Depression
Depression (also known as unipolar depression or clinical depression) is a mood disorder which often involves a loss of interest in life, or "anhedonia". It is common to feel sad, discouraged, or "down" once in a while, but for some people, this mood persists. When symptoms last two weeks or more, and are so severe that they interfere with daily living, one can be said to be suffering from depression.
Depression affects nearly 10% of the population at one time or another in their lives; it occurs most often between the ages of 24 and 44. About twice as many women as men report or receive treatment for depression, though the gap is shrinking.
Depression (also known as unipolar depression or clinical depression) is a mood disorder which often involves a loss of interest in life, or "anhedonia". It is common to feel sad, discouraged, or "down" once in a while, but for some people, this mood persists. When symptoms last two weeks or more, and are so severe that they interfere with daily living, one can be said to be suffering from depression.
Depression affects nearly 10% of the population at one time or another in their lives; it occurs most often between the ages of 24 and 44. About twice as many women as men report or receive treatment for depression, though the gap is shrinking.
Causes of depression
No specific cause for depression has been identified, but there are a number of factors believed to be involved.
· Heredity The tendency to develop depression may be inherited; there is some evidence that this disorder may run in families.
· Brain chemicals called neurotransmitters allow electrical signals to move from the axon of one nerve cell to the neuron of another.
· A shortage of neurotransmitters impairs brain communication.
Physiology: There may be changes or imbalances in certain chemicals the brain uses to transmit information. These neurotransmitters include chemicals such as serotonin, and many modern antidepressants work on the assumption that an imbalance in this chemical is a factor in depression. While it is not clear which is the cause and which is the effect, it is known that antidepressant medications do help alleviate the symptoms of depression. Seasonal affective disorder (SAD) is a type of depressive disorder that occurs in the winter when daylight hours are short. It is believed that the body's production of melatonin, which is produced at increased levels in the dark, plays a major part in the onset of SAD, and that many sufferers respond well to bright light therapy, also known as phototherapy.
· Psychological factors Low self-esteem and self-defeating or distorted thinking are connected with depression. While it is not clear which is the cause and which is the effect, it is known that sufferers who are able to make corrections to their thinking patterns can show improved mood and self-esteem. Psychological factors include the complex development of one's personality and how one has learned to cope with external environmental factors, such as stress.
Early experiences Events such as the death of a parent, abandonment or rejection, neglect, chronic illness, and severe physical, psychological, or sexual abuse can also increase the likelihood of depression later in life. Post-traumatic stress disorder (PTSD) includes depression as one of its major symptoms.
· Life experiences Job loss, financial difficulties, long periods of unemployment, the loss of a spouse or other family member, or other traumatic events may trigger depression.
Medical conditions Certain illnesses including hepatitis or mononucleosis may contribute to depression, as may certain prescription drugs such as birth control pills and steroids.
· Alcohol and other drugs Alcohol can have a negative effect on mood, and misuse or abuse of alcohol, benzodiazepine-based tranquillizers and sleeping medications, or narcotics can all play a major role in the length and severity of depression.
· Post-partum depression About ten percent of new mothers experience some form of depression after childbirth. When it occurs, the onset is typically within three months after delivery, and it may last for several months. About two new mothers out of a thousand have depression so severe it includes hallucinations or delusions.
· Living with a depressed person Those living with someone suffering from depression experience increased stress, anxiety, and life disruption, which increases the possibility of their also becoming depressed.
· BioMechanical-Neurological Excessive stimulation of the neuroloigical system may lead to clinical depression. The degree and persistence of the depression is directly related to the degree and persistence of the stimulation. This neurological reflex is part of the bodies natural defenses, that have evolved through evolution,to protect itself from harm. Over work,physically or mentally, may over stimulate the neurological system which reflexively responds by creating a sense of tiredness mentally and physically-the desire to do anything is much reduced.
Signs and symptoms
According to the DSM-IV-TR (p. 356), the two principal or required elements of depression are:
· depressed mood, or
· loss of interest or pleasure.
According to the DSM-IV-TR (p. 356), the two principal or required elements of depression are:
· depressed mood, or
· loss of interest or pleasure.
It is sufficient to have either of these symptoms in conjunction with four of a list of other symptoms. The diagnosis does not require "loss of interest in life, anhedonia". Likewise, "lack of energy and motivation" is not at all a required symptom of major depression.
In adults, symptoms accompanying depression often include:
· feelings of overwhelming sadness, or complete lack of emotion
· marked decrease in interest in pleasurable activities
· changing appetite and marked weight gain or weight loss
· disturbed sleep patterns, either insomnia or sleeping more than normal
· changes in activity levels, restless or moving significantly slower than normal
· fatigue, both mental and physical
· feelings of guilt, helplessness, anxiety, and/or fear
· lowered self-esteem
· decreased ability to concentrate or make decisions
· thinking about death or suicide
· drug or alcohol use.
· feelings of overwhelming sadness, or complete lack of emotion
· marked decrease in interest in pleasurable activities
· changing appetite and marked weight gain or weight loss
· disturbed sleep patterns, either insomnia or sleeping more than normal
· changes in activity levels, restless or moving significantly slower than normal
· fatigue, both mental and physical
· feelings of guilt, helplessness, anxiety, and/or fear
· lowered self-esteem
· decreased ability to concentrate or make decisions
· thinking about death or suicide
· drug or alcohol use.
Depression in children is not as evident as it is in adults; symptoms children demonstrate include
· loss of appetite
· sleep problems such as nightmares
· problems with behavior or grades at school where none existed before
· significant behavioral changes; becoming withdrawn, sulky, aggressive
· In older children and adolescents, an additional indicator may be the use of drugs or alcohol.
· loss of appetite
· sleep problems such as nightmares
· problems with behavior or grades at school where none existed before
· significant behavioral changes; becoming withdrawn, sulky, aggressive
· In older children and adolescents, an additional indicator may be the use of drugs or alcohol.
Most people who have not experienced clinical depression do not properly understand its emotional impact, interpreting it instead as being similar to "having the blues" or "feeling down". As the list of symptoms above indicates, clinical depression is a syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry and an overall reduction in brain activity. One consequence of a lack of understanding of its nature is that depressed individuals are often criticized by themselves and others for not making an effort to help themselves. However, the more severe the depression is, the more the depression may take on an autonomous nature, responding neither to positive events nor to the person's own efforts to feel better. Because of its intractable nature, it is imperative that the depressed individual seek professional help. Untreated depression is typically characterized by progressively worsening episodes separated by plateaus of temporary stability or remission, and often leads to suicide.
Types of major depression
Major depression is also referred to as major depressive disorder or biochemical, clinical, endogenous, or biological depression. It is characterized by a severely depressed mood that persists for at least two weeks. Episodes of depression may start suddenly or slowly and can occur several times though a person's life.
Major depression is also referred to as major depressive disorder or biochemical, clinical, endogenous, or biological depression. It is characterized by a severely depressed mood that persists for at least two weeks. Episodes of depression may start suddenly or slowly and can occur several times though a person's life.
Classification
Clinicians recognise several subtypes of major depression.
· Melancholia is very severe, and includes a number of major physical symptoms including sleep and appetite disturbances, weight loss, and withdrawal. The name derives from 'black bile', one of the imagined 'four humours' postulated by Hippocrates.
· Psychotic depression is similar to melancholia, and is accompanied by hallucinations or delusions.
· Atypical depression is characterized by anxiety and panic attacks.
· Chronic dysthymic disorder is a long-term, mild depression that lasts for at least two years. It often begins in adolescence and spans several decades.
Clinicians recognise several subtypes of major depression.
· Melancholia is very severe, and includes a number of major physical symptoms including sleep and appetite disturbances, weight loss, and withdrawal. The name derives from 'black bile', one of the imagined 'four humours' postulated by Hippocrates.
· Psychotic depression is similar to melancholia, and is accompanied by hallucinations or delusions.
· Atypical depression is characterized by anxiety and panic attacks.
· Chronic dysthymic disorder is a long-term, mild depression that lasts for at least two years. It often begins in adolescence and spans several decades.
Major depression may also be referred to as unipolar affective disorder.
Bipolar disorder
Bipolar disorder, sometimes called manic depression, is a cyclical illness in which moods fluctuate between extreme happiness or giddiness and frantic activity (the manic stage) and profound depression.
Bipolar disorder, sometimes called manic depression, is a cyclical illness in which moods fluctuate between extreme happiness or giddiness and frantic activity (the manic stage) and profound depression.
Treatment
Treatment of depression varies broadly, and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically employed in conjunction with one another, medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT) may be used where chemical treatment fails. Other alternative treatments used for depression include exercise, and the use of vitamins, herbs, or other nutritional supplements.
The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.
Treatment of depression varies broadly, and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically employed in conjunction with one another, medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT) may be used where chemical treatment fails. Other alternative treatments used for depression include exercise, and the use of vitamins, herbs, or other nutritional supplements.
The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.
Medication
Medication which effectively ameliorates the symptoms of depression has been available for several decades. Tricyclic antidepressants are the oldest, and include such medications as amitryptyline and desipramine. They are used less commonly now, due to side-effects which may include increased heart rate, drowsiness, and memory impairment.
Medication which effectively ameliorates the symptoms of depression has been available for several decades. Tricyclic antidepressants are the oldest, and include such medications as amitryptyline and desipramine. They are used less commonly now, due to side-effects which may include increased heart rate, drowsiness, and memory impairment.
Monoamine oxidase inhibitors (MAOIs) may be used if other antidepressant medications are ineffective. Because there are undesirable interactions between this class of medication and certain foods and drugs, it is important that the user be aware of which ones to avoid. A new MAOI has recently been introduced. Moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase A (RIMA), follows a very specific chemical pathway and does not require a special diet.
Selective serotonin reuptake inhibitors (SSRIs) comprise the current standard family of antidepressants. It is thought that one cause of depression is that an inadequate amount of serotonin, a chemical which the brain uses to transmit signals between nerve cells, is produced. These drugs work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), and nefazodone (Serzone). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, though such effects as drowsiness, dry mouth, and decreased ability to function sexually may occur.
Selective serotonin reuptake inhibitors (SSRIs) comprise the current standard family of antidepressants. It is thought that one cause of depression is that an inadequate amount of serotonin, a chemical which the brain uses to transmit signals between nerve cells, is produced. These drugs work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), and nefazodone (Serzone). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, though such effects as drowsiness, dry mouth, and decreased ability to function sexually may occur.
Some antidepressants have been found to work more effectively in some patients when used in combination with another drug. Such "augmentor" drugs include tryptophan (Tryptan) and buspirone (Buspar). Tranquillizers and sedatives, typically the benzodiazepines, may be prescribed to ease anxiety and promote sleep. Because of their high potential for addiction, these medications are intended only for short-term or occasional use. Medications are often employed not for their primary function, but to exploit what are normally side effects. Quetiapine fumarate (Seroquel) is designed primarily to treat schizophrenia and bipolar disorder, but a frequently-reported side-effect is somnolence. Hence, this non-addictive drug can be used in place of an addictive anti-anxiety agent such as clonazepam (Klonopin, Rivotril).
Antipsychotics such as risperidone (Risperdal) and olanzapine (Zyprexa) are prescribed as mood stabilizers and are also effective in treating anxiety. However, they may have serious side effects, particularly at high doses, which may include blurred vision, muscle spasms, restlessness, tardive dyskinesia, and weight gain.
Lithium remains the standard treatment for bipolar disorder, but may also be effective for people with depression, particularly in preventing relapse. Lithium's potential side effects include thirst, tremors, light-headedness, and nausea or diarrhea.
Failure to take medication, or failure to take it as prescribed, is one of the major causes of relapse. Should one feel a change or discontinuation of medication is necessary, it is critical that this be done in consultation with a doctor.
Failure to take medication, or failure to take it as prescribed, is one of the major causes of relapse. Should one feel a change or discontinuation of medication is necessary, it is critical that this be done in consultation with a doctor.
Psychotherapy
In psychotherapy, or counselling, one receives assistance in understanding and resolving problems which may be contributing to depression. This may be done individually or with a group, and is conducted by health professionals such as psychiatrists, psychologists, social workers, or psychiatric nurses. It is important to enquire about both the therapist's training and approach; a very close bond often forms between practitioner and client, and it is important that the client feel understood by the clinician.
Counsellors can help a person make changes in thinking patterns, deal with relationship issues, detect and deal with relapses, and understand the factors that contribute to depression.
There are many therapeutic approaches, but all are aimed at improving an individual's personal and interpersonal functioning. Cognitive therapy focuses on how people think about themselves and their relationship to the world. It works to counteract negative thought patterns and enhance self-esteem. Therapy can be used to help a person develop or improve interpersonal skills in order to allow them to communicate more effectively and reduce stress. Behavioral therapy is based on the assumption that behaviors are learned. This type of therapy attempts to teach individuals new and healthier types of behaviors. Supportive therapy encourages people to discuss their problems and provides them with emotional support. The focus is on sharing information, ideas, and strategies for coping with daily life. Family therapy helps people live together more harmoniously and undo patterns of destructive behavior.
In psychotherapy, or counselling, one receives assistance in understanding and resolving problems which may be contributing to depression. This may be done individually or with a group, and is conducted by health professionals such as psychiatrists, psychologists, social workers, or psychiatric nurses. It is important to enquire about both the therapist's training and approach; a very close bond often forms between practitioner and client, and it is important that the client feel understood by the clinician.
Counsellors can help a person make changes in thinking patterns, deal with relationship issues, detect and deal with relapses, and understand the factors that contribute to depression.
There are many therapeutic approaches, but all are aimed at improving an individual's personal and interpersonal functioning. Cognitive therapy focuses on how people think about themselves and their relationship to the world. It works to counteract negative thought patterns and enhance self-esteem. Therapy can be used to help a person develop or improve interpersonal skills in order to allow them to communicate more effectively and reduce stress. Behavioral therapy is based on the assumption that behaviors are learned. This type of therapy attempts to teach individuals new and healthier types of behaviors. Supportive therapy encourages people to discuss their problems and provides them with emotional support. The focus is on sharing information, ideas, and strategies for coping with daily life. Family therapy helps people live together more harmoniously and undo patterns of destructive behavior.
Electroconvulsive therapy
Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a small and carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia. This therapy may be employed where other means of treatment have failed, or where the use of drugs is unacceptable, such as in pregnancy. In a typical regimen of treatment, a patient receives three treatments per week over three or four weeks. Repeat sessions may be required. Short-term memory loss or headache may result from this treatment.
Electroconvulsive therapy, also known as electroshock therapy, shock therapy, or ECT employs a small and carefully controlled current of electricity to induce an artificial epileptic seizure while the patient is under general anesthesia. This therapy may be employed where other means of treatment have failed, or where the use of drugs is unacceptable, such as in pregnancy. In a typical regimen of treatment, a patient receives three treatments per week over three or four weeks. Repeat sessions may be required. Short-term memory loss or headache may result from this treatment.
Transcranial Magnetic Stimulation
Repetitive Transcranial Magnetic Stimulation (rTMS) is currently under study as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. In this therapy, a powerful magnetic field is used to stimulate the left prefrontal cortex, an area of the brain which typically shows abnormal activity in depressed individuals. Studies currently show an efficacy similar to that of ECT, but with fewer side effects. No sedation is required, and the only reported side effects are a slight headache in some patients, and facial muscle contraction during treatment.
------------------------------------------------------------
Repetitive Transcranial Magnetic Stimulation (rTMS) is currently under study as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. In this therapy, a powerful magnetic field is used to stimulate the left prefrontal cortex, an area of the brain which typically shows abnormal activity in depressed individuals. Studies currently show an efficacy similar to that of ECT, but with fewer side effects. No sedation is required, and the only reported side effects are a slight headache in some patients, and facial muscle contraction during treatment.
------------------------------------------------------------
Bipolar disorder
As categorized by the DSM-IV, bipolar disorder is a form of mood disorder characterised by a variation of mood between a phase of manic or hypomanic elation, hyperactivity and hyper imagination, and a depressive phase of inhibition, slowness to conceive ideas and move, and anxiety or sadness. Together these form what is commonly known as manic depression.
Manic depression with its two principal sub-types, bipolar disorder and major depression, was first clinically described near the end of the 19th century by psychiatrist Emil Kraepelin, who published his account of the disease in his Textbook of Psychiatry. As described below, there are several forms of bipolar disorder.
It should be noted that this disease does not consist of mere "ups and downs". Ups and downs are experienced by virtually everyone and do not constitute a disease. The mood swings of bipolar disorder are far more extreme than those experienced by most people.
Note: Bipolar disorder is also commonly called "manic depression" by laymen (and by some psychiatrists in the twentieth century), although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term manic depression to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now use bipolar disorder to describe the bipolar form of manic depression.
As categorized by the DSM-IV, bipolar disorder is a form of mood disorder characterised by a variation of mood between a phase of manic or hypomanic elation, hyperactivity and hyper imagination, and a depressive phase of inhibition, slowness to conceive ideas and move, and anxiety or sadness. Together these form what is commonly known as manic depression.
Manic depression with its two principal sub-types, bipolar disorder and major depression, was first clinically described near the end of the 19th century by psychiatrist Emil Kraepelin, who published his account of the disease in his Textbook of Psychiatry. As described below, there are several forms of bipolar disorder.
It should be noted that this disease does not consist of mere "ups and downs". Ups and downs are experienced by virtually everyone and do not constitute a disease. The mood swings of bipolar disorder are far more extreme than those experienced by most people.
Note: Bipolar disorder is also commonly called "manic depression" by laymen (and by some psychiatrists in the twentieth century), although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term manic depression to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now use bipolar disorder to describe the bipolar form of manic depression.
General description
Bipolar disorder is a condition that causes extreme shifts in mood, energy, and functioning. In most populations it affects around 1 percent of the population. Men and women are equally likely to develop this often-disabling illness. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.
There is a tendency to romanticize bipolar disorder, especially in artistic circles. Many artists, musicians, and writers have experienced its mood swings, and some credit the condition with their creativity. However, many lives are ruined by this disease, and it is associated with a greatly increased risk of suicide.
Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.
Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; hypersexuality and excessive involvement in risky behaviors or activities.
"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation. Also known as dysphoric mania (from Greek 'dysphoria', 'dys', difficulty, 'phorós', bearer, and 'mania', mania, insanity).
Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When 4 or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.
Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time.
Bipolar disorder is a condition that causes extreme shifts in mood, energy, and functioning. In most populations it affects around 1 percent of the population. Men and women are equally likely to develop this often-disabling illness. The disorder typically emerges in adolescence or early adulthood, but in some cases appears in childhood. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life.
There is a tendency to romanticize bipolar disorder, especially in artistic circles. Many artists, musicians, and writers have experienced its mood swings, and some credit the condition with their creativity. However, many lives are ruined by this disease, and it is associated with a greatly increased risk of suicide.
Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.
Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; hypersexuality and excessive involvement in risky behaviors or activities.
"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation. Also known as dysphoric mania (from Greek 'dysphoria', 'dys', difficulty, 'phorós', bearer, and 'mania', mania, insanity).
Especially early in the course of illness, the episodes may be separated by periods of wellness during which a person suffers few to no symptoms. When 4 or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.
Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time.
Diagnostic criteria
Bipolar disorder takes two principal forms, neither of which requires plural "cycles". According to the DSM-IV-TR (p. 345), these two principal forms of Bipolar disorder are:
Bipolar I disorder, the diagnosis of which requires over the entire course of the patient's life at least one manic (or mixed state) episode which is usually (though not always) accompanied by episodes of Major Depressive disorder.
Bipolar II disorder, which over the course of the patient's life must involve at least one Major Depressive episode and must be accompanied by at least one hypomanic episode; i.e. there need be no full manic episodes at all.
Bipolar disorder takes two principal forms, neither of which requires plural "cycles". According to the DSM-IV-TR (p. 345), these two principal forms of Bipolar disorder are:
Bipolar I disorder, the diagnosis of which requires over the entire course of the patient's life at least one manic (or mixed state) episode which is usually (though not always) accompanied by episodes of Major Depressive disorder.
Bipolar II disorder, which over the course of the patient's life must involve at least one Major Depressive episode and must be accompanied by at least one hypomanic episode; i.e. there need be no full manic episodes at all.
Therefore Bipolar disorder need not have both severe mania and depression and in certain cases has only episodes of the one type. There need be no "cycles" of mania and depression. This is the reason why certain contemporary psychiatrists shy away from the original name, Manic Depression, i.e. because the latter name might suggest that all patients have both mania and depression. It has nothing to do with the notion of equal distribution of cycles of mania and depression, since there need not be any cycles at all--in fact, even when there is one (or more) bout of both mania and depression over the course of a patient's life, the two episodes may be so unrelated to each other temporally and otherwise that this need not constitute a cycle. However, a significant portion of bipolar patients does experience the classical alternating episodes (cycles) of mania and depression and therefore it is overstating the case to say that the classical alternation "rarely" occurs.
The DSM-IV treats these bipolar disorders as variants of mood or affective disorders. Others types include Major Depressive Disorder and Dysthymic Disorder. Bipolar and other mood disorders may have no identifiable medical, traumatic or other external cause (endogenous) or may be due to e.g. a medical condition (exogenous).
Cycles in bipolar disorder
Kraepelin included in his description of Manic Depression the phenomenon that episodes of acute illness, whether mania or depression, are usually punctuated by relatively symptom-free intervals during which the patient is able to function normally both at work and in social affairs.
The cycles of bipolar disorder may be long or short, and the ups and downs may be of different magnitudes: for instance, a person suffering from bipolar disorder may suffer a protracted mild depression followed by a shorter and intense mania. The manic periods typically include euphoria, tirelessness, and impulsiveness; the depressed periods may seem much worse following a manic period.
The name bipolar disorder is used to distinguish the condition from unipolar depression, and bipolar disorder is in turn divided into two forms, "Bipolar I" and the "Bipolar II" form, considered by some as a 'milder' version of the disorder. However, other doctors believe there is no sound basis for the blanket statement that Bipolar II is "milder" than Bipolar I.
Environmental factors affecting mood in bipolar disorder
In mid-2003, a twin study was published concerning environmental factors and bipolar disorder. The bipolar twin was found to be far more affected by changes in sunlight. Longer nights resulted in mood and sleep-length changes far greater than the healthy twin. Sunny days also did more to improve mood. In fact, natural light in general was found to have a profound positive effect upon the well-being of the bipolar twin (Hakkarainen, 2003).
Kraepelin included in his description of Manic Depression the phenomenon that episodes of acute illness, whether mania or depression, are usually punctuated by relatively symptom-free intervals during which the patient is able to function normally both at work and in social affairs.
The cycles of bipolar disorder may be long or short, and the ups and downs may be of different magnitudes: for instance, a person suffering from bipolar disorder may suffer a protracted mild depression followed by a shorter and intense mania. The manic periods typically include euphoria, tirelessness, and impulsiveness; the depressed periods may seem much worse following a manic period.
The name bipolar disorder is used to distinguish the condition from unipolar depression, and bipolar disorder is in turn divided into two forms, "Bipolar I" and the "Bipolar II" form, considered by some as a 'milder' version of the disorder. However, other doctors believe there is no sound basis for the blanket statement that Bipolar II is "milder" than Bipolar I.
Environmental factors affecting mood in bipolar disorder
In mid-2003, a twin study was published concerning environmental factors and bipolar disorder. The bipolar twin was found to be far more affected by changes in sunlight. Longer nights resulted in mood and sleep-length changes far greater than the healthy twin. Sunny days also did more to improve mood. In fact, natural light in general was found to have a profound positive effect upon the well-being of the bipolar twin (Hakkarainen, 2003).
Treatment of bipolar disorder
Medications, called "mood stabilizers" can sometimes be used to prevent manic or depressive episodes. Periods of depression can also be treated with antidepressants. In extreme cases where the mania or the depression is severe enough to cause psychosis, antipsychotic drugs may also be used. (See the end of the article for an external resource on psychopharmacology.) In contrast to schizophrenia, insight-oriented psychotherapy may be of some use in treating bipolar disorder.
These drugs do not work in all patients, work sometimes in others, and it is very difficult to determine in any particular case whether they are effective at all since bipolar disorder is mostly transient or episodic, and patients experience remissions and periods of virtually normal functioning whether or not they receive treatment.
It is not clear how it would even be possible to determine that medications prevent such episodes. Tens of millions of patients have severe mood disorders and if any medication could prevent episodes, such diseases as bipolar disorder would be rare indeed. There is some evidence that they may be effective for some patients, some of the time but the evidence for their efficacy is at best statistical and it is virtually impossible to say that any particular patient was benefited by any particular treatment. In discussing these medications one must also take into account the fact that many patients experience severe side effects. Until recently, one might reasonably question whether the enormously harmful side effects and the tendency to abuse psychotropic drugs outweighed any possible benefits (real or imagined). The anti-psychotic drug Navane, became notorious after several people using it committed violent homicides, attributing to the drug a share of responsibility for destabilizing them.
Compliance with medications can be a major problem because some people becoming manic lose insight, or an awareness of having an illness, and discontinue medications; then they often suffer a manic episode and may suddenly find themselves initiating multiple projects often being scattered and ineffective, or may go on a spending spree or take a poorly planned trip landing them in an unfamiliar location without cash. The manic periods, euphoric as they may be, are often disastrous because of the impulsiveness and irrationality that comes with them. Contrary to the patient's wishes, the depression does not respond instantaneously to resumed medication, typically taking 2-6 weeks to respond.
Whilst bipolar disorder can be one of the most severe and devastating medical conditions, many individuals with bipolar disorder can also live full and mostly happy lives with correct management of their condition. Compared to patients with schizophrenia, persons with bipolar disorder are more likely to have periods of normal functioning in the absence of medication. Although schizophrenic patients may have remissions with relatively high levels of functioning, schizophrenic patients tend to suffer some impairment during these intervals, if they are not medicated, in contrast to persons with bipolar disorder who often appear completely normal when they are between mood swings.
Medications, called "mood stabilizers" can sometimes be used to prevent manic or depressive episodes. Periods of depression can also be treated with antidepressants. In extreme cases where the mania or the depression is severe enough to cause psychosis, antipsychotic drugs may also be used. (See the end of the article for an external resource on psychopharmacology.) In contrast to schizophrenia, insight-oriented psychotherapy may be of some use in treating bipolar disorder.
These drugs do not work in all patients, work sometimes in others, and it is very difficult to determine in any particular case whether they are effective at all since bipolar disorder is mostly transient or episodic, and patients experience remissions and periods of virtually normal functioning whether or not they receive treatment.
It is not clear how it would even be possible to determine that medications prevent such episodes. Tens of millions of patients have severe mood disorders and if any medication could prevent episodes, such diseases as bipolar disorder would be rare indeed. There is some evidence that they may be effective for some patients, some of the time but the evidence for their efficacy is at best statistical and it is virtually impossible to say that any particular patient was benefited by any particular treatment. In discussing these medications one must also take into account the fact that many patients experience severe side effects. Until recently, one might reasonably question whether the enormously harmful side effects and the tendency to abuse psychotropic drugs outweighed any possible benefits (real or imagined). The anti-psychotic drug Navane, became notorious after several people using it committed violent homicides, attributing to the drug a share of responsibility for destabilizing them.
Compliance with medications can be a major problem because some people becoming manic lose insight, or an awareness of having an illness, and discontinue medications; then they often suffer a manic episode and may suddenly find themselves initiating multiple projects often being scattered and ineffective, or may go on a spending spree or take a poorly planned trip landing them in an unfamiliar location without cash. The manic periods, euphoric as they may be, are often disastrous because of the impulsiveness and irrationality that comes with them. Contrary to the patient's wishes, the depression does not respond instantaneously to resumed medication, typically taking 2-6 weeks to respond.
Whilst bipolar disorder can be one of the most severe and devastating medical conditions, many individuals with bipolar disorder can also live full and mostly happy lives with correct management of their condition. Compared to patients with schizophrenia, persons with bipolar disorder are more likely to have periods of normal functioning in the absence of medication. Although schizophrenic patients may have remissions with relatively high levels of functioning, schizophrenic patients tend to suffer some impairment during these intervals, if they are not medicated, in contrast to persons with bipolar disorder who often appear completely normal when they are between mood swings.
Research into new treatments
Electroconvulsive therapy (ECT) was an accepted treatment in the past, and is still used today when other treatments have failed. There is current research work on transcranial magnetic stimulation as an alternative to ECT. In late 2003, researchers at McLean Hospital in Belmont, Massachusetts have found tentative evidence of improvements in mood during EP-MRSI imaging, and attempts are being made to develop this into a form which can be evaluated as a possible treatment.
Lithium Orotate is used as an alternative treatment to lithium carbonate by some sufferers of Bipolar Disorder, mainly because it is available without a doctor's prescription, and because it can be taken at lower non-toxic dosages. It should be noted that there are few human studies involving lithium orotate, and that self-treatment of bipolar disorder entails risks.
It has been hypothesized that bipolar disorder may be the result of poor membrane conduction in the brain and that one possible cause may be a deficiency in omega-3 polyunsaturated fatty acids. Following an encouraging small-scale study, several large scale trials of treatment using omega-3 fatty acids are under way.
Electroconvulsive therapy (ECT) was an accepted treatment in the past, and is still used today when other treatments have failed. There is current research work on transcranial magnetic stimulation as an alternative to ECT. In late 2003, researchers at McLean Hospital in Belmont, Massachusetts have found tentative evidence of improvements in mood during EP-MRSI imaging, and attempts are being made to develop this into a form which can be evaluated as a possible treatment.
Lithium Orotate is used as an alternative treatment to lithium carbonate by some sufferers of Bipolar Disorder, mainly because it is available without a doctor's prescription, and because it can be taken at lower non-toxic dosages. It should be noted that there are few human studies involving lithium orotate, and that self-treatment of bipolar disorder entails risks.
It has been hypothesized that bipolar disorder may be the result of poor membrane conduction in the brain and that one possible cause may be a deficiency in omega-3 polyunsaturated fatty acids. Following an encouraging small-scale study, several large scale trials of treatment using omega-3 fatty acids are under way.
Treatments (from NIH public domain article and assorted publications)
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy, and psychoeducation.
Lithium has long been used as a first-line treatment for bipolar disorder. Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA), lithium has been an effective mood-stabilizing medication for many people with bipolar disorder. Lithium is also noted for reducing the risk of suicide in major affective disorders, such as bipolar disorder: suicide risk on the whole drops to below the average level for society (Baldessarini, 2003).
Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Valproate was FDA approved for the treatment of acute mania in 1995. Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.
According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.
During a depressive episode, people with bipolar disorder commonly require additional treatment with antidepressant medication. Typically, lithium or anticonvulsant mood stabilizers are prescribed along with an antidepressant to protect against a switch into mania or rapid cycling. The comparative efficacy of various antidepressants in bipolar disorder is currently being studied.
In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. More research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with the illness have some residual symptoms. Certain types of psychotherapy or psychosocial interventions, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family therapy, and psychoeducation.
Lithium has long been used as a first-line treatment for bipolar disorder. Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug Administration (FDA), lithium has been an effective mood-stabilizing medication for many people with bipolar disorder. Lithium is also noted for reducing the risk of suicide in major affective disorders, such as bipolar disorder: suicide risk on the whole drops to below the average level for society (Baldessarini, 2003).
Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Valproate was FDA approved for the treatment of acute mania in 1995. Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.
According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician.
During a depressive episode, people with bipolar disorder commonly require additional treatment with antidepressant medication. Typically, lithium or anticonvulsant mood stabilizers are prescribed along with an antidepressant to protect against a switch into mania or rapid cycling. The comparative efficacy of various antidepressants in bipolar disorder is currently being studied.
In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. More research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.
Research findings
Bipolar disorder appears to run in families, that is, a vulnerablility for bipolar disorder may be inherited. The rate of suicide is higher in people who have bipolar disorder than in the general population. The rate of prevalence of bipolar disorder is roughly equal (around 1%) in men and women.
More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.
Researchers are using advanced medical imaging techniques to examine brain function and structure in people with bipolar disorder. An important area of imaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Better understanding of the neural circuits involved in regulating mood states may influence the development of new and better treatments, and may ultimately aid in diagnosis.
Bipolar disorder appears to run in families, that is, a vulnerablility for bipolar disorder may be inherited. The rate of suicide is higher in people who have bipolar disorder than in the general population. The rate of prevalence of bipolar disorder is roughly equal (around 1%) in men and women.
More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process.
Researchers are using advanced medical imaging techniques to examine brain function and structure in people with bipolar disorder. An important area of imaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders. Better understanding of the neural circuits involved in regulating mood states may influence the development of new and better treatments, and may ultimately aid in diagnosis.
New clinical trials
NIMH has initiated a large-scale study at 20 sites across the U.S. to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5 to 8 years. For more information, visit the Clinical Trials page of the NIMH Web site.
NIMH has initiated a large-scale study at 20 sites across the U.S. to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5 to 8 years. For more information, visit the Clinical Trials page of the NIMH Web site.
There are reports that Omega-3 fatty acids may be beneficial in the treatment of bipolar disorder. A significant study was conducted by Dr Andrew L Stoll at Harvard University's McLean Hospital. The Stanley Foundation is sponsoring research regarding the beneficial claims.
Recent genetic research
Bipolar Disorder is considered to be primarily a genetically caused disorder. The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Relatives of persons with Bipolar Disorder also have an increased incidence of having unipolar depression.
In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder. This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder.
Bipolar Disorder is considered to be primarily a genetically caused disorder. The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Relatives of persons with Bipolar Disorder also have an increased incidence of having unipolar depression.
In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder. This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder.
Mania
Mania describes a condition characterised by severely elevated mood. Associated with bipolar disorder, where episodes of mania alternate with episodes of depression. (Note: not all mania is bipolar disorder, other diseases can cause mania - however bipolar disorder is the 'classic' manic disease).
Hypomania refers to a less severe variant of mania, where there is less loss of control.
Although 'severely elevated mood' sounds pleasant, the actual experience of mania is usually unpleasant and frightening for the person involved, and may lead to behavior that they may regret later.
Mania describes a condition characterised by severely elevated mood. Associated with bipolar disorder, where episodes of mania alternate with episodes of depression. (Note: not all mania is bipolar disorder, other diseases can cause mania - however bipolar disorder is the 'classic' manic disease).
Hypomania refers to a less severe variant of mania, where there is less loss of control.
Although 'severely elevated mood' sounds pleasant, the actual experience of mania is usually unpleasant and frightening for the person involved, and may lead to behavior that they may regret later.
Other manic symptoms include hypersexuality, religiosity, and hyperactivity.
Mania can also be experienced at the same time as depression, in so-called dysphoric mania. This has caused speculation amongst doctors that mania and depression are two independent axes in a bipolar spectrum, rather than opposites. Some collective mania (craze) can also take place, as individuals have a tendancy to lose their own personality inside a crowd (fads, herding, crowd hysteria)
No comments:
Post a Comment