According to the Mayo Clinic (2012), depression is also known as “major depression, major depressive disorder, and clinical depression, and it will affect almost 15 percent of the population at some time in their lives (Turnquist, in Payne, 2011).” It is more than just a sense of being “down;” it is a real, persistent disorder that affects your mood in such a way (i.e. sadness or loss of interest in former activities) that it interferes with your daily life. It is a chronic condition, and it can last for weeks, months, or even years. People who suffer from it often have repeated bouts during their life (Psychology Today, 2012). What is important to know is that this is a physical illness stemming from a chemical imbalance in the brain (Payne, 2011), and that patients cannot simply “make themselves happy.” It must be – and can be – treated in some fashion, usually with medication, therapy, or both, in order to reduce or eliminate the symptoms.
The symptoms of major depression vary between individuals, but according to Psychology Today (2012), they may include: a persistently sad mood that comes with feelings of hopelessness, guilt, worthlessness, or general pessimism. People may feel lethargic and have difficulty deciding things or concentrating on anything; they may entertain ideas about death or killing themselves; and they may display an appetite gain or loss, depending if they binge eat or if they lose interest in eating, too. In addition, they may suffer from persistent physical symptoms whose source is not easy to find and that do not respond easily to treatment; these may include headaches, gut disturbances, and an inability to sleep.
It is not known what specifically triggers depressive episodes, and that may be because there are a variety of underlying factors that contribute to its manifestation (Mayo Clinic, 2012). First, people who suffer from major depression display physical changes in their brain structure, although the exact reason for these changes is uncertain.
In addition, there may be inadequate levels of certain neurotransmitters, such as serotonin, that may influence which nerves are triggered, and thereby what mood source is stimulated or reinforced. Second, people with depression may experience a change in the body's delicate balance of hormones; this can result from conditions such as thyroid disorders or menopause, and they can trigger (or fail to trigger) certain mood stimulating pathways in the body. Third, genetics may play an important role in whether a person becomes depressed. Major depression is more common in families where other members suffer from the condition, and there is a great deal of research being conducted to find the gene or genes responsible for “flipping the mood switch.” Last, trauma in childhood or other major life events, such as death of someone close or high levels of stress, can cause permanent changes in the brain’s structure that make the individual more susceptible to acquiring depression at some point in his/her life.
Diagnosing and treating depression starts with a detailed patient history by a medical doctor, followed by lab tests and an interview (Psychology Today, 2012). This is because some medications, as well as medical conditions such as a faulty thyroid or a viral infection, can cause the same symptoms as depression, and these must be ruled out. If no physical evidence is present, either the doctor or a mental health professional will conduct a psychological evaluation that includes a mental status exam. This exam should also cover any alcohol or drug use, as these are common occurrences with depressive symptoms, as well as if the patient has had recent thoughts about death or suicide.
Medications are the first line of defense in treating major depression, and they can include a number of different classes. According to the Mayo Clinic (2012), these may come as Selective serotonin reuptake inhibitors (SSRIs), including Prozac®, Paxil®, and Zoloft®; Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta® and Effexor®; Norepinephrine and dopamine reuptake inhibitors (NDRIs), like Wellbutrin®; Atypical antidepressants, including Oleptro® and Remeron®; and Monoamine oxidase inhibitors (MAOIs), such as Parnate® and Nardil®, which are usually prescribed as a last resort, when other medications haven't worked. While all types of medications can have side effects, some of them serious, the MAOIs can have the most serious ones, including dangerous reactions with certain types of food.
Medications are best combined with some form of psychotherapy, also known as “talk therapy” (Mayo Clinic, 2012). One of the most effective forms is cognitive behavioral therapy, which lets you target beliefs or behaviors that are inherently negative and replace them with those that are more positive, thereby lifting you out of the depression. And with medication to help suppress the depressive feelings, you can take control of how you feel and behave.
Electroconvulsive Therapy (ECT, or “shock” therapy) is a treatment that is usually used as a last resort (Mayo Clinic, 2012), in part because it still bears the stigma that faces most aspects of mental illness among the general public (i.e. the “nut cases” displayed in the Oscar-winning film, “One Flew Over the Cuckoo’s Nest”). In ECT, electrical currents are sent through the brain. These currents may offer immediate or fast-acting relief of even severe depression, yet it is unclear how, exactly, they work. Many physicians, though, believe these currents alter neurotransmitter levels in the brain. The treatment does bear some side effects, such as confusion and memory loss, but both of these are usually temporary.
Bipolar disorder is also referred to as manic-depressive illness, and it is another form of brain disorder that is both chronic and likely to produce repeated episodes (NIMH, 2012). It affects some 5.5 million people each year, and, as with depression, it can last for weeks, months, or even years (eHow.com, 2012). Unlike depression, though, the person shifts from mania (excessive highs) to depression (excessive lows), and both phases can interfere with the ability to carry out day-to-day tasks, as well as destroy personal and/or professional relationships, result in an inability to perform well in school or on the job, and even end in suicide. Generally the disorder develops in a person's late teen or early adult years, with at least half of all cases starting before the person reaches 25, but some cases have been reported as early as around six years old (WebMD, 2012). This disorder can also be treated, so the earlier you can get an accurate diagnosis, the more likely you will be helped by treatments that are available.
According to NIMH (2012), individuals with bipolar disorder experience unusually intense emotional states, which happen in what are called "mood episodes." The manic episode displays as an overly excited state, full of bursts of energy and “risky” behaviors, and the depressive episode displays as an extremely sad or even hopeless one. When a person experiences a mood episode that contains both extremes, it is known as a “mixed state.” It is also possible for a person to experience a long period of unstable moods, not just discrete episodes; this becomes evident when they show extreme changes and fluctuations in their energy, amount of activity or sleep, and their general behavior.
As with depression, there is a lack of complete understanding as to what causes bipolar disorder, although genetics is thought to play a major role. This cannot be the only factor involved, however, as studies of identical twins have shown that even though the siblings share the exact same genes, if one individual has the disorder, it does not mean that the other one will get it, too (NIMH, 2012). There must also be underlying biochemical imbalances and environmental triggers to set off the episodes of both mania and depression.
Diagnosing and treating bipolar disorder starts with a detailed patient history by a medical doctor, followed by lab tests and an interview, just as it does with depression (NIMH, 2012). At this time, bipolar disorder cannot be diagnosed from a blood test or a brain scan; what these tests can do, though, is to help weed out other factors that may be causing the symptoms, such as a stroke or a brain tumor. Again, if the doctor cannot find anything, he may refer the patient to a mental health professional for further testing. However, as people with bipolar disorder are more likely to seek assistance when they are in a depressive episode as opposed to a manic one, it is important to rule out unipolar, or major, depression as a cause of the patient’s symptoms before making a definitive diagnosis of bipolar disorder.
The correct diagnosis and treatment of bipolar disorder is also highly dependent on whether or not the patient has a substance abuse problem, much more so than in major depression (WebMD, 2012). In fact, some studies have demonstrated that approximately 60% of bipolar individuals also abuse drugs and/or alcohol. If the abuse is not controlled, it becomes almost impossible to manage the massive mood swings. Substance abuse may make the emotional episodes more frequent and/or more severe, and drugs used to treat the disorder are usually ineffective when an abuse condition is present.
As with major depression, the most effective treatment comes from a combination of medications and psychotherapy (NIMH, 2012). The first line of medication defense is the class of drugs known as mood stabilizers. Most of these are anticonvulsant medications, such as Neurontin® and Topamax®, normally used to treat epileptic seizures; only lithium, which also falls in this category, is not. First approved by the FDA and used in the 1970s, lithium controls manic symptoms effectively and also prevents the swing between manic and depressive episodes. Depakote® joined the class’s ranks in 1995, followed shortly by Lamictal®.
Another class of drugs is the atypical antipsychotic medications, drugs that are taken with other medications to help control symptoms. One drug, Zyprexa®, has shown promise by quickly treating the agitation that comes with either a manic or a mixed episode, but patients run the risk of both diabetes and heart disease when taking it. Abilify®, Risperdal®, and Geodon® have also been approved for treatment of manic or mixed episodes, and Seroquel® helps both severe and sudden manic episodes. According to the NIMH (2012), a large-scale study showed that, for most people, the best drug regimen to help with bipolar disorder is to add an antidepressant to a mood stabilizer.
One of the major difficulties associated with depression and bipolar disorder, apart from the biological and psychological toll it can take upon patients, their families, and their caregivers, is the stigma that surrounds them. Schieltz (2012) reports that 20 percent of Americans indicate they would avoid counseling or psychotherapy for themselves if diagnosed with bipolar disorder because of this stigma, and in a 2004 American Psychological Association survey, almost 30 percent of people said they would feel “concerned or embarrassed if other people knew they received mental health treatment” for it. This may be due, in part, because they mistakenly think that bipolar disorder means a person is insane or psychotic, perhaps because it may also be referred to as “mania.” However, Payne (2011) notes that “It is possible for anyone to suffer from depression or related mental disorders and it can accompany other psychological disorders, such as anxiety disorders, substance abuse disorders or an addiction to nicotine, as well as physical ailments.” The stigma has nothing to do with physical or emotional reality.
Neither depression nor bipolar disorder is a moral failing, and as Payne (2011) indicates, the conditions do not “discriminate against certain races, ages, genders, or socioeconomic status.” They cannot simply be “willed away,” but we know that they do respond to various treatments, most specifically a combination of appropriate medications and psychotherapy. If you or someone you know is suffering from one of these conditions, the best course of action is to seek help from a healthcare professional. As both disorders carry with them a risk of suicide, it is literally your life that is at stake – don’t risk it because of a common misconception or a sense of embarrassment.
References
(2012). Bipolar Disorder. NIMH. Retrieved from
(2012). Bipolar Disorder Center. WebMD. Retrieved from
(2012). Depressive Disorders Psychology Today. Retrieved from
Mayo Clinic Staff. (2012). Depression (major depression). Mayo Clinic. Retrieved from
Payne, Sarah. (2011). The Effects of Stigma Applied to Depression. Drury University. Retrieved from
Schieltz, Matthew. (2012). Stigma of Bipolar Disorder. eHow.com. Retrieved from
