About Affective Disorders and Disability
What Are Affective Disorders (Mood Disorders)?
Affective disorders are really more appropriately called mood disorders. An affect is an emotion, manifest and observable in thinking and/or behavior. Mood is a more sustained and pervasive emotional element of mental life. Affective disorders include:
A person with mania has a distinctly elevated mood, usually euphoric or elated. The person has a grossly inappropriate energy and enthusiasm for everything. He or she has grandiose plans that cannot be achieved considering the person’s actual abilities and assets. But the person is not aware of this fact. To strangers, such a person may appear charismatic and dynamic, but, to those who know him or her, obviously functioning in an abnormal state.
Dynamic, enthusiastic, and energetic people are not necessarily manic. They are organized and productive while engaging in appropriate behaviors. The manic, on the other hand, has incomplete and disorganized behaviors from grandiose efforts to accomplish goals beyond his or her capacity. Normal people know they will fail at tasks that are beyond their capacity, and apply judgment in taking on tasks. But in mania, the individual characteristically takes on projects beyond his or her ability in a general behavioral pattern affecting every aspect of life, without appreciation of consequences or chances of success. The very high arousal state impairs judgment.
Depression has the opposite characteristics of mania. Instead of being in a euphoric mood, the person has limited activities, interests, and lowered self-esteem. A depressed person sees few possibilities for happiness. This narrowed viewpoint is associated with feelings of hopelessness and even despair. In the extreme case, even the ability to take care of personal hygiene may be impaired.
Bipolar disorder is diagnosed when the individual’s mood fluctuates between the extremes of depression and mania. The cycling between depression and mania may be very rapid (e.g., days) or occur over long periods of time (e.g., years).
Advanced brain imaging has established that bipolar disorder is associated with brain tissue loss. Tissue loss increases with age and is also worse in proportion to the number of relapses. Changes are most prominent in areas affecting face recognition, motor coordination, and memory—the fusiform gyrus, the cerebellum, and the hippocampus, respectively. The reason for brain shrinkage is not clear. But this is something the Social Security Administration adjudicator should keep in mind, especially if you have a long history of bipolar disorder with multiple relapses. In these instances, you may need neuropsychological testing in addition to a mental status evaluation to evaluate whether you are disabled.
Mania can often be effectively controlled with the drug lithium carbonate. Lithium is potentially toxic and those who take it should have periodic blood levels checked by a medical doctor.
While in the past treatment for bipolar disorder was limited to lithium, now a number of medications can be used:
- The antiepileptic drugs carbamazepine (Tegretol), lamotrigine (Lamictal), and divalproex (Epival, Depakote);
- The antipsychotic drugs olanzapine (Zyprexa) and quetiapine (Seroquel); or
- Various combinations of these.
Tamoxifen (Nolvadex), long used to treat breast cancer, has been found helpful in treating mania in bipolar disorder. Considering all of these drugs, a wide spectrum of side-effects are possible.
Claimants taking these medications should always have their claims reviewed by a physician. Because of the potential toxicity of drugs used to treat bipolar disorder and other serious mental disorders, the Social Security Administration should not to allow adjudication without review of the medical evidence by a medical doctor. A psychiatrist can evaluate both the mental disorder and drug toxicity. Clinical psychologists working for the Social Security Administration are not qualified to evaluate drug toxicity information. However, it is common practice for the Social Security Administration to permit severity assessment by psychologists alone in cases of mental disorders being treated by various medications. For example, a psychologist should not be expected to recognize that a claimant’s complaint of sleepiness could be due to medication, yet that fact could limit the claimant’s ability to do jobs requiring alertness, work at unprotected heights, or around hazardous machinery.
Information from Family and Friends Is Crucial to Disability Determination
Claimants with mental disorders living with family members are most likely to be improperly denied by Social Security Administration adjudicators. It is critically important for family members or other caregivers to provide the Social Security Administration with as detailed information as possible about specific tasks you can or cannot do.
Mental health clinics will often refuse to provide the Social Security Administration with clinical records that are useful in evaluating how a mental disorder has developed over time. They might simply write a letter summarizing what they think they Social Security Administration needs to know. In some instances, the Social Security Administration is forced to fall back on purchasing a consultative mental status examination in which the examining psychiatrist or psychologist has limited time to determine the details of daily functional capacity. The Social Security Administration should ask the treating psychiatrist (or psychologist) about work-related abilities for at least unskilled work and how these conclusions match with the corresponding limiting mental symptom.
If you are receiving medication, information about side-effects must come from a medical doctor, because a psychologist is not competent to evaluate that matter. However, it is also important for the same kind of information and opinions to be obtained from family or other caregivers, to make sure that nothing is missed. The caregivers live with the claimant; they may have noticed important facts that can be brought to the treating psychiatrist’s attention and to the Social Security Administration.