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Course: NCLEX-RN > Unit 21
Lesson 2: Depression and related disorders- What is depression?
- Introduction to psychology - Depression and major depressive disorder
- Diagnosing depression
- Introduction to psychology - Depression and bipolar disorder
- Diagnosing bipolar disorder
- Types of depression and bipolar disorder in the DSM5
- Biological basis of depression
- Risk factors for bipolar disorder
- Treating depression with antidepressants
- Treatments for depression - Psychological therapies
- Treatments for bipolar disorder
- What is bipolar disorder?
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What is bipolar disorder?
What is bipolar disorder?
If you were asked to describe how you felt over the past few weeks, what would you say? You might say that most days you felt happy and hopeful for your future, or maybe you would report that a lot of the time you felt anxious and upset. The words that you choose describe your mood, or how you feel inside most of the time. Most of us have moods that are reasonably positive, stable, and consistent over time. We may have ups, downs, and mood swings once in awhile, but overall our feelings stay somewhere in the middle.
A mood disorder is a serious change or disturbance in mood that causes a person to experience extreme emotions that affect their ability to function normally. Bipolar I and bipolar II both involve severe fluctuations in mood, emotions, and symptoms, which happen during periods of time called mood episodes.
- Bipolar I involves at least one manic episode and any number of depressive or hypomanic episodes.
- Bipolar II involves at least one depressive episode and one hypomanic episode, with no manic episodes.
What keeps your mood consistent over time?
Your mood is usually stable and consistent because your brain is working to maintain homeostasis, or balance. To do this, it relies on chemical messengers called neurotransmitters. Neurotransmitters are powerful communicators that help the brain to control many of your body’s functions, including physical processes like your sleep and appetite, and emotional processes like your mood and concentration. As you experience life, neurotransmitters interact with one another to help you respond to situations in an appropriate and healthy way.
What can go wrong?
Because your neurotransmitters regulate many of your body’s functions, when they stop functioning properly there are a lot of different aspects of your mental and physical health that can be affected. Many scientists believe that the serious behavioral and emotional changes found in bipolar I and II are specifically caused by imbalances in or malfunctions of neurotransmitters called monoamines. Monoamines are found in large concentrations in your body’s limbic system, which controls your emotions, sleep, appetite, and memory. When these concentrations of monoamines are too high or too low, mood disorder symptoms emerge.
| Imbalance | Symptoms or behaviors | Associated mood | |
|---|---|---|---|
| Norepinephrine | Low levels | decreases in energy or motivation, poor attention and memory | depression |
| High levels | increases in hyperactivity, stress, and enxiety | mania | |
| Serotonin | Low levels | increases in depressed mood, food cravings, problems sleeping | depression |
| High levels | increases in hyperactivity, agitation, restlessness, and confusion | mania | |
| Dopamine | Low levels | increases in cravings, compulsive behavior and decreases in satisfaction | depression |
| High levels | increases in anxiety, hyperactivity, and psychosis | mania |
Symptoms:
Each type of mood episode has different symptoms and signs, but all mood episodes are similar in that they drastically change how a person feels and acts. Some broad symptoms that most people with mood disorders experience include:
- moods that are abnormal and excessive
- changes in body’s processes, like sleeping or eating
- dysfunction in social relationships or behaviors
- changes in overall activity level
Manic episodes: person feels incredibly “high” or “euphoric” for a week or more. They are almost hyperactive - they speak incredibly quickly, get involved in many different projects, and increase their activity level dramatically. They feel so extremely good about themselves that they think they can do anything, like advise world leaders or develop superpowers. Their activity level rapidly increases and becomes unsustainable. They don’t follow through on their projects and things end up unfinished. Their behavior is very obviously different from how it normally is, to the point where it seems outrageous. More specific symptoms must occur every day for at least one week or more and can include:
- experiencing an incredibly euphoric and irritable mood
- increasing their activity level, which feels good but becomes unsustainable
- self-esteem that is so high that it is clearly delusional
- feeling rested on very little sleep
- losing of judgment for what is reasonable or attainable
- changes in speech, such as manic speech and speech that is fast and pressured, or flight of ideas, or rapid speech that jumps from topic to topic
- difficulty concentrating
- losing insight; believing they are healthy, normal and productive
When a person has a manic episode they often have to be hospitalized because their symptoms make them dangerous to themselves or others danger to themselves. Consequences of mania can include destroyed finances, disease, divorce, family difficulties, and unwanted pregnancy.
Hypomanic episodes: person feels extremely happy but the symptoms are not nearly as severe, problematic, or obvious as they are in a manic episode. They don’t feel as agitated or driven as a person in a manic episode, though their mood is definitely different from how it usually is. Their behavior is also slightly different – they feel more comfortable and confident at parties, are more likely to talk to strangers or tell jokes in front of a crowd, and have an increased interest in sensuality and seeking out sexual partners. The specific symptoms of a hypomanic episode must occur every day for at least four days or more and can include:
- experiencing a mildly euphoric or irritable mood
- increasing their overall activity level, which feels uncomfortable
- heightened self-esteem, but not to the point of delusion
- sleeping significantly less and not feeling rested
- changes in speech, such as mild rapid and pressured speech, or mild flight of ideas
- lapses in judgment that leads to negative consequences
Hypomanic episodes do not result in hospitalization – the person might act inappropriately, but they are rarely a danger to themselves or others.
Depressive episodes: person feels extremely sad every day, and the feeling lasts for a minimum of two weeks. More specific symptoms must occur every day for at least two weeks and can include:
- feeling blue or sad more often than not
- feeling like life isn’t fun or pleasurable anymore
- losing interest in things that used to be a huge part of their life
- changes in appetite and weight, like eating significantly more and gaining weight, or not eating at all
- changes in sleep quality or amount of sleep, like sleeping less, or sleeping more but still feeling tired
- changes in speech, like becoming less talkative
- psychomotor agitation, like handwringing, pacing, or tapping the foot
- feelings of worthlessness or guilt
- low self-esteem
- thinking about death or wishing for death
Depressive episodes are especially difficult for people with bipolar I and II because the lows of depression are so different from the “highs” that they are used to feeling.
What causes bipolar disorder?
Bipolar disorder doesn’t have a single cause. Most scientists believe that multiple factors act together to create chemical imbalances that produce the disorder. Some of these include:
- Biological factors: if someone in your family has bipolar disorder, you are much more likely to develop it yourself – especially if the family member is a parent or sibling.
- Psychological factors: excessive stress, traumatic experiences, and negative life events (like financial trouble, illness, or death in the family) can all trigger mood episodes.
- Behavioral factors: increases in alcohol consumption or drug use can lead to the development of bipolar I and II, and can also make symptoms worse over time.
How common is bipolar disorder?
About 5.7 million US adults will experience bipolar disorder at some point during their life. Men and women both develop bipolar disorder at equal rates, but women usually experience depressive episodes more frequently. It affects all races and ethnic groups. You are more likely to be diagnosed with bipolar disorder if you are in your mid-twenties, or if you have a close relative with the disorder.
Is it possible to prevent bipolar disorder?
Most scientists and mental health practitioners agree that the bipolar disorder is not preventable. Instead of prevention, they focus on reducing the harmful impact of symptoms once they start. Some of these strategies include:
- Avoiding alcohol and other drugs, since they can make symptoms worse.
- Keeping a mood diary or paying close attention to emotions and behaviors, so that any abnormal changes in mood can be identified and treated quickly.
- Taking medications as they are prescribed, even if mood seems to be improving.
How are bipolar disorders treated?
Treatment for bipolar disorder usually combines psychiatric medication and therapy. These treatments work together to restore normal mood and improve the person’s ability to cope with the world around them.
- Medications for bipolar are usually mood stabilizers and antipsychotics. Mood stabilizers like lithium work to prevent symptoms of depression and mania, and antipsychotics improve symptoms of mania like delusions and impulsive behavior. Individuals diagnosed with bipolar disorder are advised not to take medications made to treat depression because they can trigger a manic episode.
- Psychotherapy for bipolar disorder often has the goal of minimizing any damage caused by a person’s behavior during a manic episode. This can include interpersonal therapy, which focuses on improving relationships between a person with bipolar disorder and his or her loved ones, or cognitive behavioral therapy (CBT), to help the person better understand and control their thoughts, emotions and behaviors.
Psychoeducation is also a very important part of treatment. When patients and their loved ones know about the causes and symptoms of bipolar disorders, it’s easier to quickly tell when a person might be experiencing a mood episode and help them get treatment.
Consider the following:
Many people with bipolar disorder eat more sugar when they have depressive episodes and manic episodes. Why do you think that is? Some doctors believe that they’re actually self-medicating! Sugary snacks can have powerful effects on the brain’s neurotransmitters (especially serotonin) and can help moods feel less extreme. The effects are usually short lived because the body processes simple sugars so quickly. So, while it may be tempting to self-medicate with sugar, people with bipolar disorder should choose nutrient dense foods like complex carbohydrates and lean proteins – even though a sugar high feels great for a while, a balanced diet is better for their symptoms in the long run.
Want to join the conversation?
it was sad and happy a she and mud(2 votes)- If SSRI have caused manic episodes in Bipolar I patient what antidepressant would be a better choice?(2 votes)
Why does this give people less time to think?(1 vote)