Bipolar Disorder and Major Depressive Disorder
Bipolar Disorder and Major Depressive Disorder
The focus of the following papers is bipolar disorder and major depressive illness. The bipolar disorder describes a manic-depressive illness characterised by changes in mood, activity levels, mood, energy and the capacity to carry out daily tasks. The major depressive disorder is a condition of chronic and pervasive low mood. Other accompaniments of the disease include disinterest in normally pleasurable activities and a low self-esteem. The following paper examines these disorders.
Deep, extensive and profound depression characterise the disease alternating with periods of an increased level of excitement or an irritable mood also referred to as mania (Kemner et al, 2015). The manic episodes are marked by at least one full week of extensive disturbance of mood (Martínez-Arán et al, 2014). The mood varies from elation, irritability to that of expansiveness. For an accurate diagnosis the patient must have three of either: insomnia, pressured speech, racing thoughts, distractibility, increased goal-focused activity (sexual or such), and increased interest in pleasurable activities (Martínez-Arán et al, 2014).
The hypomanic episodes feature excitement, or an irritable mood for at least four days (consecutive). Hypomania is a state of the less severe form of mania. During this period, the patient feels very relaxed, is highly productive and can function appropriately (Kemner et al, 2015). With no proper treatment it develops into a full-blown mania. The disorder can also present in a mixed state where the individual presents with both depression and mania. In this condition, the patient is agitated, insomniac and experiences shifts in appetite and is suicidal.
Major Depressive Disorder.
The disorder can present itself in unity (unipolar) or as a component of other psychiatric disorders (schizophrenia, bipolar disorder, substance abuse and organic brain disorder). The patients usually present with a dysphoric mood (expressed as heaviness, melancholy, numbness or mood swings, sometimes and irritability). The patient might also show psychotic features (ruminative thinking) (Eberhart, Auerbach, Bigda-Peyton & Abela, 2011). Major depressive disorder is confirmed if within two weeks the individual experiences at least five of a list of particular symptoms (Eberhart, Auerbach, Bigda-Peyton & Abela, 2011). These include hypersomnia or insomnia, depressed mood, a remarkable loss or gain of weight, increase or decrease in appetite, fatigue, guilty feelings or feeling of worthlessness, suicidal thoughts and a decreased attention ability.
Aetiology from a Diathesis-Stress Model perspective.
The diathesis-stress model suggests that individuals possess vulnerabilities and predispositions for certain illnesses (referred to as diatheses). These vulnerabilities interact with life stresses to facilitate the onset of the disease (Kemner et al, 2015). The life stresses are usually environmental in nature and present themselves in the form of external pressures and demands (Kemner et al, 2015). In the context of bipolar disorder, the vulnerabilities include biological and psychological factors.
Biological factors are linked to some neurotransmitters that affect multiple biochemical pathways. Glutamate, an excitatory neurotransmitter is a principal factor in facilitating the excitatory state of the disorder (Martínez-Arán et al, 2014). Serotonin, dopamine and norepinephrine are also potential triggers of mania. Genetic factors also play a role in the aetiology of the bipolar disorder. Psychological etiological factors revolve around psychologic behaviourism (Martínez-Arán et al, 2014). These allude to the past psychosocial factors and organic factors that result in the development of basic Behavioural features. Past psychosocial factors entail issues relating to the person’s self-esteem and personality as well as motivation and emotion. Such individuals may tend towards grandiose self-labelling during manic episodes as a result.
Environmental factors implicated in the aetiology include factors such as pregnancy in women. Other factors include increased demands either at work or at school. In the presence of these environmental factors, it is significantly easier for the individuals with the biological or psychological predisposition (Martínez-Arán et al, 2014).
Major Depressive Disorder
The diatheses involved in the causation of the major depressive disorder also include biological and psychological factors. The greater the individual’s innate vulnerability for the development of major depressive disorders, the less environmental stress required for him to develop the major depressive disorder. The reverse is true.
The biological factors implicated in the aetiology are related to the immune, neurotransmitter and endocrine (hormone) system. The monoamine hypothesis describes the roles of individual’s neurotransmitters such as serotonin, dopamine and norepinephrine whose depletion leads to depressive disorders (Kemner et al, 2015). Disturbances in the levels of the cortisol hormone destabilise the endocrine system that predisposes one to depression.
The psychological factors include impaired emotional intelligence, defects in the coping skills, problems in judgement and negative thoughts (Casacalenda, Perry ; Looper, 2014). A low self-esteem and negative feelings of self may affect a person’s way of coping with stresses. These factors/vulnerabilities affect the degree of environmental stresses required to cause depression in one someone.
The environmental pressures include the death of a loved one, loss of a job, milestones such as puberty and marriage divorce, alcoholism and drug abuse (Casacalenda, Perry & Looper, 2014). These factors can cause major depressive disorder in someone who is already predisposed (by having a deficit or problem concerning the bio psychological factors).
It is imperative that one considers the phase of the bipolar episode (mania or depression) in choosing the treatment. Two treatment approaches considered in the treatment of the disorder include pharmacotherapy or psychotherapy. Pharmacotherapy entails the use of medication to control the disease. Mood destabilising drugs are used to control manic episodes (Kemner et al, 2015). Antidepressant agents are used for a bipolar condition whereby depression is the chief manifestation. Anti-psychotic drugs are instituted in a bipolar depression with psychotic features. After the determination of the phase of the disease, the patient is monitored for risk of mania, mood destabilisation and presence of some symptoms that emerge after the institution of pharmacotherapy.
The psychotherapy approach is sometimes used alone or in combination with the pharmacotherapy approach. The psychotherapy approach involves psychosocial tools of intervention. These include psychoeducational and psychotherapeutic strategies (Kemner et al, 2015). The psychotherapeutic strategies include Behavioural cognitive therapy, social rhythm therapy and family-focused therapy. These therapeutic interventions help in providing social support as well as the tools critical in saving the patient from self-harm (Kemner et al, 2015). The patient gets to know and understand his or her condition and the importance of taking the drugs as prescribed.
Major Depressive Disorder.
As in the bipolar disorder, the major depressive disorder can be treated using medication therapy and psychotherapy (Blier, Ward, Tremblay, Laberge, Hébert & Bergeron, 2014). The reason is to facilitate the addressing of specific issues in the individual life that result in the disease as well as in the treatment of the signs and symptoms (Tondo, Baldessarini, Vázquez, Lepri, & Visioli, 2013). As regards medication, the clinician should consider the anticipated safety and tolerability of the patient. The primary group of drugs used in the treatment of depression are the antidepressants that fall under three generations. The patient preferences and the previous efficacy of the drugs should be considered in choosing the line of drugs to use (Tondo, Baldessarini, Vázquez, Lepri, & Visioli, 2013). Examples include the TCAs, which are the most common drugs used in treatment.
Psychotherapy is usually done when the individual is an outpatient on a regular basis (usually weekly). The psychotherapy involves talks and discussions designed to help in understanding and mastering the problems that might impede an individual’s ability to function efficiently in his life (Tondo, Baldessarini, Vázquez, Lepri, ; Visioli, 2013). Psychotherapy incorporates behavioural and cognitive therapy. Behavioural therapy focuses on the habits that cause stress while cognitive therapy involves learning to modify one’s thoughts to accompany shifts in mood (Casacalenda, Perry & Looper, 2014).
Bipolar disorder and depressive disorder are pretty common psychiatric disorders. Correspondingly, it is important that the psychiatrists learn their aetiological factors, symptoms and the treatment options comprehensively. Knowledge of these factors facilitates quality management of the condition.
Blier, P., Ward, H. E., Tremblay, P., Laberge, L., Hébert, C., & Bergeron, R. (2014). Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. The American journal of psychiatry.
Casacalenda, N., Perry, J. C., & Looper, K. (2014). Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. American Journal of Psychiatry.
Eberhart, N. K., Auerbach, R. P., Bigda-Peyton, J., & Abela, J. R. (2011). Maladaptive schemas and depression: Tests of stress generation and diathesis-stress models. Journal of Social and Clinical Psychology, 30(1), 75-104.
Kemner, S. M., van Haren, N. E., Bootsman, F., Eijkemans, M. J., Vonk, R., van der Schot, A. C., … & Hillegers, M. H. (2015). The influence of life events on first and recurrent admissions in bipolar disorder. International journal of bipolar disorders, 3(1), 6.
Martínez-Arán, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sánchez-Moreno, J. … & Salamero, M. (2014). Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. American Journal of Psychiatry.
Tondo, L., Baldessarini, R. J., Vázquez, G., Lepri, B., & Visioli, C. (2013). Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders. Acta Psychiatrica Scandinavica, 127(5), 355-364