Functional and Dissociative Neurological Symptoms : a patient's guide

Hemi

Low Mood

Depression and Low Mood are common in patients with functional and dissociative neurological symptoms.

This website is not designed to cover these symptoms in detail. Some links are provided below

Two things are worth getting straight though in relation to functional symptoms:

• If you have depression or low mood, this does not mean it is the cause of your symptoms. You may feel sensitive when doctors or others ask you how you are feeling, but a good doctor should always ask this, regardless of your diagnosis. For example, patients with multiple sclerosis can suffer from anxiety and depression. When they do, their quality of life is generally not as good so its important to do whatever is possible to improve them. The situation with functional symptoms should be no different.

• Admitting to depression or low mood does not mean you are ‘mental’ / ‘off your head’ / ‘weak willed’ or any of the other things that some people (perhaps even you!) think. There is a lot of stigma out there for these kinds of problems and it is not always easy to deal with. See 'All in the mind' for more about this.

• The commonest cause of low mood in patients with functional symptoms is low mood about the symptoms themselves. What are they due to? Why doesn't anyone seem to believe me? Am I going mad? Will I become disabled in the future? Just because the low mood is about the symptoms does not mean it isn't "low mood".

Many patients do not realise what constitutes a diagnosis of depression Here are the widely used criteria for making a diagnosis of these conditions from the American Psychiatric Association.

Something that can be a surprise is that it is possible to have depression without feeling depressed or sad. Depression can be diagnosed in someone who does not feel sad if they have lost interest in things, are tired, have poor concentration, disturbed sleep, and altered appetite.

Depression can also manifest as severe feelings of frustration and anger.

DEPRESSION

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms are not due to bipolar disorder.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are severe

.. Depression can be diagnosed in someone who does not feel sad if they have lost interest in things, are tired, have poor concentration, disturbed sleep, and altered appetite...