BIPOLAR DISORDER AND DEPRESSON

Teenagers with bipolar disorder may exhibit grandiose fantasies with irrational and strong beliefs leading to poor decisions and reckless behavior. When considering the entire bipolar spectrum, both males and females are equally affected, but there are findings suggesting a higher occurrence of Bipolar I disorder in males and Bipolar II disorder in females. In terms of illness progression, manic episodes without depression are more common in males, while episodes of mania/hypomania with accompanying depression are more frequent in females.

Prognosis

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Approximately 60% of individuals with Bipolar Disorder experience their first episode before the age of 19, with the peak onset between 15 and 19 years old.

In children transitioning from Major Depressive Disorder to Bipolar Disorder, 80% of depressive onsets occur before the age of 12.

The onset of the bipolar disorder is often presumed to manifest initially in the form of depression. If the first episode is early-onset and manic, a familial predisposition may be considered. The likelihood of recurrence increases to 50% within one year, 70% within four years, and up to 90% within five years (Yeloğlu and Hacıoğlu, 2017).

Ahmet Can Kahveci

Aykut Emre Budanır

Betül Oruç

Beyza Demir

Dilay Arslan

Eda Biçer

Emir Kaan Arslankurt

Feyza Gönen

Nurcan Boyacı

Pelin İster

Hayriye Akkaynak

Sudenaz Büyükcırık

BIPOLAR DISORDER AND DEPRESSION

Etiology

Factors that affect

Depression and Bipolar Disorder

Definition

Depression

DSM-5 diagnostic criteria should be followed to accurately detect depression. A shift from prior functioning, five or more symptoms within a two-week period, and at least one symptom-such as depression or a loss of interest or pleasure-must all be present in the person. (American Psychiatric Association, 2017).

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Typical of chronic bipolar disorder are recurring episodes of mixed moods, mania, hypomania, or depression that do not follow any particular order.

This mood condition significantly impairs a person's ability to function in social, family, and professional contexts. (Yeloğlu, 2017)

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Bipolar I

Bipolar II

Definiton of Depression

At least one current or past manic (or mixed) episode is symptomatic of bipolar I disorder.

Bipolar II disorder is defined as having experienced, or being at risk of experiencing, at least one major depressive episode and one hypomanic episode (but not a manic or mixed episode in the past).

Definiton of Bipolar Disorder

• Feeling down most of the time
• Visible anhedonia
• Extreme weight loss
• Decreased or increased appetite
• Overnight insomnia or excessive sleepiness every day
• Exhaustion or lack of energy
• Excessive guilt or worthlessness
• Difficulty concentrating or making a choice
• Frequent suicidal thoughts or thoughts of death on an unplanned basis

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Treatment

Classical Treatment Methods

Play Therapy

Family Therapy

Psychoanalytic Treatment

Classical Treatment Methods

Widely Used Treatment Methods

Psychotherapy

Medication

Subtitle

Medication is the most common treatment for bipolar disorder in children and adolescents. Medications help to prevent episodes of mania and depression.

Widely Used Treatment Methods

Types of psychotherapy used to treat bipolar disorder in children and adolescents include:

• Family therapy:

• Cognitive behavioral therapy (CBT)

• Interpersonal and social rhythm therapy (IPSRT):

Newly Developed Treatment Methods

• Marian Chace- First Dance Therapist

• Dance and Movement Therapy

Another study found that DMT group treatment was more effective in improving stress management and reducing psychological distress than no treatment. Additionally, DMT effects last over time.

Bräuninger I. Dance movement therapy group intervention in stress treatment: A randomized

controlled trial (RCT). The Arts in Psychotherapy. 2012; 9(5): 443-50.

• Dance and Movement Therapy

A method used in movement analysis is the movement profile system developed by psychoanalyst Judith Kestenberg in association with Anna Freud's developmental processes.

In this system, which is based on the developmental characteristics of movement, movement rhythms that serve the dominant drive discharge in each psychosexual period are defined.

These rhythms can be observed in changes in tension in the muscles and in the body's patterns of expansion and contraction in space.

In patients with depression, the lack of weight in their bodies is noticeable, and the person has difficulty in using the weight of his body. Letting patients feel their body weight through movement may be the first step towards treatment. It is easier to move a trait discovered on the physical level to the emotional and relational level. Çatay Z. Beden ve Ben Arasında Dokunan Ağ: Dans/ Hareket Terapisi. İstanbul Bilgi Üniversitesi, 2013

Dance/movement therapy (DMT) provides the healthy application of movement as a

psychotherapeutic use to promote the individual's emotional, social, medical and physical

integration for the purpose of learning health and well-being. (ADTA)

Today, studies have shown that dance and movement therapy have positive effects on depression:

In a study conducted with chronic depression patients, it was observed that there was a significant decrease in the depression scores of the individuals in the experimental group after the intervention.

Röhricht F, Papadopoulos N, Priebe S. An exploratory randomized controlled trial of body psychotherapy for patients with chronic depression. Journal of Affective Disorders. 2013; 151(1): 85-91

• Dance and Movement Therapy

• Music Therapy

It has been observed in various studies that music therapy reduces patients' depression scores. It is said that treatment with music therapy breaks down patients' verbal barriers in expressing their feelings, so therapists can give them guidance treatment more easily. In treatments with music therapy; When measured with EEG, it is seen that music shifts the activity from the right frontal lobe to the left, resulting in positive affect and mood.

Erkkila J, Gold C, Fachner J, Ala-Ruona E, Punkanen M, Vanhala M. The effect of

improvisational music therapy on the treatment of depression: a protocol for a randomised

controlled trial. BMC Psychiatry 2008; 8: 50.

Newly Developed Treatment Methods

• Vagus Nerve Stımulation

• Vagus stimulation is a procedure that sends electrical impulses to your brain to improve symptoms of depression. Vagus nerve stimulation is one of several new brain stimulation methods designed to treat chronic depression when other treatments have not worked

• While studying people with epilepsy, it began to be discussed whether vagus nerve stimulation would be effective in treating depression. Studies have shown that the mood of patients receiving vagus nerve stimulation treatment improves. This finding led to further studies that produced various results, but it is a very new treatment method whose risks are still being considered and studies are ongoing.

Depresyon tedavisinde vagus sinir uyarımı. (2023, 5 Şubat). Erişim adresi

https://www.hemensaglik.com/makale/depresyon-tedavisinde-vagus-siniri-uyarimi

• Deep Brain Stimulation / Deep TMS (Transcranial Magnetic Stimulation)

• Deep Brain Stimulation / Deep TMS (Transcranial Magnetic Stimulation)

• Deep TMS is a drug-free treatment that stimulates the cerebral cortex with electromagnetic induction using a mechanism placed on the skull. The patient is awake and conscious during the TMS treatment.

• In major depression, high-frequency stimulation applied to the left dorsolateral prefrontal cortex (DLPFC) of the brain and low-frequency stimulation of the right DLPFC have been found to be effective in the treatment of depression. However, this effect has not been proven for bipolar patients. Studies in this area continue.

Divanlıoğlu, D.(2021). Transkraniyel Manyetik Stimülasyon: Endikasyonlar, Teknik ve Komplikasyonlar. Türk Nöroşir Dergisi, 31(3):379-390.