TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 233 including relationships, functioning at work and self-care. When symptoms of depression increase, individuals may not feel motivated to spend time with others. They may feel no pleasure in previously enjoyable activities and experience interactions with others as draining. Similarly, a previously motivated and engaged employee may seem distracted or disconnected at work and absenteeism may become a problem. In addition to problems in relationships and at work, self-care also is impacted by major depression. Time and energy for healthy habits such as exercise and meal preparation may be lost. In severe cases, a lack of attention to basic hygiene may be observable. The severity and length of symptoms can vary tremendously for individuals with major depressive disorder. Some people never experience remission while others may enjoy years without symptoms (National Institute of Mental Health [NIMH], n.d.-a). The longer the period of remission, the lower the likelihood of a recurrence (APA, 2013). For those individuals who have more severe episodes, a history of multiple previous episodes, or were first diagnosed at a younger age, lifelong mental health treatment may be necessary to increase quality of life (APA, 2013). Treatment . Almost 11 million people diagnosed with major depressive disorder sought treatment in 2012, which was approximately 68% of those diagnosed with the disorder (SAMHSA, 2013; based on DSM-IV- TR criteria). The most common forms of treatment are medications (e.g., antidepressants), psychotherapy/ counseling or a combination of the two. In 2012, 45% of all individuals who had a major depressive episode used a combination of psychotherapy/counseling and medications, while 14.1% used psychotherapy/counseling only, and 6.6% used medication only (SAMHSA, 2013). More than half of the individuals who received medication for their major depressive episode did so from their general practitioner (SAMHSA, 2013). For those who sought psychotherapy/counseling, many accessed outpatient counseling at a mental health clinic or private practice in the community. About .8% reported they were hospitalized at some point in the year (SAMHSA, 2013). Others may have received treatment that included more intensive interventions such as case management to help with access to services and subsistence or day treatment to provide all-day support and supervision when needed. Because such a small percentage of clients seek psychotherapy/counseling alone (SAMHSA, 2013), it is likely that counselors who work with clients who have major depressive disorder do so as part of a treatment team. Counseling is an essential part of treatment, as there is ample empirical evidence for its effectiveness, particularly cognitive-behavioral and interpersonal techniques (e.g., Paradise & Kirby, 2005). Bipolar I Disorder Bipolar I disorder affects roughly .6% of the population (APA, 2013). It is a lifelong disorder, as nearly all of the individuals who have one manic episode will have multiple episodes in their lifetime (APA, 2013). Symptoms of bipolar I disorder can be detrimental to relationships, daily functioning and financial stability of the individual who is diagnosed with the disorder. The cyclical nature of bipolar I disorder leads to instability, as the episodes of depression, mania and remission each have a different impact on the individual’s life. During episodes of depression, the impact is similar to that caused by major depressive disorder, as described above. In contrast, some individuals with bipolar I disorder report enjoying manic episodes as they escalate because of improved mood, energy and productivity. However, elevated mood often comes with dangerous grandiosity, distractibility and impulsivity. During periods of remission when symptoms are mild or absent, the person may attempt to repair the consequences of their manic episodes (e.g., excessive shopping) and depressive episodes (e.g., neglected chores). Few people seek treatment on their own during manic episodes. Initiating or expanding treatment during a manic episode is important to prevent irreparable damage and to ensure safety. Grandiosity combined with risky behaviors can lead to physical injuries and property damage, and the euphoria of elevated mood can quickly