Mood Disorders
Abnormal Psychology
Mood disorders are a broad category of psychopatholog
y that includes depressive disorders and bipolar disorders. These conditions are defined in terms of episodes in which the person's behavior is dominated by either clinical depression or mania. Depression, or unipolar mood disorder, refers either to a symptom, a mood, or a clinical syndrome. The first widely accepted classification system to include depression was proposed by Emil Kraeplin. Mental disorders were divided into two categories by Kraeplin: dementia praecox and manic-depressive psychosis. His differentiation was based on such salient features as age of onset, clinical symptoms, and courses of the disorder. According to Kraeplin, manic-depressive psychosis in his patients was usually characterized by an episodic, recurrent course, with a relatively good prognosis. The psychiatrists Adolf Meyer and Sigmund Freud also greatly influenced to the classification system of depressive disorders. Meyer's works seemed to stress the biological and psychological functions that play a role when adapting to one's environment, thus classifying depression as a reaction to the environment rather than an illness.
Terms
Anticonvulsant Drugs -A class of drugs, such as carbamazepine (Tegretol) or valporic acid (Depakene), that has been proven an effective form of treatment of bipolar mood disorders. These drugs, which are characterized by such side effects as gastrointestinal distress, are usually prescribed to patients who have not responded well to lithium treatments.
Bipolar I -One of the bipolar disorders, bipolar I consists of individuals who have experienced at least one manic episode and who may or may not have experienced a depressive episode. (See Bipolar II.)
Bipolar II -One of the bipolar disorders that consists of individuals who have experienced at least one depressive episode, and have periods of hypomania instead of full-blown manic episodes. (See Bipolar I.)
Bipolar Mood Disorders -A type of mood disorder characterized by episodes of depression alternating with episodes of mania. Its subsets are bipolar I, bipolar II, and cyclothymia.
Chronic - Of long duration.
Cyclothymia- One of the bipolar disorders, cyclothymia is a chronic, but less severe, form of bipolar mood disorder, or the bipolar equivalent of dysthymia.
Depression - Refers to a symptom, mood, or clinical syndrome.
Depressive Mood Disorders -A class of mood disorders characterized by prolonged or frequent bouts of depression and consists of dysthymia and major depression as subsets.
Depressive Triad -A term coined by the psychologist Aaron Beck to describe the negative and demeaning views of the self, the world, and the future, that he believed central to the cognitive pattern exhibited by depressed individuals.
Dysphoria -An unpleasant mood.
Dysthymia - One of the depressive disorders, dysthymia is a mild form of depression characterized by a chronic course. It differs from major depression in terms of both severity and duration.
Explicit -That which is overtly expressed and part of the individual's consciousness and, therefore, part of his or her self-knowledge.
Expressed Emotion (EE) -A concept that describes negative and thus, damaging, behavior sometimes exhibited by the relatives of individuals suffering from a mental disorder. If the relatives display a lot of criticism and over-involvement toward the patient, then the family environment is said to be high in EE, and the patient therefore is said to be at a higher risk of relapse.
Group Cognitive Therapy -A form of therapy, involving treating more than one person at a time, that is based on the assumption that a patient's depression will be relieved if his or her irrational, distorted, and self-defeating beliefs are replaced with more rational and affirmative self-statements.
Hopelessness Theory -A theory that places great importance on the role that cognitive events play in the etiology of depression and proposes that depression is associated with the expectation that desirable outcomes will not occur and aversive, or undesirable, outcomes will occur regardless of any action taken by the individual.
Hypomania -Periods of increased energy that are less severe and shorter than manic episodes.
Iatrogenesis -A creation of a disorder by an attempt to treat it.
Implicit -That which may influence behavior or thought but does not itself enter into consciousness. Implicit measures therefore access the thoughts and beliefs of which the individual him- or herself may not be aware.
Interpersonal Therapy -A form of treatment of bipolar mood disorders that focuses on monitoring and handling the relationship between social interactions and behavior during episodes, and maintaining normal patterns of both sleep and work.
Light Therapy -A type of treatment proven to be an effective form of therapy for seasonal affective disorder, wherein the patient is exposed to a bright source of light on a daily basis.
Mania -A mood disturbance wherein the individual may possess such symptoms as a grandiose sense of self, an exaggerated feeling of physical and emotional well- being, elation, hyperactivity, and irritability.
Manic-Depressive Psychosis -A term coined by the psychologist Emil Kraeplin, used to describe a category within his classification system that was characterized by an episodic, recurrent course, with relatively good prognosis.
Monoamine Oxidase (MAO) -Enzymes that break down monoamines and therefore deplete the levels of certain neurotransmitters such as norepinephrine, dopamine, and serotonin in the brain.
Monoamine Hypothesis -A biological theory stating that depression is caused by the underactivity in the brain of monoamines, such as dopamaine, serotonin, and norepinephrine.
Monoamine Oxidase Inhibitors -A category of antidepressant drugs that inhibit the action of MAO's and therefore raise the levels of certain neurotransmitters such as norepinephrine, dopamine, and serotonin in the brain.
Mood -A pervasive and sustained emotional response that may play an important role in influencing the individual's perception of events that occur in the world.
Mood Disorders -Mood disorders are a broad category of psychopathology characterized by prolonged and severe disruptions in mood, including depressive disorders and bipolar disorders. Categorical definitions depend on whether the individual's behavior is dominated by either clinical depression or mania.
Mutual Support Therapy -A form of treatment that builds communication and problem-solving skills, involving role-playing and non-directive discussions of social difficulties and unexpressed or unacknowledged negative emotions. Mutual support therapy has been shown to be effective in producing improvements in depressed individuals.
Predictive Study (longitudinal study) - A type of research design wherein subjects are studied over at an extended period of time (instead of at one point in time), thereby helping to identify and establish whether a hypothesized cause does in fact precede the effects of a disorder.
Proband -In behavior genetic studies, a term used to describe index cases of family members who have a disorder. The relatives of these probands are then examined for concordance rates.
Psychomotor Retardation - A decrease in, or slowing of, physical and emotional reactions. Frequently seen as a symptom of depression, psychomotor retardation is usually characterized by a slowing of movements and speech.
Reaction Formation -A type of defense mechanism wherein the mind turns a frightening thought or wish into its safer opposite.
Relapse -A regression after partial recovery from an illness, or more specifically, the reappearance of active symptoms of a disorder after a period of remission.
Remission -A lessening of intensity or severity of the symptoms of an illness, or more specifically, a stage of a disorder wherein previously present symptoms are now absent.
Schema -A general cognitive pattern or map that governs and guides the way in which an individual perceives, interprets, and subsequently interacts with his or her environment.
Seasonal Affective Disorder (SAD) -A type of mood disorder, either unipolar or bipolar, wherein there has been a regular temporal association between the presence of the individual's episodes and a particular time of the year. The most common form of seasonal affective disorder is characterized by a severe depression during the fall and winter apparently caused by or related to the reduced amounts of daylight.
Selective Serotonin Reuptake Inhibitors (SSRIs) - A class of antidepressants that inhibit the reuptake of serotonin into the presynaptic nerve endings, thus promoting neurotransmission in serotonin pathways.
Theory of Learned Helplessness - Originally proposed by Martin Seligman, a behavioral theory proposing that, similar to the behavior of animals who had been exposed to inescapable shock in the lab, depressed individuals fail to realize the contingency between their behavior and outcomes in their environments. These individuals tend to believe that they are helpless--that they have no control over events that occur in their lives.
Theory of Multiplicity -A social-cultural theory proposing that the onset of a major depressive episode may be the result of the lost of an important social role, such as wife or mother, which therefore causes irreparable damage to the individual's concept of the self. Proponents of this theory thus state that it is healthy, and perhaps imperative, that individuals possess many different "selves" in order to have other domains to fall back on in the event that one role is lost.
Tricyclics -A class of antidepressants, including imipramine (Trofanil) and amitriptyline (Elaveil), that block the uptake of neurotransmitters, such as norepinephrine and dopamine, from the synapse.
Unipolar Mood Disorder -(Also called major depressive disorder, major depression, clinical depression.) A type of depressive disorder characterized by episodes of severe depression and accompanied by additional symptoms such as fatigue, changes in appetite and weight, and sleeping difficulties, which lasts without remission for at least two weeks.
Definition and Diagnostic Criteria of Major Depressive Disorder
It is important to mention that that the DSM- IV attempts to differentiate depression from normal sadness along the lines of intensity, absence of precipitants, quality, associated features, and history. This means that the depressive mood must pervade all aspects of the individual's life, and usually leads to social and occupational dysfunction. It is not an expected reaction to external stimuli, but a reaction that is extremely out of proportion, or an onset of a mood that occurs with no precursor at all. The mood change is inherently different from that of normal sadness; it may be accompanied by other symptoms or be preceded by a history of similar episodes. Major depression is the "common cold" of mood disorders because it is the one from which most individuals are likely to suffer. It does not seem to discriminate according to socioeconomic standing. Men have a 5 to 10 percent lifetime prevalence of developing the disorder. Their point prevalence, or the number of men likely to be diagnosed with depression at any time, is approximately 2 to 3 percent. The lifetime prevalence of women who will meet the criteria for major depression is 10 to 20 percent; the point prevalence ranges from 5 to 9 percent. Therefore, women (whether this is a reflection of biased data collection or the bias of women being more likely to seek treatment and be labeled as depressive) show a higher prevalence rate than men for unipolar mood disorder (also called major, or clinical, depression). Clinical depression, contrary to what one might expect, is also less likely to appear in the elderly than in younger adults. Unipolar mood disorders usually have an age of onset between twenty and forty years of age, with depressive episodes lasting of a minimum duration of two weeks, although they can be much longer.
With or without medication, subjects tend to improve within six months within the beginning of a major depressive episode. Of those who recover, 40 percent relapse within a year. If the disorder goes untreated, these individuals will remit within six to twelve months; if treated, the disorder remits in about twelve weeks. About 50 percent of those in remission, regardless of treatment, will relapse. However, the risk of relapse does tend to decrease as the period of remission increases. In about 10 percent of the cases, individuals will depress into manic or hypomanic stages and can then be classified as having bipolar mood disorder. Unfortunately, there are no cures for these disorders, but only methods of shortening the length of the episodes. Of those individuals who suffer from major depression, about 18 percent end their life in suicide. Cross- cultural studies indicate that clinical depression is a universal phenomenon, although symptoms may vary from one culture to another, and is highly comorbid with many other psychological disorders such as anxiety and alcoholism.
The diagnostic criteria of the DSM-IV for major depression includes a combination of emotional, cognitive, somatic and behavioral symptoms that are recurrent and pervasive. One of the most prominent emotional symptoms consists of a dysphoric, or unpleasant, mood. This entails feelings of gloom, dejection, and despondence. Feelings of anxiety are also common amongst people suffering from depression (similarly, depression is a common feature of many anxiety disorders. The cognitive symptoms refer to changes in the way the individual feels about him- or herself and his or her surroundings. Depressed individuals are usually characterized by trouble concentrating and by easily being distracted. Guilt and worthlessness are also common cognitive features of depressed individuals. Not only do they tend to blame themselves more for failure, even in the face of contradicting evidence, but they also tend to focus attention on the negative features of themselves, their environments and their future (labeled by Aaron Beck as the "depressive triad"). Depression also leads to the exhibition of avolition, or loss of willpower, and general tendencies of indecisiveness and ambivalence. Depressed individuals are also usually occupied with suicidal ideas.
The somatic symptoms of depression concern changes in psychological functions. These include changes in sleep pattern--inability to sleep and waking early, or sleeping too much, and changes in appetite--usually unintentional weight loss, or, less commonly, weight gain. Bodily symptoms also include fatigue or loss of energy, headaches, and muscular aches and pains. Finally, depression may be characterized by loss of interest in activities and sources of pleasure, also known as anhedonia, such as a decrease in sexual activity and enjoyment of it. The behavioral symptoms that contribute to a diagnosis of depression fall under the category of psychomotor retardation; depressed individuals are more likely to walk and talk at slower rates than usual. In total, five of the nine symptoms mentioned must be experienced to meet the criteria for a diagnosis of major depression.
Dysthymia is a mild form of depression that is characterized by a chronic course and differs from major depression in terms of both severity and duration. To meet the diagnostic criteria of dysthymia, the individual, must, over a period of at least two years, exhibit a depressed mood for most of the day on more days than not, and this mood cannot be absent for more than two months at any time in the two year period. If the person at any time in the two-year period experiences a depressive episode, the diagnosis would be major depression or bipolar mood disorder (if the individual also experiences a manic episode within this period.
Socio-cultural Etiology of Major Depressive Disorder
There seems to be a higher predictability rate for major depression correlated with the prevalence of stressful life events in an individual's life than with heritability. One of the most influential studies concerning this phenomenon was conducted by Brown and Harris. Four hundred single mothers were assessed twice between an interval of one year to research how much stressful life events could serve as a predictor of major depression. Brown and Harris found that there was an increased risk of developing the disorder in those women who had not only experienced a stressful life event, but for whom the event occurred in an area of her life especially important to her value system. The event was something in which she was highly involved and to which she was seriously committed, and also in an area in which she had been experiencing ongoing difficulties. Other important factors concerned the absence of an intimate relationship, having several young children at home, lacking employment away from the home, and the loss of a mother at an early age.
Brown and Harris' study was important because, since it was a predictive study, it helped to resolve some of the ambiguities concerning the relationship between depression and stressful life events. For the women in the study, clearly depression followed the occurrence of negative events such as divorce, loss of a job, and loss of a loved one. Furthermore, this study showed the importance of having multiple social roles. Multiplicity of social roles implies that if one role is lost, the individual still has other domains to fall back on should he or she fail in one, and thus avoid irreparable damage to the concept of the self.
Psychological Causes of Major Depressive Disorder
Freud's Psychoanalytic Theory of Depression
One of the leading psychoanalytical theories concerning depression was first proposed by Sigmund Freud. Freud argued that at some point in early childhood, the depressed patient suffered the loss, real or imagined, of someone with whom they were very close. Moreover, the individual depended on that other person to maintain his/her self-esteem. Unable to cope with the loss, the person then creates an internal representation of the lost individual so that they can maintain the close relationship. Anger begins to develop to develop towards the lost individual, but since this anger is not recognized and dealt with on a conscious level and since the object is internalized, the person directs the feelings toward him- or herself.
Depression, then, is essentially an instance of anger turned inwards. This theory, since it deals with the unconscious, is hard to support, but it does manifest itself in some of the social and psychological explanations for depression. One support comes from the discovery that depressed individuals were more likely to have experienced stressful life events than non-depressed individuals--and, more significantly, many of these stressful or negative events involved the loss of an important person or role.
Beck's Cognitive Schema
One of the most influential proponents of a cognitive view of depression has been Aaron Beck. Beck proposed that the depressed individual's tendency to express more negativity than non-depressed individuals is derived from his or her cognitive distortions, or erroneous ways, of thinking about the self. Negative and derogatory views of the self, the world, and of the future are core features of the depressed individual. More specifically, a depressed individual tends to attribute global, personalized reasons for failure, form overarching principles of the self based on negative experiences, to exaggerate negative events and dismiss positive events, and to selectively recall more negative events. One could then say that these self-defeating biases lead to the development of a cognitive schema that affects the way the individual interprets, perceives, and interacts with the environment. This negative schema in turn increases the probability of the individual being more negatively affected by stressful life events.
Seligman's Theory of Learned Helplessness
A behavioralist would more likely identify with the Theory of learned helplessness originally proposed by Marty Seligman to explain major depression. Seligman suggested that depression was similar to the passive behavior shown by animals that had been exposed to shock. Depressed individuals, then, like the animals in the lab experiments, begin to believe that they are helpless--that they do not have the power to control the events in their lives. They therefore fail to realize the contingency between their actions and the outcome of events. Learned-helplessness theory, in an attempt to answer some of the criticisms raised against it, such as the fact that most people do not become depressed after experiencing a negative life event, was later revised and described instead in terms of "hopelessness." L. Y. Abramson and his colleagues proposed that individuals who are vulnerable to depression possess an attributional style consisting of negative expectations concerning future events, regardless of their own actions. After the occurrence of a negative life event, the causal attributions (explanations and importance) that the person ascribes to the event is correlated with the probability of then becoming depressed. This attributional style also consists of the tendency to explain negative events as internal, stable, and global factors. This means that unlike non-depressed individuals, a depressed person is more likely to think of negative events as proof of their own inadequacies (internal), as having existed in the past and continuing to persist in the future (stable), and responsible for his or her failure in other areas of life (global).
Similar to Beck's cognitive schema, this theory points to an influential factor that may predispose an individual to developing depression. Taken together, people with this attributional style--logically, it may seem--tend to perpetuate the levels of stress that they may experience in the environment, again demonstrating the reciprocal relationship between stressful life events and the individual's cognitive response to failure. Thus, depression may be self- perpetuating, in that through this erroneous cognitive schema, negative life events enhance the intensity of the depression, which in turn leads to more stimuli being interpreted as negative. This results in an increased memory for negative events, regardless of whether or not the perception of these events is accurate.
Biological Etiology of Major Depressive Disorder
Heritability
Research has shown a strong genetic diathesis0 for depression. In reviews of twin studies, adoption studies, and family studies, heredity does seem to play a role in predisposing the individual to depression. One study in particular, performed by Kendler and his colleagues, looked at 2000 pairs of female twins. Evidence showed that the individuals at the greatest risk were those with a depressed monozygotic co-twin, followed by those with a dizygotic co-twin with a history of depression, followed by non-identical co-twins with no history of depression. Those with the least risk factor were identical twins with no history of depression. This study also showed that women who had experienced stressful negative events were more likely to develop depression than those who had not. Yet, the effect of this stress, in those who had experienced a negative event, was greater for those individuals who were more genetically liable. In another study that looked at the concordance rate for developing mood disorders between monozygotic and dizygotic twins, Bertelson and his colleagues found, in an index of Danish same-sexed twins in which at least one was diagnosed with a mood disorder, a concordance rate of .69 and of .19 respectively. Furthermore, family studies, such as the one performed by Katz and McGuffin, show that the risk of a proband developing a mood disorder increases as their degree of relatedness to a relative diagnosed with the disorder also increases. All of these studies point to an increased vulnerability for developing unipolar mood disorder in those individuals for whom a relative has also expressed depression. However, these studies also indicate that environment must play a role in the development of depression, since heritability is not one hundred percent, as would be the case if genetics was the only contributing factor.
Neurobiological Theories
Other biological factors concerning the etiology of depression focus on the role of neurotransmitters in the brain. One such hypothesis, the monoamine hypothesis, puts forth the theory that depression is caused by the underactivity of monoamines such as dopamaine, seratonin, and norepinephrine. This realization was based partly on the discovery that a group of drugs that inhibit the action of monoamine oxidases, enzymes that break down monoamines, was successful in treating depressed patients. Evidence that further supported this theory was the discovery that the drug reserpine, which was being used to treat hypertension, was leading to the development of major depressive disorder in 15 percent of the subjects. They later found out that reserpine was responsible for depleting levels of norepinephrine and seratonin in nerve terminals. Furthermore, in studies conducted where subjects were given liquid meals either balanced or not balanced with Tripthan, a precursor needed to make seratonin, researchers found that if the meal was not balanced, those subjects reported symptoms of sadness and depression.
However, one of the major problems with these neurobiological theories is that while antidepressants immediately restore the amount of monoamine levels in the brain, their effects on the depressive moods usually take weeks to manifest themselves. This has led to theories proposing that depression is caused by more than simply a deficiency in the amount of neurotransmitters--perhaps by an increase in density and sensitivity of postsynaptic receptors. Animal studies to support this theory, such as the ones performed by McNeal and Cimbolic, have shown that anti-depressants lead to a decrease in the sensitivity and density of these receptors.
Treatment of Major Depressive Disorder
Many forms of treatment for depression are not effective because they tend to have an iatrogenic effect; that is, the doctor or source of treatment is making the depression worse because it forces the individual to dwell on negative events. Whether they are an antecedent or consequence of the depression, cognitive behavioral therapy (CBT) helps the individual to deal with their cognitive symptoms and emotions. CBT focuses on erroneous cognitions that seem to be a part of the depression. The therapy focuses on the patient's sense of control and identifies the tendencies of misattribution, replacing them with other ways of thinking. Group cognitive therapy and mutual support therapy have also been shown to be effective in producing improvements in depressed patients. Other treatments such as electro-convulsive therapy (ECT), which stimulates a controlled seizure in the brain and immediately decreases sensitivity of norepinephrine receptors in the brain, has been shown to be effective immediately in cases of chronic and serious depression. Yet one major side-effect of this form of treatment is severe memory loss.
Other forms of treatment include monoamine oxidase inhibitors, a class of antidepressants that are monamine agonists, blocking the actions of the monamine oxidase and increasing monamine activity). One major problem in treating this disorder is that certain classes of antidepressants such as tricyclics, which include imipramine (Trofanil) and amitriptyline (Elaveil), block the re- uptake of serotonin and norepinephrine, but are deadly if taken in excess. Selective serotonin re-uptake inhibitors (SSRIs), also effective in treating depression, such as Prozac and Zoloft, only block the re-uptake of serotonin. The major side effects of SSRIs are gastro-intestinal discomfort and dry-mouth.
Definition and Diagnostic Criteria of Bipolar Disorders
Bipolar mood disorder is a kind of mood disorder in which the person experiences episodes of mania as well as episodes of depression. The onset period for developing the disorder is usually late twenties to early thirties. The first episode may be either manic or depressive. Bipolar individuals tend to have more episodes than unipolar patients, and the disorder tends to follow a long-term, episodic course, with mixed prognosis. Manic episodes usually remit within one to three months without treatment, while depressive episodes typically last three times longer. The lifetime prevalence of bipolar mood disorders is about 1 percent of the population. No gender differences have been found regarding the risk for developing the disorder.
There are three types of bipolar mood disorders: bipolar I; bipolar II; and cyclothymia. To meet the diagnostic criteria, the mood disorders must be severe and long enough to cause social and occupational dysfunction. All three types involve either manic or hypomanic episodes. Individuals with bipolar I are characterized by having experienced at least one manic episode, and although they do not need to have experienced a depressive episode to meet diagnostic criteria, most of them actually have episodes of major depression in addition to manic episodes. Manic episodes are distinct periods in which mood is elevated, expansive, or irritable for at least a week. If the symptoms are elevated or expansive, the individual only needs to meet three of the following criteria: inflated self-esteem or grandiosity; decreased need for sleep, yet no feelings of fatigue; more talkative than usual or feeling pressure to keep talking; flight of ideas or subjective experience of thoughts racing; distractibility; increase in goal directed activity or psychomotor agitation; and excessive involvement in pleasurable activities that have a high potential for painful experiences. If the individual expresses irritable symptoms instead, they must meet four of the above seven criteria. Manic episodes trump everything else--meaning that the presence of a manic episode immediately identifies the disorder as bipolar, and manic episodes usually lead to severe functional impairment.
Individuals in the bipolar II category have experienced at least one depressive episode, but do not have full-blown manic episodes. Instead, they have periods of hypomania: periods of increased energy that are less severe and shorter than manic episodes. Hypomanic episodes, which only last for about four days and do not include psychotic symptoms, produce noticeable impairment, but not enough to lead to social or occupational dysfunction. Cyclothymia is a chronic but less severe form of mood disorder, or the bipolar equivalent of dysthymia. Individuals who fit the criteria for cyclothymia usually have rapid cycling of hypomanic and depressive episodes and do not have a history of manic or major depressive episodes.
Etiology of Bipolar Mood Disorders
Socio-Cultural Causes
Evidence suggests that the weeks preceding the onset of a manic episode are usually marked by an increase in frequency of stressful life events in the individual's life. Stressful life events have also been shown to trigger higher rates of relapse amongst individuals who have recovered from previous episodes. Bipolar individuals with an extroverted personality are less likely to relapse, suggesting that these individuals may have a greater ability to maintain a supportive social network that contributes to their ability to cope with the disorder. Individuals who are surrounded by an environment or family high in criticism and hostility--high in expressed emotion (EE)--are more likely to relapse shortly after discharge.
Psychological Causes
The leading psychoanalytic theory concerning the etiology of bipolar mood disorders asserts that both depressive and manic episodes result from a low self-concept. Depressive episodes reflect this directly. Manic episodes represent a defense against the low self-concept by acting in the opposite direction, a type of reaction formation. Proof for this theory comes from cognitive research that has shown that bipolar patients in a manic episode explicitly report higher ratings of self-esteem than bipolar individuals in a depressive episode, ratings similar to those of individuals without any mood disorders. Yet, on implicit measures, bipolar patients exhibit lower self-esteem ratings in both manic and depressive episodes compared to normal controls.
Biological Causes
Genes have been shown to account for much of the vulnerability factor for developing bipolar mood disorder, accounting for about 80 percent of the variance in vulnerability. The concordance rate for monozygotic twins is about 69 percent and about 19 percent for dizygotic twins. The risk is much higher for individuals with a relative who express the disorder; yet it is unclear what exactly is being inherited. Among the relatives of bipolar probands, the risk for both bipolar and unipolar mood disorder is much higher than for individuals in the general population. Family studies also indicate that bipolar mood disorder should be considered a separate disorder from unipolar mood disorder, since the risk for developing bipolar is higher among the family of those individuals with bipolar disorder.
Treatment of Bipolar Mood Disorders
Lithium has been shown to be a very effective form of treatment for individuals with bipolar disorders in either manic or depressive episodes. Bipolar patients who maintain their lithium medication are also less likely to suffer a relapse. The side effects of lithium include memory impairment, weight gain, and impaired coordination. Many individuals, because of these negative side effects, fail to comply with the medication. Some individuals, especially those who possess both manic and schizophrenic symptoms, or who rapidly alternate between manic and depressive episodes, also exhibit a non- response to the medication and do not show improvement. Anticonvulsant drugs such as carbamazepine (Tegretol) and valporic acid (Depakene) are another form of drug therapy. Common side effects of anticonvulsants include nausea, vomiting and diarrhea. Like lithium, these drugs not only reduce the severity and frequency of relapse, but can also help alleviate manic episodes.
Both interpersonal therapy and cognitive therapy are also used in conjunction with biological intervention. Cognitive therapy helps patients to cope with stressful life events and fears of taking medication. Interpersonal therapy focuses on monitoring and handling the relationship between social interactions and behavior during episodes and maintaining normal patterns of both sleep and work. Electro-convulsive therapy (ECT) has also been shown to be effective in the treatment of bipolar mood disorders.
Seasonal Affective Disorders
Seasonal affective disorders (SAD) are a type of mood disorder, either unipolar or bipolar, in which there has been a correlation between the appearance or disappearance of episodes and a particular time of the year. In other words, they are episodes of mood disorders brought on by fluctuations in the seasons. Although it is not clear exactly how it works, light therapy (exposing the patient to a bright source of light on a daily basis) has been proven to be an effective form of therapy for this disorder; improvements are seen within two to five days.
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