanced, the brain is unable to regulate moods the way it is meant to.
Symptoms
Approximately one in seven people suffers from bipolar disorder, with symptoms usually originating among men and women in their early twenties and sometimes occurring in children and adolescents. The mood swings that people with bipolar disorder cycle through are vastly different from the moods of an average individual. In adults, their manic or depressive episodes can easily last up to weeks or even months. A teenager suffering from bipolar disorder can go through cycles of mania and depression over the course of a single day. Sometimes the episodes are unpredictable and will come on without warning; other times, the episodes follow a pattern that goes along with the changing of the seasons. Rapid cycling of moods (at least four or more per year) is more common in women, children and adolescents, whereas slow mood changes over time are seen more frequently in adult men.
What is mania? Mania is characterized by an extremely elevated mood and seemingly endless energy, a decreased need for sleep, excessive irritability and anxiety, and strange or unusual thought patterns.
What is depression? Depression is a feeling of sadness and melancholy that disrupts one’s daily functioning. A person with depression loses interests in activities that were previously enjoyable, is unable to concentrate, feels fatigued, worthless and even suicidal.
Symptoms of bipolar disorder are seen on a spectrum from severe depression to extreme mania
Diagnosis
Bipolar disorder can be difficult to diagnose because there is no blood test or brain scan that can detect it. It also has a long history of being either undiagnosed or misdiagnosed. A physical exam is the first step towards diagnosis and blood work is taken to rule out any medical illnesses, such as syphilis, which can present significant psychological symptoms. A brain scan is ordered to exclude epilepsy and brain legions, and a verbal history is taken.
There are four types of bipolar disorder: Bipolar I, Bipolar II, Cyclothymia and Bipolar disorder NOS (Not Otherwise Specified).
Bipolar I requires one or more manic or mixed episodes. A depressive episode is not required.
Bipolar II, which is the most common form of the disease, is characterized by alternating episodes of hypomania (at least one instance) and depression. The manic stage must be present in order to distinguish bipolar disorder from standard depression.
Cyclothymic disorder involves numerous hypomanic episodes with a spattering of depression. It is usually a low grade mood disorder that does not generally interfere with daily functioning.
Bipolar disorder NOS means that the person is clearly suffering from a type of bipolar disorder but does not meet the full criteria for any of the above.
This graph shows how bipolar disorder differs from standard, or unipolar, depression ((wellesley.edu))
Diagnostic Criteria
Criteria for a manic episode
Abnormally elevated mood, energy and irritability lasting at least one week
Three or more of the following symptoms during that week: decreased need for sleep, unusually talkative, racing thoughts, unable to concentrate or easily distracted, partaking in activities with no regard to consequences (e.g. shopping sprees, promiscuity). The mood disturbance is severe enough to impair functioning and at time require hospitalization. Psychotic features may also be present.
Criteria for a major depressive episode
Decrease in mood for a period of at least two weeks
Five or more of the following symptoms present: depressed mood every day, lack of interest in all pleasurable activities, loss or appetite and significant weight loss, insomnia, fatigue, lack of energy, feeling worthless or guilty, unable to concentrate, indecisive, recurrent thoughts of suicide or death.
Criteria for a hypomanic episode
A period of elevated or irritable mood lasting at least four days
Three or more of the following symptoms: Inflated sense of self-esteem, decreased need for sleep (at least 3 hours), more talkative than usual, racing thoughts, easily distractible, partaking in activities with no regard to consequences (e.g. shopping sprees, promiscuity). What separates it from a manic episode is that hypomanic episodes are usually not severe enough as to impair functioning nor require hospitalization.
Criteria for a mixed episode
In order to classify as a mixed episode, the criteria for both manic episodes and depressive episodes must be present every day over a period of at least one week.
Treatment
Bipolar disorder is a serious medical illness. It can be difficult for someone who does not suffer from the disease to understand, and yet it is understanding and patience that is needed to help your loved ones manage bipolarity. A bipolar individual cannot just “snap out of it” when depressed or “calm down” when manic. It is not a weakness or character flaw; the chemistry in their brain simply does not allow it. It is a biochemical disease that new information shows may be genetic in nature as well, and although there is no cure, bipolar disorder can be dealt with by working closely with a professional psychologist or psychiatrist to develop a treatment plan. Usually the treatment plan involves administration of a mood stabilizer such as lithium or Risperdal, in conjunction with talk therapy. If a well-informed patient is kept on an adequate dose of medication and participates actively in therapy sessions, he or she can live a full and successful life despite the presence of bipolar disorder.
