Download Depression and Manic Depression or Bi

Depression and Manic
Depression or Bi-Polar
Disorder
Manic disorder is when people cannot stop being active
and their gestures become wild and uncontrolled.
Depressive disorder is when a person experiences lack of
motivation, a sense of pointlessness and a feeling of
weepiness, loss of appetite, sleep disturbance etc.
1
Uni-polar and bi-polar disorder






Usually when somebody has mania, it is
accompanied by depression.
This is called bi-polar disorder.
Very rarely, mania occurs alone, but many people
experience only depression.
These are called uni-polar disorders.
Seligman called depression ‘the common cold of
psychological problems.’
Most healthy people feel ‘down’ for some of the
time but it usually passes fairly quickly.
2
The symptoms of clinical depression
Cognitive:








Low self esteem
Guilt
Self-dislike
Loss of libido
Negative thoughts
Suicidal thoughts
Poor memory
Lack of ability to think and concentrate
3
Symptoms of clinical depression
Behavioural:





Decrease in sexual activity
Loss of appetite
Disordered sleep patterns
Poor care of self and others
Suicidal attempts
4
Symptoms of clinical depression
Emotional:



Sadness
Irritability
Apathy (no interest or pleasure in activity
5
Symptoms of clinical depression
Physical:





Loss of weight
Loss of energy
Aches and pains
Sleep disturbance
Menstrual changes
6
2 types of depression



At first, depression was classified into two
main categories:
Endogenous: This means coming from
within and usually the person does not
know the reason for the depression. There
is usually a biochemical link.
Exogenous: This means coming from the
outside. There is a cause for this
depression.
7
Bi-polar disorder and depression






Bi-polar disorder, or manic-depression, varies in length and
duration.
Periods of depression are followed by periods of euphoria.
Some people have long periods of being normal, whereas
others have one mania followed by a depression, followed by
a mania in quick succession.
Depression can occur at any age.
Manic depression usually appears in the early twenties.
Depression is more common in women.
8
Manic depression



Manic depression is equally common in men and
women, but manic depression is much less
common than depression.
Jamieson (1989) demonstrated that there are
more creative and artistic people who suffer from
manic depression than the general population.
Of the award-winning writers and artists, 38%
have been treated for manic depression, whereas
in the general population it is only 1%.
9
Explanations of Depression




The Behavioural Model – The focus is on
reinforcement.
Lewinson (1974) argued that when a person is
depressed, their friends pay attention to them
initially.
This attention is reinforcement.
If someone continues to be depressed, their
friends eventually avoid them and this makes the
person even more depressed, and so they
become caught in a cycle of depression.
10
Seligman’s learned helplessness
experiment




The Cognitive Behavioural Model –
Seligman (1967) performed an experiment in
which he gave electric shocks to dogs. The dogs
were unable to escape.
Subsequently, they were provided with an escape
route, but all the dogs did was to continue to
whine while they were being shocked.
It took hundreds of trials to show the dogs that
they could escape before they actually did.
11
Learned helplessness


This inability to see the way out of a bad
situation Seligman termed ‘learned
helplessness’.
He extrapolated (widened the field) that if
humans experience many negative events
which they feel powerless to change, they
develop feelings of learned helplessness.
12
Criticisms of Seligman’s conclusions


This theory has been criticised because if it
were true, depressed people would blame
the external world for their depression.
Most depressed people feel guilty and
blame themselves, and have a tendency to
say all the good things that have happened
to them are because of luck, rather than
their own efforts.
13





Questionnaires were given out to people to see if there was
any difference in cognition between depressed and nondepressed people.
They found once a depression passes, both groups of people
have the same attitude towards life.
Beck said people who have a tendency towards depression
also have a tendency to think more negatively.
He attributes this to experiences in childhood and
adolescence, and says depressed people develop a cognitive
triad – self, the world, the future.
Essentially, the self will experience many bad things in life
because of its unworthiness, the world is full of pain and the
future is bleak, dark and depressing.
14
Cognitive explanations



Haaga and Beck (1992) altered the theory that
depressed people always have a negative view of
life.
Depressed people tend to think negatively when
they are under stress, whereas non-depressed
people have a more constructive attitude towards
stressful situations.
There are two main causes of depression:
rejection by others, and failure to reach goals.
15
Psychodynamic explanation


Psychodynamic Model – Freud, in a book
called ‘Mourning and Melancholia’
observed the similarities between grief and
depression.
He believed depression was a reaction to
loss, either real or imagined, and that this
loss was connected to childhood feelings of
loss and abandonment.
16
Psychodynamic explanation




He also believed the greater the loss in childhood, the more
difficult it is to cope with rejection and loss in adulthood.
Freud further suggested that hostile feelings towards parents
are often repressed. When you are rejected in adulthood, the
anger boils over and is usually, though not always, directed
towards the self.
Ultimately, the inward-directed anger appears in the form of
suicide.
Very often when people die we become very angry with them
but as this anger is unacceptable, we repress it. It is
frequently directed against the self.
17
Psychodynamic explanation of manic
depression





Psychodynamic theory sees manic depression, or bipolar
disorder as a battle between the superego and the ego.
When the superego dominates (this is what authority figures
taught you you should and shouldn’t do), you feel worthless
because you can’t live up to these expectations.
This is when you experience depression.
The manic phase begins when the ego dominates and tells
you that you are wonderful and far from being the nasty
person you thought you were.
This causes elation (great happiness).
18
Main criticisms of the
psychodynamic model



People do not always experience death as
rejection and do not always feel angry.
If anger is always turned inwards, why do
some depressed people show irritability
towards others?
Not all people who experience loss in
childhood become depressed in adulthood.
19
The medical or biological explanation





Medical Model – There is evidence that mood disorders are
linked to families.
If one parent has a mood disorder the chances of a child
developing a disorder is ten times more than the general
population.
Identical twins who both suffer from manic depression is
72%.
This is the highest percentage of any psychological disorder.
Adoption societies also show that depression is more likely if
the biological parents suffer from the same mood disorders.
20
Heritability or inheritance




Heritability or inheritance
The disorder runs in families. More than two-thirds of
people with bipolar disorder have at least one close
relative with the disorder or with unipolar major
depression.
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.
21
Twin studies




There is increasing evidence for a genetic component in the
causation of bipolar disorder, provided by a number of twin
studies and gene linkage studies.
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.
Dizygotic twins have a 23% concordance rate.
These concordance rates are not universally replicated in the
literature; recent studies have shown rates of around 40% for
monozygotic and <10% for dizygotic twins (see Kieseppa,
2004 and Cardno, 1999).
22
2007 gene linkage study

A 2007 gene-linkage study by an
international team coordinated by the NIMH
has identified a number of genes as likely
to be involved in the etiology of bipolar
disorder, suggesting that bipolar disorder
may be a polygenic disease.
23
How to help people with bi-polar
disorder



Bipolar disorder cannot be cured, instead the emphasis of
treatment is on effective management of acute episodes and
prevention of further episodes by use of pharmacological and
psychotherapeutic techniques.
Hospitalization may occur, especially with manic episodes.
This can be voluntary or (if mental health legislation allows it)
involuntary (called civil or involuntary commitment).
Following (or in lieu of) a hospital admission, support services
available can include drop-in centers, visits from members of
a community mental health team or Assertive Community
Treatment team, supported employment and patient-led
support groups.
24
Medication


Medication
The mainstay of treatment is a mood
stabilizer medication; these comprise
several unrelated compounds which have
been shown to be effective in preventing
relapses of manic, or in the one case,
depressive episodes. The first known and
"gold standard" mood stabilizer is lithium.
25
Drugs



Treatment of the agitation in acute manic
episodes has often required the use of
antipsychotic medications, such as Quetiapine,
Olanzapine and Chlorpromazine.
More recently, Olanzapine and Quetiapine have
been approved as effective monotherapy for the
maintenance of bipolar disorder.
A randomized control trial in 2005 has also shown
olanzapine monotherapy to be as effective and
safe as lithium.
26
Biochemical influences






Biochemical influences – There are 2 neurotransmitters
which are known to influence mood (noradrenaline and
serotonin).
What has been found is that too much noradrenaline results
in mania
and too little in depression.
Animals given drugs to decrease noradrenaline become
sluggish and inactive, which are conditions associated with
depression.
Lithium carbonate is a drug for treating mania and this
decreases noradrenaline.
In increased quantities, noradrenaline gives rise to mania.
27
Biochemical influences





When noradrenalin and serotonin are broken down by
enzymes, which then make compounds, these compounds
are found in large quantities in the urine of depressed people.
When people are depressed, noradrenaline and serotonin
are lower.
However, when people are in a manic state, noradrenaline is
higher and serotonin is lower.
Ketty argues that serotonin limits the production of
noradrenaline.
When serotonin production goes down, it cannot limit the
production of noradrenaline and so noradrenaline goes up.
28
Anti-depressant drugs




The main argument against this is that antidepressant drugs do not work immediately.
Anti-depressants take a few weeks to work, but
the drugs should change the production of
neurotransmitters immediately.
A further complication is that not everyone
benefits from anti-depressant drugs.
Some depressed people do not produce lower or
higher levels of neurotransmitters, so they are not
always responsible for depression and the exact
role they play is not known.
29
External factors and biochemical
factors



The question is, is it the neurotransmitters that
alter moods, or do the neurotransmitters increase
due to mania or depression?
It was found that Seligman’s dogs, in the ‘learned
helplessness’ experiments, had lower levels of
noradrenaline.
This could not have been inherited and is clearly
the result of environmental changes.
30
Sex differences in depression





Women are 2 to 3 times more likely to have
symptoms of clinical depression than men.
Of all the mental disorders women suffer from,
depression is the highest.
Why is this?
Depression is associated with the menstrual
cycle, childbirth and the menopause.
Postnatal depression affects 1 in 10 women.
31
The effects of cortisol, a hormone
associated with stress


A biological explanation has emerged from
endocrinology.
Levels of the hormone cortisol are found to
be high in those suffering from depression
and techniques known to suppress cortisol
secretion have been found to be successful
in depressive patients (Carroll, 1982).
32
The influence of the endocrine system




A study by Nemeroff et al, 1992, has shown that
there is marked adrenal gland enlargement in
those suffering from major depression.
Endocrine (hormonal) changes could account for
depression relating to pre-menstrual, post-natal
and menopausal phases.
In the case of post-natal depression, psychotic
elements often appear, such as fantasies and loss
of control with reality.
Some mothers with severe post-natal depression
may harm or even kill their newborn child.
33
Hormonal changes







Pre-menstrual depression occurs in the week prior to
menstruation.
25% of women are affected.
An oestrogen-progesterone imbalance has been suggested.
In pre-menstrual depression, oestrogen levels are too high
and progesterone levels are too low.
At menopause, oestrogen levels drop.
Depressive states appear to occur more frequently during
periods of hormonal change.
A possible explanation is that hormonal changes interact with
a genetic predisposition to depression, together with
excessive tiredness and a stressful domestic situation.
34
Explanations for sex differences





Cochrane (1995) suggests that one of the reasons women
may become more depressed is that in childhood they are
more likely to be sexually abused than boys.
Clinical depression is associated with sexual abuse in
childhood.
Women also experience the ‘empty nest’ syndrome, which is
when the children leave home.
Women may also experience ‘learned helplessness’ because
many see themselves as having no control over their lives.
Another reason for the imbalance is that men often do not
admit to being depressed.
35