May 18

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​The Mood Rollercoaster


People who experience polar opposites from elation or agitation to despair are said to have bipolar mood disorders. This term includes any significant up-and-down cycles in moods and makes it easier to recognize the problem before it reaches the incapacitating stages that warranted a (now out-of-date) diagnosis of manic-depressive illness. Low periods are often confused with “unipolar” disorders of major depression, recurrent depression, and dysthymia (low energy, pessimism, and withdrawal). Medication that treats one disorder may not be effective for the other. The
table below can help distinguish these two branches of the same biochemical tree.

  • Other physical problems or medication reactions have been ruled out. A complete thyroid battery should be done if a person has gained weight, feels exhausted or is sensitive to cold.
  • Routine activities are becoming increasingly difficult: problems concentrating, making decisions, working, sleeping, or carrying out daily tasks.
  • Suicidal thoughts are causing problems.
  • Concentration and energy are not sufficient to counsel on past trauma or recent loss.
  • A family history of depression is present.
  • More than one previous episode of significant depression has occurred.
  • Medication has been helpful in the past and has not caused prolonged side effects.
  • Interest in or ability for self-examination is lacking.
  • Therapy to change thinking, behavior, or interaction patterns has not helped.

CHANGING THE CHEMISTRY OF DEPRESSION

Since the 1950s, nonaddictive antidepressants have helped 60–75% of people with depression find relief. Any side effects usually disappear or become tolerable after a couple of weeks. These medications act directly on various neurotransmitters:

  • Dopamine—linked to pleasure and self-stimulation.
  • Norepinephrine—enables the nervous system to respond to incoming stimuli.
  • Serotonin—balances the action of dopamine and norepinephrine.
  • MAO (monoamine oxidase)—an enzyme that breaks down adrenaline and serotonin.

The variety of options is steadily growing: tricyclics (TCAs), MAO inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and other “designer” antidepressants that target very specific neurotransmitters with fewer and fewer side effects:                          

Unipolar Mood Disorders Course of illness

Bipolar Mood Disorders Course of illness

Likely to begin in late 20s or early 30s

Likely to begin in late teens or early 20s.

 Two-thirds of all cases will have recurring depression.

Almost all cases have recurring highs and lows.

 Can be triggered by illnesses,  stress, grief, hormonal  changes      (in women), or  nothing

Can be triggered by changes  in seasons, jet lag, sleep loss,             grief,   stress, or nothing.

 Frequency and intensity of depression can increase over  the          years.

Frequency and intensity of highs and lows can increase over the   years.

During depressed periods

During depressed periods

Shallow sleep and early waking more likely.

Lengthened sleep (12+ hours) more likely.

Interest in food is reduced.

Increased desire to eat.

Genetics and biochemistry

Genetics and biochemistry

There is a 43% chance of identical twins having episodes of depression.

There is greater than 70% chance of identical twins
having bipolar disorder.2

Depression may be due to overregulation or depletion of chemical messengers that enhance mood.

Possibly due to poor regulation of neurotransmitters that excite the brain, causing “high” periods followed by depletion.

Lithium or Depakote alone will  not relieve depression but  may boost the effect of other antidepressants.

Lithium alone can sometimes stabilize mood by reducing
brain excitability and strengthening serotonin.

DETECTING BIPOLAR DISORDER AND ITS COUSINS

The best way of identifying a bipolar disorder is by careful observation of mood over time. The 0–100 scale on the Mood Chart is offered for that purpose. It can also be used to classify several varieties of mood disorders:

  • Normal mood: Moods vary from 40 to 60 except for periods of grieving a loss.
  • Cyclothymia: Mood cycles from 30 to 70 over a period of hours or days
  • Dysthymia: Mood has been in the range of 30 to 45 for over a two-year period.
  • Hypomania: Mood stays in the 55 to 70 range most of the time but can have manic episodes.
  • Bipolar II disorder: Mood is most often in the 30s or 40s, with periods of relief in the 60s.
  • Bipolar disorder: Mood can swing from the 30s or below to the 70s or above.
  • Major and reoccurring depression: Mood is below 40 for two or more weeks.

Reference

See A Mood Apart by Peter Whybrow (Harper Perennial, 1997, p. 113). 

Other research shows a 0–13% chance of both fraternal twins having

depression, suggesting a strong genetic link in unipolar depression.

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