Symptoms can also vary by age. In younger children, bipolar disorder may include physical complaints such as stomachaches and headaches, also irritability, social withdrawal, and changes in eating habits. They may feel unenthusiastic about school and other activities. In adults, common symptoms include a sad mood; sleep disturbances, and a lack of energy. Elderly people with depression usually complain of physical problems rather than emotional ones, which sometimes lead doctors to misdiagnose the illness (PlanetRx).
Some depressions seem to come unexpectedly, even when things are going well. Others seem to have an obvious cause such as a marital conflict, financial difficulty, or some personal failure. Yet, many people with these problems do not become deeply depressed. Most psychologists believe depression results from an interaction between stressful life events and a person's biological and psychological vulnerabilities (Sommers 32-35).
Genes may influence depression by causing abnormal activity in the brain. Studies have shown that certain brain chemicals called neurotransmitters play an important role in regulating moods and emotions. Neurotransmitters involved in depression include norepinephrine, dopamine, and serotonin. Research suggested that depression results from lower than normal levels of these neurotransmitters in parts of the brain. Support for this theory came from the effects of antidepressant drugs, which work by increasing the levels of neurotransmitters involved in depression (Kaufman, "Lithium Pills" 2).
The genes that a person inherits seem to have a strong influence on whether the person will develop bipolar disorder or not. By studying twins, researchers have found evidence of a strong genetic influence in depression. Among genetically identical twins where one twin has bipolar disorder, the other twin has the disorder in more than seventy percent of cases. However, among pairs of fraternal twins, who have about half of their genes in common, both twins have bipolar disorder in less than fifteen percent of cases in which one twin has the disorder. Adoption studies have provided more evidence suggesting a genetic role in depression. These studies show that children of depressed people are vulnerable to depression even when raised by adoptive parents. Nevertheless, there have been cases suggesting that the environment in which a person is in can change the whole situation. Sometimes when a child has bipolar disorder and is raised in a safe and carefree environment, they eventually grow out of the disorder (Bebchuk, "Surveying Genetics" 3).
Personal or work-related stress can trigger a manic episode, but this usually occurs in people with a genetic vulnerability. Psychologists agree that stressful experiences can trigger depression in people that are likely to have the illness anyway. For example, the death of a loved one, divorce, pregnancy, the loss of a job, and even childbirth are some of these very stressful situations. American psychiatrist Aaron Beck proposed that depressed people tend to view themselves, their environment, and their future in a negative way because of errors in thinking. These errors include focusing on the negative aspects of any situation, misinterpreting facts in negative ways, and blaming themselves for any misfortune. In Beck's view, people learn these self-destructing ways of looking at things during their early childhood (Yahoo Health).
One study examined the children of identical twins in which only one member of each pair of twins had bipolar disorder. The study found that regardless of whether the parent had the disorder or not, all of the children had the same high ten percent rate of bipolar disorder. This observation clearly suggests that risk for bipolar illness comes from genetic influence, not from exposure to a parent's bipolar illness of from family problems cause by that illness (Bebchuk "Surveying Genetics" 1).
Depression typically cannot be shaken or forced away. An episode must therefore run its course until it weakens either on its own or with treatment. Different therapies may shorten, delay, or even prevent the extreme moods caused by bipolar disorder. Depression can be treated effectively with antidepressant drugs, psychotherapy, or a combination of both (Sommers 48).
Despite the availability of effective treatment, most depressive disorders go untreated and undiagnosed. Studies indicate that general physicians fail to recognize depression in their patients at least half of the time. In addition, many doctors and patients view depression in elderly people as a normal part of aging, even though treatment for depression in older people is usually very effective.
Up to seventy percent of people with depression, respond to antidepressant drugs. These medications appear to work by altering the levels of serotonin, norepinephrine, and other neurotransmitters in the brain (Kaufman, "Lithium Pills" 1). They generally take at least two to three weeks to become effective. Doctors cannot predict which type of antidepressant drug will work best for any particular person; so depressed people may need to try several types. Antidepressant drugs are not addictive, but they may produce unwanted side effects. To avoid relapse, people usually must continue taking the medication for several months after their symptoms improve (Bipolar Home Pages).
Commonly used antidepressant drugs usually fall into three major classes: tricyclics, MAO inhibitors, and SSRIs. These antidepressants work by interacting with neurotransmitters at three different points. They can change the rate at which the neurotransmitters are either created or broken down by the body; they can block the process in which a spent neurotransmitter is recycled by a neuron and used again, called reuptake; or they can interfere with the binding of a neurotransmitter to neighboring cells.
Tricyclics, named for their three-ring chemical structure, include Elavil, Tofanil, Norpramin, Sinequan, and Pamelor. Side effects of tricyclics include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth (Moore, "Lithium" 1). Tricyclic work by blocking the reuptake of neurotransmitters into the neurons, keeping the neurotransmitter in the synapse longer, and making more of the neurotransmitter available to the postsynaptic cell.
MAO inhibitors include Marplan, Nardil, and Parmate. People who take MAO inhibitors must follow a diet that excludes tyramine, a substance found in wine, beer, some cheeses, and many fermented foods, to avoid a dangerous rise in blood pressure. In addition, MAO inhibitors have many of the same side effects as tricyclics (Bipolar Home Pages). MAO inhibitors work by decreasing the rate at which neurotransmitters are broken down by the body so they are more available to interact with neurons.
SSRIs include Prozac, Zoloft, and Paxil. These drugs generally produce fewer and milder side effects than do other types of antidepressants, although SSRIs may cause anxiety, insomnia, drowsiness, headaches, and sexual dysfunction. SSRIs work by blocking the reuptake of the neurotransmitter serotonin into the neurons, thereby prolonging its activity (PlanetRx).
All antidepressants decrease symptoms of depression in about seventy percent of depressed people who take them. Most antidepressants take about two to three weeks of treatment before beneficial effects occur. Because no antidepressant is more effective than the others are, doctors determine which antidepressant to prescribe according to the type of side effects an individual can tolerate.
Studies have shown that short-term psychotherapy can relieve mild to moderate depression as effectively as antidepressant drugs. Unlike medication, psychotherapy produces no physiological side effects. In addition, depressed people treated with psychotherapy appear less likely to experience a relapse than those treated only with antidepressant medication. However, psychotherapy usually takes longer to produce benefits.
There are many kinds of psychotherapy. Cognitive-behavioral therapy assumes that depression stems from negative, often irrational thinking about oneself and one's future. In this type of therapy, a person learns to understand and eventually eliminate those habits of negative thinking. In interpersonal therapy, the therapist helps a person resolve problems in relationships and support helps alleviate the depression. The subsequent improvement in social relationships and support helps alleviate the depression. Psychodynamic therapy views depression as the result of internal, unconscious conflicts. Psychodynamic therapists focus on a person's past experiences and the resolution of childhood conflicts. Psychoanalysis is an example of this type of therapy. Critics of long-term psychodynamic therapy argue that its effectiveness is scientifically unproven (Sommers 47-50).
In conclusion, many people throughout the world have been diagnosed with bipolar disorder and have undergone extensive treatment, but still many go throughout life untreated. Because of the genetic influence involved in the disorder, it becomes hard for the disease to "skip" a generation. Symptoms include physical pains and extreme mood swings from mania to deep depression. Although many patients deal with the disorder, ultimately, many turn to suicide.
