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Types of Depression
II
Depression in Women
II Depression in Men
II
Childhood Depression
II
Adolescent Depression
II
Depression in the Elderly
II
Clinical Depression
II
Major Depression
II
Dysthymia II
Atypical Depression
II
Bipolar Depression
II
Cyclothymia II
Seasonal Affective Disorder
II
Postpartum Depression (PPD)
II
Premenstrual Dysphoric Disorder
(PMDD)
II
Holiday Depression II
Workplace Depression.
Bipolar Depression.
More than 2 million people in the United States suffer from
bipolar depression. Bipolar depression is extremely distressing
and disruptive to the person's life - as well as the lives of
spouses, family members, friends, and employers.
Bipolar disorder typically begins in adolescence or early
adulthood and continues throughout life. Bipolar depression is
seen in children under age 12, but is not common in this age
group. In younger children, the bipolar depression symptoms are
often confused with attention-deficit/hyperactivity disorder.
Bipolar disorder is characterized by shifts in mood through phases
of extreme "highs" (mania) and extreme "lows" (depression).
Below is a copy of a National Institutes of Mental Health bipolar
depression fact sheet;
There is a tendency to romanticize bipolar disorder. Many artists,
musicians, and writers have suffered from its mood swings. But in
truth, many lives are ruined by this disease; and without
effective treatment, the illness is associated with an increased
risk of suicide.
Bipolar disorder, also known as manic-depressive illness, is a
serious brain disease that causes extreme shifts in mood, energy,
and functioning. It affects approximately 2.3 million adult
Americans—about 1.2 percent of the population. Men and women are
equally likely to develop this 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.
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; 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.
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 four 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 typically reflect the extreme mood state at the time.
Treatments
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.
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 20.8 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
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.9 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 imaging techniques to examine brain
function and structure in people with bipolar disorder.10,11 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 will
influence the development of new and better treatments, and will
ultimately aid in diagnosis.
(NIH Publication No. 01-4595)
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