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Bipolar and Mood Disorders

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Lieu Nguyen

on 28 October 2015

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Transcript of Bipolar and Mood Disorders


Bipolar and Mood Disorders
History of Mood Disorders
A brief overview


DSM IV vs. DSM 5

Culture & Society
Treatment
Assessment
Co-morbidity & Differential Diagnosis
Background:
Co-Morbidity
is the existence of two or more conditions/diseases present in a subject. The summary explains the differences in diagnoses of bipolar and other mood disorders, and how they are separated into their own category.
The following clarifies disorders that are more likely to be together and recur, such as substance abuse and depression.

Differential Diagnoses
is distinguishing disorders from one another, such as depression from generalized anxiety. The Hamilton scale can be used to rule out other disorders with several methods. If it was all the same, why is it not called the same name?

Etiology
History, Cultural/Societal Views, Assessment, Treatment, Etiology, Co-morbidity & Differential Diagnosis, and Personal Experiences/Course of Disorder
A Brief Overview
Personal Experience & Course of Disorder
Works Cited
Bipolar Disorder
Picture provided by: clevelandclinicmeded
"Bipolar Mood Disorder is diagnosed in about 2% of a general population" (8)
Co-morbidity and Differential Diagnosis
(1) Angst, J., Gamma, A., Bowden, C. L., Azorin, J. M., Perugi, G., Vieta, E., & Young, A. H. (2013).
Evidence-based definitions of bipolar-I and bipolar-II disorders among 5,635 patients with major depressive episodes in the Bridge Study: validity and comorbidity. European Archives Of Psychiatry & Clinical Neuroscience, 263(8), 663-673.
(2) Bezerra-Filho, S., Almeida, A. G., Studart, P., Rocha, M. V., Lopes, F. L., & Miranda-Scippa, Â.
(2015). Personality disorders in euthymic bipolar patients: a systematic review. Revista Brasileira De Psiquiatria, 37(2), 162-167.
(3) Chou, K., & Cheung, K. C. (2013). MAJOR DEPRESSIVE DISORDER IN VULNERABLE GROUPS OF
OLDER ADULTS, THEIR COURSE AND TREATMENT, AND PSYCHIATRIC COMORBIDITY. Depression & Anxiety (1091-4269), 30(6), 528-537.
(4) Culpepper, L. (2015). Pathways to the Diagnosis of Bipolar Disorder. Journal Of Family Practice,
S4-S9.
(5) Ishizaki, J., & Mimura, M. (2011). Dysthymia and Apathy: Diagnosis and Treatment. Depression
Research & Treatment, 1-7.
(6) Kaye, MD. N. (2005, July 1). Is Your Depressed Patient Bipolar? Retrieved September 18, 2015.
(7) Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic Stress Disorder in the
National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-1060.
(8) Martin, D. J., & Smith, D. J. (2013). Cardiometabolic Comorbidity in Bipolar Disorder. Dusunen
Adam: Journal Of Psychiatry & Neurological Sciences, 26(4), 315-319.
(9) Paparrigopoulos, T., Melissaki, A., Tzavellas, E., Karaiskos, D., Ilias, I., & Kokras, N. (2014).
Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: A two-year follow-up study. International Journal Of Psychiatry In Clinical Practice, 18(1), 25-31.
(10) Sagman, MD, D., & Tohen, MD, M. (2009, March 23). Comorbidity in Bipolar Disorder.
Retrieved September 14, 2015.
(11) Semra Karataş, K., Güler, J., & Hariri, A. (2013). Bipolar Disorder and Obsessive Compulsive
Disorder Comorbidity: Three Case Reports. Journal Of Mood Disorders, 3(1), 33-36.
(12) Thompson, K. S., & Fox, J. E. (2010). Post-partum depression: a comprehensive approach to
evaluation and treatment. Mental Health In Family Medicine, 7(4), 249-257.

Distinguishing Features
Bipolar I
=
more pronounced hyperactivity/ manic episodes
Bipolar II
=
hypomania, a less severe form of mania, and longer periods of depression (4)
According to the DSM-5, individuals who are diagnosed with either Bipolar I or II, experience manic and depressive episodes over their lifetime (4).
(1) Mood Disorders Introduction and Historical Review. (n.d.). Retrieved October 7,
2015, from http://www.enetmd.com/content/mood-disorders-introduction-and-historical-review
(2) Highlights of Changes from DSM-IV-TR to DSM-5. (n.d.). Retrieved October 7,
2015, from http://www.dsm5.org/Documents/changes from dsm-iv-tr to dsm-5.pdf
(3) Mitchell, P., & Hadzi-Pavlovic, D. (2000). Lithium Treatment for Bipolar Disorder.
Retrieved October 7, 2015, from http://www.who.int/docstore/bulletin/pdf/2000/issue4/classics.pdf
(4) Schou, M. (1959). Lithium in psychiatric therapy. Retrieved October 7, 2015.
http://link.springer.com/article/10.1007/BF00408113#page-1
(5) Fitzpatrick, L. (2010, January 7). A Brief History of Antidepressants.
Retrieved October 7, 2015. http://content.time.com/time/health/article/0,8599,1952143,00.html
(6) Ferrier, N. (2001). Developments in Mood Stabilizers. Retrieved October 7, 2015.
http://bmb.oxfordjournals.org/content/57/1/179.full
Greco-Roman Origins (1)
Depression
ADHD
The Hippocratic School described melancholia as a condition associated with aversion to food, despondency, sleeplessness, irritability, restlessness and mania
Usually diagnosed as major depressive disorder, because the long depressive stage in bipolar II
However, one long experience of mania or hypomania is the differential factor (6).
Claudius Galen said that melancholia resulted from excessive black bile and mania from excessive yellow bile
Treatment: bathing, exercise, massages and wine
Areteaus of Cappadocia's understanding of bipolar disorder: the patient who was previously euphoric and hyperactive suddenly has the tendency to melancholy and feels ashamed
Longer bouts or even the existence of depression and manic/hypomanic experiences during other times (4)
The Middle Ages (1)

Includes:
Ability to function with decreased sleep (2-3 hours)
Family history of bipolar disorder
Risky behaviors; such as the involvement in pleasurable, though harmful activities—drugs, alcohol, sexual relations (4)
Mania/Hypomania:
In Europe, monk physicians upheld humane treatment and emphasized the Hippocratic empirical tradition, however by the 12th century, the tradition had given way to a more theological-non-empirical way of diagnosis
In the Middle East, physicians took a more diplomatic approach and became a modern synthesizer of Greek, Roman, and religious traditions. This Canon of Medicine transmitted the view of mood disorders that "the material which produces mania is the same producer of melancholia".
During the 8th century, asylums were first built in Fez, Morocco and Baghdad but were not established until the 15th century in Europe
(4)
The Enlightenment helped progress medicine in Europe and by the 18th century there was a revival of clinical-empirical tradition in medicine, with advanced descriptions of mania and melancholia
The Nineteenth Century: French Clinical Psychiatry (1)
In 1854, Dr. Jean Falret described circular disorder which was an illness in which "the succession of mania and melancholia manifests itself with continuity and in a manner most regular"
In the same year, Dr. Jules Baillarger described essentially the same thing, emphasizing that the manic and depressive episodes were not different attacks but rather different stages of the same attack
Comorbidities
Anxiety
Although anxiety is more associated with depression, it is related to patients who have bipolarity.
Bipolar patients may have obsessive-compulsive disorder (OCD), phobias, or just generalized anxiety disorders (1)
Despite these contributions, most clinical investigators continued to regard mania and melancholia as separate entities
Obsessive Compulsive Disorder
A short-term case study with 3 patients, all middle-aged females diagnosed with bipolar disorder, showed the increase symptoms of obsessive compulsive-disorder.
In all the cases, mood stabilizers are used in order to treat the symptoms of OCD. After, antidepressants are used to calm anxiousness and also to calm depressive thoughts and mania found in bipolar disorder (11)
Comorbidities
Borderline Personality Disorder
Several personality disorders have been identified in bipolar patients. Personality disorder in the DSM-V is categorized into several groups: A, B, and C. (2)
The hybrid methodology retains six personality disorder types: • Borderline • Obsessive-Compulsive (commonly known as OCD) • Avoidant • Schizotypal • Antisocial • Narcissistic (American Psychiatric Association, 2013).

Image from: Functionofarubberduck
Comorbidities
Cardiometabolic (Heart and Metabolism Issues)
Heart problems: cardiovascular disease and metabolic issues: diabetes and obesity are prevalent with patients with bipolar disorder.
Sufficient evidence obtained to show the early deaths in patients that has both (8)
Type II Diabetes reported in general population in relation to bipolar (10)
Mellitus (type II) is high risk, but there have been no correlational studies.
Due to the decrease in activity and compliancy to ingest/swallow medication, depression may take a toll on the patients' health and increase obesity risk (8)
"Approximately 1/3 of patients with bipolar disorder are obese" (8)
3 major factors that are thought to contribute to a bipolar/mood disorder
Neurotransmitters, genetics, and psycosocial factors.
Nature (neurotransmitters/genetics) versus nurture (psycosocial) scenario.
Neurotransmitters-Basic Concept
Neurotransmitter: a chemical message that is sent to pass on an electrical stimulus sent by the brain or spinal cord.
Electrical messages are sent down a nerve cell by way of action potentials, which are a change in voltage across the cell membranes.
Neurotransmitters have many functions, including movement, cognition, and mood.
Neurotransmitters and Mood Disorders
Decrease or Increase in some neurotransmitters is hypothesized to contribute to a mood disorder.
Deficiencies of neurotransmitters such as dopamine, seratonin, and nopenephrine have been hypothesized to contribute to mood disorders (columbia.edu).
Hyperactivity of other neurotransmitters like acetylcholine can play a role in mood disorder.
No one single neurotransmitter is responsible, but rather the combination and interaction among them (1).


Smoking and lack of activity lead to more visceral fat, lower metabolic rates; decreased amounts of sleep and rest inhibits the body's metabolism which may lead to:
Increased BMI
Waist Circumference
Body Fat %
Insulin Resistance (8)
Comorbidities
Attention Deficit Hyperactive Disorder (ADHD)
In the early stages, children who are diagnosed with ADHD are later diagnosed with Bipolar Disorder.
Correlational studies have shown that up to 85% of children with bipolar, also had ADHD, and in about 22% of children with ADHD were diagnosed with bipolar
Due to those studies, 4 hypotheses were drawn:
Bipolar children relayed symptoms similar to ADHD causing a misdiagnosis
Children with bipolar commonly experienced ADHD first (ADHD is the onset)
Psychostimulants used for ADHD causes bipolar
Bipolar disorder and ADHD have similar biological root (10)
From: Cchrint
Depression
• "Depression is the most diagnosed psychological disorder in a general population of adults internationally" (6)
From American Psychological Association
Distinguising Features
Bipolar Disorder
The presence of mania or hypomania exists with the depressive moods. There are:
"Distinct periods of persistently elevated, expansive, or irritable mood lasting throughout >4 days" (6)
Genetic Factors
The specific defective genes that could lead to the increase or decrease of neurotransmitter actvity are still being identified .
27% of children with one parent diagnosed with a mood disorder will also be diagnosed with a mood disorder (1).
That number increases to 50-75% if both parents have a mood disorder (3).
In the general population, the lifetime risk of being diagnosed with bipolar disorder is about 1%. However, if someone a first-degree relative diagnosed with bipolar disorder, the lifetime risk can increase to up to 10% (1).
The likelihood of being at risk of a unipolar disorder can be up to 30% for those with a first-degree relative with bipolar disorder compared to the 10% risk found in the general population (1).
Compared to the general population, a patient is up to 3 times more likely to be diagnosed with depression if a first-degree relative also has depression (3).
Just because someone is predisposed genetically to a mood disorder, it does not necessarily mean they will develop or be be diagnosed with one. (i.e. identical twins)
Psychosocial Factors
A common psychosocial factor that can cause a mood disorder is what is generally termed a “loss,” a traumatic event (car crash, near death experience, war), loss of a loved one, the end of a relationship or friendship, a loss of self-esteem, or others (3).
“Losses” can trigger a person who is genetically predisposed to a mood disorder to develop that mood disorder.
Other factors include those that occur during childhood development.
A 2002 study showed that animals who were exposed to maternal deprivation after nine days had a deficit in brain-derived neurotrophic factor (BDNF) when they are adults (2). A decrease in levels of BDNF is suggested to have adverse affects including the decreased function of brain cells and even cells death, which may play directly in the development of a mood disorder.
bipolar disorder does not show distinct symptoms (1)
there is no single test to confirm the condition (1)
"About 40% of patients with bipolar disorder are initially diagnosed with major (or unipolar) depression" (3)
Symptoms of bipolar disorder also model other mental illness such as ADHD, anxiety disorder, schizophrenia, borderline personality disorder, and major depression (3)
combinations of methods are needed for a doctor to make a diagnosis (1)
blood and urine analysis used to determine if any other factors are causing the symptoms (1)
Two most commonly used measurements
Interview for DSM-IV (SCID)
recommended as a routine part of clinical intake procedures
semi structured interview that is divided into modules to cover different diagnoses (1)
Schedule for Affective Disorders and Schizophrenia (SADS)
Designed to assess a broad range of Axis I diagnoses
Probes focus on the symptoms of the most recent episode and then capture a broad overview of past episodes (1)
Turn of the Twentieth Century: Kraepelinian and Freudian views (1)
Emil Kraepelin clearly segregated manic-depressive illness and schizophrenia, two illnesses that were often mistaken for each other

Kraepelin did this by nosology, the classification of diseases, which was the first extensive and carefully organized model in psychiatry

Freud's classic work on mood disorders "Mourning and Melancholia" argues that melancholia is a depressive process that arises from the tension between feelings toward a parent

This theory was later expanded to define melancholia as "unacceptably hostile feelings turned inward toward oneself, rather than outward towards others
The Unipolar-Bipolar Distinction (1)
The psychopharmacology revolution (3,4,5,6)
Differences between DSM-IV and DSM V (2)
Comorbidities
Research concludes that patients who were on medication for depression were showing underlying bipolar disorder.
Issues: side effects of several antidepressants include mania, which can furthermore aggravate the mania side of bipolar disorder (1)
Bipolar Disorder
Physicians who interact with patients on antidepressants have reported symptoms related to anxiety, sleeplessness, as well as other mood disorders.

Self-medication can take form in substance (alcohol) and medication abuse (1)
Bipolar and anxiety are the top disorders that are co-present
Patients who are dependent on drugs have a direct correlation to the patients who have anxiety and depression.
Medication prescribed to patients with anxiety may “intensify” depressive moods, and bipolar symptoms.
Panic disorders have been reported as well in conjunction with anxiety, which relates to the usage of medication induced depression (10)

Alcohol abuse or dependence:
49% for bipolar men - genetics
29% for bipolar women - depression (10)

Substance/Medication Induced Depressive Disorder
Because there is difficulty concentrating and similar stressors (threats, death, etc.), it may lead to different levels of anxiety and depression coexisting (3)
Anxiety can exist, and in some cases be the causation for depression in patients (1)
Individuals with one disorder is at a high risk of developing the other.
Depression may bring about depressive and anxious thoughts leading to anxiety and increasing amount of sleeplessness.
Generalized Anxiety Disorder
Depression that is more mild, but enduring/persistent—up to around 2 years of depressive moods that lasts for the whole day (DSM-V).
According to the DSM-IV, dysthymia can be diagnosed in patients if there were no prior major depressive or manic episodes in the previous two years; the number is less in children (5)
If the two or the more of the following are present:
(1) poor appetite or overeating
(2) insomnia or hypersomnia
(3) low energy or fatigue
(4) low self-esteem
(5) poor concentration or difficulty making decisions
(6) feelings of hopelessness (5)
In order to distinguish from MDD, the depression research and treatment organization incorporate:
increase of appetite/weight gain
hypersomnia
feelings of leaden paralysis
extreme sensitivity to rejection

Unfortunately, there is a stigma that is attached to depression, therefore individuals are not diagnosed with dysthymia (5)

Dysthymia
Post Traumatic Stress Disorder (PTSD)
Other Statistics
Although more common in women, men experience depression as well.

Due to the social stigma commonly attached to male depression, there is less known cases of postpartum in males.
Post-Partum Depression
Co-existing Mood Disorders
In 1957, Karl Leonhard and Karl Kleist observed that some patients had histories of both depression and mania, while others had depression only. Indicating that they are two different illnesses

Leonhard and Kleist also noticed that patients with a history of mania had a higher incidence of mania in their families when compared with those with depression only

In 1966, Jules Angst, Carl Perris, and George Winokur independently provided systematic family history data to support Leonhard's distinction. However, later studies proved that both illnesses are genetically caused, but bipolar is slightly more severe.
Mental health specialists are used for further evaluations (1)
Psychiatrists and psychologists will ask a series of questions to assess the patient's overall mental health (1)
Bipolar disorder includes questions about symptoms, duration, and how they are disrupting their life (1)
Questions about certain risk factors may be asked too
family medical history and any history of substance abuse (1)
Breaking the myth of post-partum in men
Criteria for Bipolar Disorder
According to DSM-IV, PPD occurs during delivery or up to 4 weeks after birth
Some experience mood episodes before, and so early exposure to anxiety and depression may intensify the depression
Psychotic symptoms from some first-time pregnant women, especially those previously diagnosed or have familial history have been noted.
Detection pre-natal and post-natal is recommended because there are increase chances of developing depression again (12)
At least one depressive and maniac episode (2)
questions about the feelings during and after these episodes would be asked (2)
doctors would want to know if the patient was in control during the mania and how long the episode lasted (2)
doctor may ask the patient's friends or family members about his/her behavior (2)
Co-existing Mood Disorders
Reasons for PTSD in research includes: sex, age, adulthood traumatic events, childhood traumatic events, stressful life events, lifetime of psychiatric history, and social issues (9)
The time between the mid-twentieth century up until the early twenty-first can be classified as a boom in psycho-pharmaceuticals

The use of lithium in patients to subdue their manic stages had started in 1959 due to the research of John Cade, Morgens Shou, and Paul Basstrup

Anti-depressants were also newly being used at this time after the research of scientists at the Munsterlingen asylum in Switzerland

Mood stabilizers are a more modern medicine used mainly in the twenty-first century as an alternative to lithium treatment
Bipolar with DSM
Anxiety is co-existent with post-traumatic due to the events that may lead up to the causation of the onset of PTSD: deaths or menace present in the individuals lives (3)
Veteran patients who have returned from the ICU have shown signs of major depressive disorder. It is common to suffer a traumatic event and experience emotions such as regret, despair, and anger.
Important to assess their mental health before and after, and provide emotional and physical support (9)
Bipolar Disorders: DSM V includes new diagnosis criteria with a special emphasis on change in activity and energy as well as mood. Also, mixed episodes are also now considered an indicator for bipolar 1.

Depressive Disorders: New disorders were added to the DSM V including disruptive mood dysregulation disorder, and premenstrual dysphoric disorder

Major Depressive Disorder: There can be a coexistence of a major depressive episode with several manic symptoms, which can increase the likelihood that illness exists in a bipolar spectrum
DSM states that a major depressive episode must have at least four of the following symptoms (2)
They should be new or suddenly worse (2)
They must last for at least two weeks (2)
change in appetite or weight, sleep, or psychomotor activity
decreased energy
feelings of worthlessness or guilt
trouble thinking, concentrating, or making decisions
thoughts of death or suicidal plans or attempts
Among men and women with PTSD, lifetime prevalence of comorbid disorders was approximately:
48% for major depressive disorders
22% for dysthymia
16% for generalized anxiety disorder
30% for simple phobia
28% for social phobia
Women exhibited greater lifetime prevalence of panic disorder (12.6% to 7.3%) and agoraphobia (22.4% to 16.1%) while men exhibited greater lifetime prevalence of alcohol abuse/dependence (51.9% to 27.9%), drug abuse/dependence (34.5% to 26.9%), and conduct disorder (43.3% to 15.4%) (7)
Co-existing Mood Disorders
Co-existing Mood Disorders
Depression may exist for several years (DSM-V criteria in the next slide), but is distinguished by mania or hypomania.

• There is the presence of these from the APA:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) (6)

More Symptoms:
Depression
Bipolar Disorder
"I'd like to describe mania. Mania is like your mind is racing and you're super energetic and things seem amazing. It's a very intense feeling. I believed I was Jesus. At first it seems great, but if someone said some small thing I didn't like, I'd immediately become enraged and do or say things that would ruin my reputation." -Anonymous
Assessment
(1) Krans, B. (2014, June 28). Medical Information & Trusted Health Advice:
Healthline. Diagnosis Guide for Bipolar Disorder . Retrieved September 28, 2015, from http://www.healthline.com/health/bipolar-disorder/bipolar-diagnosis-guide#Evaluation3
(2) (n.d.). CQAIMH - center for quality assessment and improvement in
mental health. CQAIMH - STABLE Toolkit: Bipolar Disorder Screening. Retrieved September 29, 2015, from http://www.cqaimh.org/tool_bipolar.html
(3) The Challenge of Accurately Diagnosing Bipolar Disorder. (n.d.). Retrieved
October 7, 2015.
"Basically, depression is the days where I'm lethargic for no reason. I'll have days where it's hard for me to get up out of bed. I either sleep too much or too little. I need to constantly be distracted by something because my thoughts run thousands of miles per hour and I don't trust my thoughts when I'm having another depressive moment." -Anonymous
"In my experience, depression has always been something that has stood between me and other people. Despite the fact that I have social anxiety or have trouble leaving bed some days, there is always the reactions of people when they find out. I don't seem like someone who suffers from depression, so they are either overly intrigued or concerned." - Anonymous
The Course Of
"When I'm in a manic state it's like I'm a Power Ranger controlling a Zord. My thoughts are faster than ever. I can see how things will happen before they do and react before it even begins to occur. If I want something to happen, it happens without me even doing anything." -Anonymous
The Course of mood disorders is different for each individual, although some patterns exist in duration and prevalence of mental illness

People of all ages, races, and socioeconomic backgrounds can develop depression

Some studies are showing that adolescents who experienced puberty early are at higher risk for depression than the rest of their peers (3)

Young teens who experience depression are at higher risk of being depressed as an adult (1)

Symptoms of depression in teens include withdrawal, irritibility, intense sensitivity to rejection, academic decline, conflict with authority, and drug use (2)

People suffering severe depression may have hallucinations or delusions.

Most teens who commit or attempt suicide have a mood disorder (1)

Bipolar Disorder
"My mania starts in my anxiety which means if I'm manic, I'm probably stressed. This means being trapped in my thoughts constantly, trying to avoid an episode. During mania, I crave attention, so promiscuity was, for a long time, a problem. At the end of mania I become depressed. Medicins part of how I manage, as well as coping skills." -Anonymous
Depression
"Mixed episodes are the most confusing aspect of having bipolar disorder. Your mood can just change so fast in ways that seem perfectly logical at the moment. It's hard to keep friends when you're furious one second then totally calm the next. Then when the episode ends you realize the full implications of the going ons throughout the episode."-Anonymous
Personal Experience & Course Of
"Depression is horrible. Always reminding yourself what you did wrong instead of right. It's sleepless nights and feeling like a freak for having to take medicine to keep you happy. It's the constant reminder that you have your own storm cloud lingering above your head. The random spouts of crying and not wanting to get out of bed. Lacking the motivation to do what you once loved. Depression will consume your life. Once you've found your happiness depression knocks on your door to remind you it's there." - Anonymous
"The past 3-4 years were the worst in conjunction with multiple life events all happening one after the other. I would spend weeks in a depressive spiral of self hatred, constantly sabotaging myself. Getting out of bed and interacting with anyone was a chore, doing anything productive seemed impossible. My academic life went down the drain, and I lost friends." - Anonymous
Therapies
Cognitive Behavioral Therapy: Restructuring thought processes in order to recognize distorted or self-defeating thought patterns and then actively working to replace them with healthier beliefs

1.
Electroconvulsive Therapy (ECT): Machine is used to send small electrical currents to the brain, causes a seizure that lasts about 30 seconds

-Not FDA approved
Transcranial Magnetic Stimulation (TMS): Special electromagnetic device is placed on scalp and sends magnetic field pulses to parts of the brain to regulate mood. Creates a small electric current inside the brain leading to changes in the neurotransmitter levels that affect mood

-FDA approved to treat Major Depression in adults who haven't improved after one antidepressant medication at an adequate dose and duration
Vagus Nerve Stimulation (VNS): Small pulse generator is surgerically inserted into the left side of the chest and a wire is connected to the vagus nerve. Small electrical pulses are then sent into the brain to regulate the neurotransmitters associated with depression

-FDA approved to treat Epilepsy, Depression, and people 18 yrs or older who experience chronic Treatment-Resistant Depression

1.
Drug Tx
Antipsychotics
2 Classes
Typical Antipsychotics- block dopamine
Atypical Antipsychotics- block less dopamine and work on other neurotransmitters as well
Prescription process is trial and error (3)
Antidepressants
6 classes
Selective Serotonin Reuptake Inhibitors (SSRI's)
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI's)
Atypical antidepressants
Tricyclic antidepressants
Monoamine Oxidase Inhibitors(MAOI's) (3)
Mood Stabilizers
Course of and Personal Experience
Etiology
(1) Argawal, S. (2012, September 16). Neurobiology of Mood Disorders. Retrieved October 7,
2015, from http://www.slideshare.net/swapnilagrawal92/etiology-of-mood-disorder-by-swapnil-agrawal
(2) Duman, R. (2004, February 1). Role of neurotrophic factors in the etiology and
treatment of mood disorders. Retrieved October 7, 2015.
(3) Joo, P. (n.d.). The Etiology of Mood Disorders. Retrieved October 7, 2015, from http:/
www.columbia.edu/itc/hs/medical/clerkships/primcare/case/depression/depression01_04.html
(1) Teen Suicide Statistics. (n.d.). Retrieved October 7, 2015, from https://www.healthychildren.org/English/health-issues/conditions/emotional-problems
Pages/Teen-Suicide-Statistics.aspx
(2) Depression in Children and Adolescents. (n.d.). Retrieved October 7, 2015, from http://www.depressiontoolkit.org/lifespan/children.asp
(3) Nauert, R. (n.d.). Early Puberty May Put Teens at Risk for Depression. Retrieved October 7, 2015, from http://psychcentral.com/news/2014/11/20/early
puberty-may-put-teens-at-risk-for-depression/77547.html
What is the stigma for mood disorders (bipolar and depression)
stigma describes a negative view of a person with bipolar or depression
Not really viewed as someone with an illness, people are usually put off or scared can think they are crazy or 'psycho'
Why is stigma dangerous for an individual with a mood disorder
Less likely to speak up
Wearing masks
Less likely to seek and receive help/treatment
Can create feelings of shame
"Us" and "them" thinking
Self-stigma (the belief that you are weak or damaged because of your own illness) may cause people to stop their treatment, isolate themselves from loved ones, or give up on things they want to do.
Treatment
History
Culture and Society
1. Depression and Bipolar Support Alliance
Pamphlet offering general descriptions of different treatments
<http://www.dbsalliance.org/pdfsEmrgTechsBro09.FINAL.pdf>

2. Psych Education
Website offering more in depth look into Mood Stabilizers
<http://psycheducation.org/treatment/mood-stabilizers/>

3. Atypical Antipsychotics
Journal Article that gives a more indepth look at newer antipsychotics
<http://europepmc.org/abstract/med/11873706>


Mania: distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood (2)
episode must at least last for a week (2)
mood must have at least 3 of the following symptoms (2)
inflated self-esteem
little need for sleep
pressure of speech (talking constantly)
flight of ideas
easily distracted
excess pursuit of goal-directed activities or psychomotor agitation (pacing, hand writing, etc)
excess pursuit of pleasure with a high risk of danger
1
2
1. StrongerThanStigma - Wayne Brady: Why I Waited to Talk About My Depression. (2015, January 21). Retrieved October 1, 2015 from youtube.com
3. Fighting Mental Illness Stigma. (n.d.). Retrieved October 3, 2015, from http://www.dbsalliance.org/site/PageServer?pagename=help_advocacy_stigma
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Women experience depression at twice the rate of men. A 2:1 ratio exists regardless of racial or ethnic background or economic status
The lifetime prevalence of major depression is 20-26% for women and 8-12% for men.
Depression ranks among the top three workplace issues, following only family crisis and stress
Depression Statistics:
Bipolar Statistics:
2. Living with Bipolar Disorder: Stigma.(2013, January 16). Retrieved October 1, 2015, from youtube.com
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Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year.
An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.
Although bipolar disorder is equally common in women and men, research indicates that women may have more depressive episodes and more mixed episodes than do men with the illness
4. Society and Bipolar Disorder. (n.d.). Retrieved October 1, 2015
5. Living With Depression. (n.d.). Retrieved October 9, 2015, from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
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