When it comes to feelings of depression, there are two major “types” of depression. One is flat depression, and the other is depression as part of mood cycling.
Both can have particular reasons for the feeling, but flat depression tends to stick around longer. It feels… less, if that makes sense. It’s like a numbing, consistent low mood that saps enjoyment of activities and lessens emotion altogether.
Mood cycling depression is less stable and tends to last for less time each depressive cycle. Mood cycling is more common in bipolar or borderline personality disorder, where there are periods of higher emotion and less emotional stability. Flat depression is more characteristic of major depression.
Flat depression and mood cycling typically have different interactions with antidepressants. Antidepressants are most effective for flat depression. However, when taken for mood cycling depression, antidepressants can bring about even more emotional instability.
Antidepressants are meant to bring your emotional level up. Mood stabilizers, a different class of medication, are meant to stabilize emotional level. The need for both, as sometimes in bipolar, can be a delicate balance that requires the patient to understand the difference between flat depression and mood cycling. When emotions are unstable, taking antidepressants can make the highs higher, which means a bigger crash when the neurotransmitters exhaust themselves and depression hits. This is mood cycling, when mood stabilizers are most effective.
For me, I take antidepressants as needed currently. This, in my case, means that I have to know the difference between flat depression and mood cycling, and only take the antidepressants when it’s flat depression. I’m supposed to stop taking them once I start experiencing irritability or impulsitivity, as this shows that my emotional level is going up to a sustainable spot where antidepressants are no longer most effective and my mood stabilizers must do their work of keeping my mood stable.
When someone is taking both antidepressants and mood stabilizers and is experiencing mood cycling, some prescribers might be tempted to raise the mood stabilizers. Then the patient might go through more flat depression, causing them to raise antidepressants. Both dosages just go up and up until the patient is oversaturated with the medication. Generally, the fewer medications and lower dosages a patient can be on is the best option, lessening the chances and severity of side effects and possible long-term effects.
This puts some responsibility on the patient to know the difference between mood cycling and flat depression, not only so they can take their medications as needed, but so they can effectively and accurately communicate their symptoms to their doctor.