A new series highlighting the fact that teenage changes can mask incipient mental health problems. Read the first one here.
Anisha, a 23-year-old girl from Delhi, has been living in Bangalore for the past eight months. She had attended two sessions with a counselor who referred her to me as she was too depressed to respond to counseling. The counselor figured the girl might need medicines.
During the first session, Anisha was despondent, trying to hold back tears. She had been depressed for more than a month. Her depression was so deep that she hadn’t the words to express herself, despite being a writer who made her living writing for a website. She was otherwise extremely articulate and it distressed her that she couldn’t understand or explain why she was depressed. She recalled going through two or three similar episodes while in high school and college. At that time the episodes had coincided with other events in her life and had, therefore, been dismissed as reactions to them.
As we pieced together her life story from childhood onwards, she talked about two discrete episodes of being supremely happy, again for no obvious reason. She treasured those two episodes, both of which occurred when she lived in a hostel as an undergraduate student. Her roommate had remarked on her elated mood at the time. She had been full of energy, talking late into the night as she was too excited to sleep; she had animatedly discussed plans for activities they could start in college and come up with rather far-fetched ideas for funding them; she had excitedly made phone calls to half a dozen friends in the middle of the night and had had loud conversations, reacting angrily when they didn’t share her enthusiasm. Apart from these two episodes, Anisha also remembered shorter and less intense episodes of extremely happy moods that appeared out of nowhere and lasted a few hours to a couple of days.
Gradually, a picture of a mood disorder began to unfold. There were episodes where she would be angry and irritable, again triggered by nothing in particular. There was one incident where she felt very happy, standing on the terrace of a high-rise with the exhilarating thought that she could fly if she spread out her arms and jumped off. This incident was two weeks before she met me, and was what prompted her shaken boyfriend to drag her to a counselor.
Considering these incidents and her current depressed mood, I arrived at a diagnosis of a mood disorder and started treatment. Her mood became stable over the next few weeks as the medications took effect. She now comes in for reviews regularly. Her occasional blue moods are no different than anybody else’s and she’s fine with that.
It is not hard to see why moods swings need treatment. Anisha could have jumped off the top of the building in her ‘high’ mood. Or, she might have ended her life in a fit of deep depression. Besides these extreme outcomes, a ‘high’ mood can lead to excesses like reckless spending, getting into fights and destroying relationships, sexual indiscretions, etc., all of which can be mortifying once the ‘high’ mood passes. Severe depression is equally damaging as it prevents a person from getting on with what needs to be done, so that life sort of unravels.
A lot of teenage behavior is often mistakenly put down to high spirits, moodiness, hormones, PMS, interpersonal problems, low self-esteem or any of a host of reasons picked up from the internet. Or, what I often hear, “Oh, we thought she was drunk!”
Mood disorders, unlike mere moodiness, are a drastic change from a person’s usual mood either towards happiness or towards sadness. Family and friends who notice drastic mood changes should realise that something may seriously be wrong, and seek psychiatric evaluation as soon as possible, so that treatment can begin before too much damage is done.
In this series Dr Shyamala Vatsa highlights the fact that teenage changes can mask incipient mental health problems. These articles show how early symptoms of mental disorder can be taken for ordinary teenage behavior. As illustrated by the stories of young people who have suffered unnecessarily, it is important for friends and family to recognize when a behavior is outside normal limits, and seek help before things spin out of control.
Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years. If you have any comments or queries you would like to share, please write to her at firstname.lastname@example.org