By Mayo Clinic
staff
Overview
Depression is a disorder that affects your thoughts, moods, feelings, behaviour
and physical health. People used to think it was "all in your head" and that if
you really tried, you could "pull yourself out of it." Doctors now know that
depression is not a weakness, and you can't treat it on your own. It's a medical
disorder with a biological or chemical basis.
Sometimes a stressful life event triggers depression. Other times depression
seems to occur spontaneously, with no identifiable specific cause. Whatever the
cause, depression is much more than grieving or a bout of the blues.
Depression may occur only once in a person's life. Often, however, it occurs as
repeated episodes over a lifetime, with periods free of depression in between.
Or it may be a chronic condition, requiring ongoing treatment over a lifetime.
The disorder affects more than 18 million Americans of all ages and races.
Medications are available that are generally safe and effective, even for the
most severe depression. With proper treatment, most people with serious
depression improve, often within weeks, and can return to normal daily
activities.
Signs and Symptoms
Two hallmarks of depression — symptoms key to establishing the diagnosis — are:
Loss of interest in normal daily activities. You lose interest in or pleasure
from activities you used to enjoy. This is called anhedonia. Depressed mood. You
feel sad, helpless and hopeless and may have crying spells. In addition, for a
doctor or other health professional to diagnose depression, most of the
following signs and symptoms must also be present most of the day, nearly every
day for at least 2 weeks:
Sleep disturbances. Sleeping too much or having problems sleeping can be a sign
you're depressed. Waking in the middle of the night or early in the morning and
not being able to get back to sleep are typical. Impaired thinking or
concentration. You may have trouble concentrating or making decisions and have
problems with memory.
Significant weight loss or gain. An increased or reduced appetite and an
unexplained weight gain or loss of more than 5 percent of your normal weight can
indicate depression.
Agitation or slowing of body movements. You may seem restless, agitated,
irritable and easily annoyed. Or you may seem to do everything in slow motion
and answer questions slowly in a monotonous tone of voice. Fatigue. You feel
weariness and lack of energy nearly every day. You may feel as tired in the
morning as you did when you went to bed the night before. Low self-esteem. You
feel worthless and have excessive guilt.
Less interest in sex. If you were sexually active before developing depression,
you may notice a dramatic decrease in your level of interest in having sexual
relations.
Thoughts of death. You have a persistent negative view of yourself, your
situation and the future. You may have thoughts of death, dying or suicide.
Depression can also cause a wide variety of physical complaints, such as
generalized itching, blurred vision, excessive sweating, dry mouth,
gastrointestinal problems (indigestion, constipation and diarrhoea), headache
and backache.
Children, teens and older adults may react differently to depression. In these
groups symptoms may take a different form or may be masked by other conditions.
Dry mouth
Constipation
Diarrhoea
The main types of depression include:
Major depression. This type of mood disturbance lasts more than 2 weeks.
Symptoms may include overwhelming feelings of sadness and grief, loss of
interest or pleasure in activities you usually enjoy, and feelings of
worthlessness or guilt. This type of depression may result in poor sleep, severe
fatigue, difficulty concentrating, change in appetite and suicide.
Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but a more continuous form
of depression. It lasts for at least 2 years and often more than 5 years. Signs
and symptoms usually aren't disabling, and periods of dysthymia can alternate
with short periods of feeling normal. Having dysthymia places you at an
increased risk of major depression.
Adjustment disorders. If a loved one dies, you lose your job or you receive a
diagnosis of cancer, it's perfectly normal to feel tense, sad, overwhelmed or
angry. Eventually, most people come to terms with the lasting consequences of
life stresses, but some don't. This is what's known as an adjustment disorder —
when your response to a stressful event or situation causes signs and symptoms
of depression. Some people develop an adjustment disorder in response to a
single event. In others, it stems from a combination of stressors. Adjustment
disorders can be acute — lasting less than 6 months — or chronic — lasting
longer. Doctors classify adjustment disorders based on the primary signs and
symptoms of depression or anxiety.
Bipolar disorder. Having recurrent episodes of depression and elation (mania) is
characteristic of bipolar disorder. Because this condition involves emotions at
both extremes (poles), it's called bipolar disorder or manic-depressive
disorder. Mania affects your judgment, causing you to make unwise decisions.
Some people have bursts of increased creativity and productivity during the
manic phase. The number of episodes at either extreme may not be equal. Some
people may have several episodes of depression before having another manic
phase, or vice versa.
Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of
depression related to changes in seasons and a lack of exposure to sunlight. It
may cause headaches, irritability and a low energy level.
Many people with depression have symptoms of anxiety as well. Anxiety that
develops after age 40 is often related to depression rather than being an
independent problem.
Causes:
There's no single cause for depression. The illness often runs in families.
Experts believe a genetic vulnerability combined with environmental factors,
such as stress or physical illness, may trigger an imbalance in brain chemicals
called neurotransmitters, resulting in depression. Imbalances in three
neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked
to depression.
Scientists don't fully understand how imbalances in neurotransmitters cause
signs and symptoms of depression. It's not certain whether changes in
neurotransmitters are a cause or a result of depression.
Here are factors that contribute to depression:
Heredity.
Researchers have identified several genes that may be involved in bipolar
disorder, and they're looking for genes linked to other types of depression. But
not everyone with a family history of depression develops the disorder.
Stress.
Stressful life events, particularly a loss or threatened loss of a loved one or
a job, can trigger depression.
Medications.
Long-term use of certain medications, such as some drugs used to control high
blood pressure, sleeping pills or, occasionally, birth control pills, may cause
symptoms of depression in some people.
Illnesses. Having a chronic illness, such as heart disease, stroke, diabetes,
cancer or Alzheimer's disease, puts you at higher risk of developing depression.
Studies reveal an as-yet-unexplained link between depression and heart disease.
Depression occurs in up to half the people who've had heart attacks. Left
untreated, depression may put you at a higher risk of death in the early years
after a heart attack. Having an under active thyroid (hypothyroidism) — even
mild hypothyroidism — also can cause depression.
Personality. Certain personality traits, such as having low self-esteem and
being overly dependent, self-critical, pessimistic and easily overwhelmed by
stress, can make you more vulnerable to depression.
Postpartum depression. It's common for mothers to feel a mild form of distress
that usually occurs a few days to weeks after giving birth. During this time you
may have feelings of sadness, anger, anxiety, irritability and incompetence. A
more severe form of the baby blues, called postpartum depression, affects up to
25 percent of new mothers.
Alcohol, nicotine and drug abuse.
Experts once thought that people with depression used alcohol, nicotine and
mood-altering drugs as a way to ease depression. But studies show that using
these substances may actually contribute to depression and anxiety disorders.
Diet.
Deficiencies in folic acid and vitamin B-12 may cause symptoms of depression.
Low levels of both nutrients are linked to a poorer response to antidepressant
medications.
Risk Factors
Depression affects all ages and all races. Typically, the first episode occurs
between ages 25 and 44. It's not any more common in older adults, but it's more
likely to go unrecognized in this age group.
Depression rates are lower among married people, especially married men, and
those in long-term, intimate relationships. It's higher among divorced people
and those who live alone.
Major depression, dysthymia and seasonal affective disorder are more common in
women. Over the course of a lifetime, about one in five American women will
experience major depression or dysthymia, compared with about 1 in 10 American
men. Men and women have about the same risk of bipolar depression.
These gender differences may be in part due to biological causes, such as
hormones and different levels of neurotransmitters.
When to Seek Medical Advice
If you feel sad, helpless, tired or worthless, if your eating and sleeping
habits have changed greatly, and if you show little interest in once enjoyable
activities, see your doctor to determine if depression is the cause. If you know
someone who exhibits the characteristics of depression, encourage him or her to
seek professional help.
Screening and Diagnosis
To diagnose depression, your doctor may perform a physical examination,
including tests to rule out conditions that can cause symptoms that mimic
depression.
If your doctor sees signs of severe depression or suspects the possibility of
suicide, he or she may refer you to a medical doctor who specializes in mental
illness (psychiatrist) or even recommend immediate hospitalization.
Your doctor or psychiatrist diagnoses depression based on the hallmark signs and
symptoms of the disease, plus the presence of other signs and symptoms that
typically accompany depression.
Complications
Depression is a serious illness that can take a terrible toll on individuals and
families. Untreated, depression can lead to a downward spiral of disability,
dependency and suicide. About 9 out of 10 people who commit suicide have one or
more mental illnesses, most commonly depression.
As many as one in eight teens may have depression. The suicide rate for young
adults ages 15 to 24 has risen in recent years. Among older adults, depression
often is overlooked and therefore untreated. This may explain why the suicide
rate for older adults is more than 50 percent higher than for the general
population.
Certain warning signs may indicate serious depression and the possibility of
suicide. Take any threat of suicide seriously, even if the person is already
being treated for depression. If you see any of the following danger signs, call
a doctor, mental health clinic or suicide hot line immediately:
Pacing, agitated behavior, frequent mood changes and sleeplessness for several
nights
Actions or threats of assault, physical harm or violence
Threats or talk of death or suicide, such as "I don't care anymore," or "You
won't need to worry about me much longer" Withdrawal from activities and
relationships
Putting affairs in order, such as saying goodbye to friends, giving away prized
possessions or writing a will A sudden brightening of mood after a period of
being depressed , Unusually risky behaviour , such as buying or handling a gun
or driving recklessly.
Treatment
The development of newer antidepressant medications and mood-stabilizing drugs
in the last 20 years has revolutionized the treatment of depression. Medication
can relieve symptoms of depression, and it has become the first line of
treatment for most types of the disorder.
Treatment may also include psychotherapy, which may help you cope with ongoing
problems that may trigger or contribute to depression. A combination of
medications and a brief course of psychotherapy usually is effective if you have
mild to moderate depression. If you're severely depressed, initial treatment
usually is with medications or electroconvulsive therapy. Once you improve,
psychotherapy can be more effective.
Doctors usually treat depression in two stages. Acute treatment with medications
helps relieve symptoms until you feel well. Once your symptoms ease, maintenance
treatment typically continues for 6 to 12 months to prevent a relapse. It's
important to keep taking your medication even though you feel fine and are back
to your usual activities. Episodes of depression recur in the majority of people
who have one episode, but continuing treatment for at least 6 months greatly
reduces your risk of a rapid relapse. If you've had three or more previous
episodes of depression, your doctor may suggest long-term treatment with
antidepressants.
Medications
Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider
selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem),
paroxetine (Paxil), sertraline (Zoloft) and citalopram (Celexa), as the
first-line treatment for depression because they have fewer serious side
effects. They seem to work by increasing the availability of the
neurotransmitter serotonin in your brain. Drugs similar to SSRIs include
serotonin and norepinephrine reuptake inhibitors (SNRIs), such as nefazodone
(Serzone), trazodone (Desyrel, Trialodine) and venlafaxine (Effexor), and
dopamine reuptake inhibitors, such as bupropion (Wellbutrin, Zyban).
Tricyclic and tetracyclic antidepressants. These medications also affect
neurotransmitters but by a different mechanism than SSRIs. Doctors often
prescribe them to treat moderate to severe depression. Among tricyclic
antidepressants are amitriptyline (Elavil, Endep), desipramine (Norpramin,
Pertofrane), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil),
trimipramine (Surmontil) and a combination of perphenazine and amitriptyline
(Triavil, Etrafon). Tetracyclics include maprotiline (Ludiomil) and mirtazapine
(Remeron).
Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine
(Nardil) and tranylcypromine (Parnate), prevent the breakdown of
neurotransmitters. The drugs have potentially serious side effects if combined
with certain other medications or food products. Doctors rarely use them unless
other options have failed. Your doctor may prescribe them if you have chronic
depression and eat or sleep excessively.
Stimulants. If you're severely depressed, your doctor may initially prescribe a
stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine
(Dexedrine, DextroStat) or modafinil (Provigil) in addition to an antidepressant
because most antidepressants are slow to work. After 1 to 4 weeks, your doctor
may then switch you to just an antidepressant.
Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith,
Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine
(Epitol, Tegretol, Carbatrol) to treat bipolar depression. These medications
provide relief 50 percent to 80 percent of the time. Medications called atypical
antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and
quetiapine (Seroquel) were initially developed for treatment of psychotic
disorders. Doctors sometimes also use them to treat bipolar disorder.
Most antidepressants have a similar level of effectiveness. However, a
medication that works for someone else might not work for you. Doctors choose
antidepressants based on your family history and the match between your symptoms
and the medication's side effects. For example, if you have insomnia, a sedating
antidepressant may help you. But if you're lethargic, then a more energizing
antidepressant may be more helpful.
Most antidepressants are slow to work. You may see a response in 2 weeks, but
many people don’t see a full benefit for 6 to 8 weeks. If your response to
medication isn't resulting in satisfactory progress after 6 to 8 weeks, your
doctor may suggest either adding another antidepressant or replacing the first
medication with another drug from a different chemical family.
In addition to medications, depression treatment may
include:
Psychotherapy
There are several types of psychotherapy. Each type involves a short-term,
goal-oriented approach aimed at helping you deal with a specific issue.
Prolonged psychotherapy is seldom necessary to treat depression. If an
underlying factor contributing to your depression is an inability to get along
with others or difficulty finding your place in life, then prolonged
psychotherapy could help you.
The success of therapy depends on finding a doctor, psychiatrist or psychologist
you're comfortable with. Both medications and psychotherapy can take 4 to 8
weeks to have an effect. Specialized and supervised group therapy, such as
bereavement groups, stress management classes, marital counseling and family
therapy, may also help.
Light therapy
This therapy may help if you have seasonal affective disorder (SAD). This
disorder involves periods of depression that recur at the same time each year,
usually when days are shorter in the fall and winter. Scientists believe fewer
hours of sunlight may increase levels of melatonin, a brain hormone thought to
induce sleep and depress mood. Treatment with a specialized type of bright
light, which suppresses production of melatonin, may help if you have this
disorder.
Self-Care
Once treatment for depression begins, you still have to manage on a day-to-day
basis. Here are some
Guidelines:
See your doctor regularly. Your doctor can monitor your progress, provide
support and encouragement, and adjust your medication if necessary.
Take your medications. Finding the best medication for you may take several
tries. It may take several weeks for you to start seeing results. Once you feel
better, continue to take your medication as prescribed.
Don't become isolated. Try to participate in normal activities.
Take care of yourself. Eat a healthy diet and get the right amount of sleep and
exercise. Exercise can help treat some forms of depression, ease stress and help
you relax.
Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or
prevent your recovery.
Coping Skills
Self-help organizations have become potent allies for people who are coping with
mental illness or who care about someone with such an illness. For depression or
other mental illnesses, self-help groups include the National Mental Health
Association (NMHA) and the National Alliance for the Mentally Ill (NAMI).
The NMHA is based in Washington, D.C., and has hundreds of affiliates in the
United States. The group educates the public and the policy makers about mental
health issues. The association's online resources include discussion groups and
screening for depression.
The NAMI provides support and education to people with severe mental illness and
their families. Founded in 1979, the group has more than 1,200 state and local
chapters. The chapters rely on volunteers, most of whom have had mental illness
in their families.
Complementary and Alternative
Medicine
Herbal and dietary supplements sold in stores have become increasingly popular.
People take them to help prevent or treat a number of health conditions. Some of
these alternative therapies are being studied to determine their effectiveness
in helping depression. Within the next few years, researchers may know more
about these products, how effective they are and if they can cause other health
problems or interfere with medications.
In the meantime, talk with your doctor before taking any herbal or dietary
supplement. The downfall of herbal and dietary products is that they aren't
regulated. The Food and Drug Administration doesn't test them for safety, purity
and effectiveness. You can't always be sure what you're getting and if it's
safe.
The following are some of the more popular supplements
marketed or taken for treatment of depression.
St. John's Wort
St. John's wort is an herbal preparation from the Hypericum perforatum plant. It
has long been used in folk medicine, and today it's widely prescribed in Europe
to treat anxiety, depression and sleep disorders. In the United States it's sold
in health food stores and pharmacies in the form of tablets or tea.
European studies suggest that St. John's wort may work as well as
antidepressants and with fewer side effects. Adverse reactions include dry
mouth, dizziness, digestive problems, fatigue, confusion and sensitivity to
sunlight. In most cases, symptoms are mild. Of concern is that St. John's wort
can interfere with the effectiveness of prescription medications, including
antidepressants, drugs to treat human immunodeficiency virus (HIV) infections
and AIDS, and drugs to prevent organ rejection in people who have had
transplants. There's also a risk of serotonin syndrome if St. John's wort is
used with an SSRI or another serotonin-active antidepressant.
The National Institute of Mental Health has begun a large-scale, controlled
clinical trial of St. John's wort to help determine its effectiveness and
safety.
SAM-e
Pronounced "Sammy," short for S-adenosyl-methionine, this chemical substance is
available in Europe as a prescription drug to treat depression. In the United
States it's sold as an over-the-counter dietary supplement.
SAM-e is a chemical substance found in all human cells and plays a role in many
body functions. It's thought to increase levels of serotonin and dopamine, but
this is unproven. Studies in Europe suggest it works as well as standard
antidepressants but with milder side effects.
The pills are expensive, especially considering their effectiveness is unproven.
Too much of the product could be harmful, boosting serotonin to dangerously high
levels.
5-HTP
One of the raw materials that your body needs to make serotonin is a chemical
called 5-HTP, which is short for 5-hydroxytryptophan. 5-HTP is prescribed in
Europe to treat depression and other conditions, including obesity and insomnia.
In the United States it's available as an over-the-counter supplement.
In theory, if you boost your body's level of 5-HTP, you should also elevate your
levels of serotonin. One small study compared 5-HTP with the SSRI fluvoxamine.
People taking three daily doses of 100 milligrams of 5-HTP reported slightly
more relief and fewer side effects than did those taking fluvoxamine. But
there's not enough evidence to determine if 5-HTP is effective and safe. Larger
studies are needed.
In the 1980s a serious medical complication called erythromyalgia developed in
some people who took 5-HTP from a bad batch. Many suffered permanent neurologic
damage. This is an example of why you should be cautious when considering
supplements.
Omega-3 fatty acids
Omega-3 fatty acids are found in fish oil and certain plants. They're being
studied as a possible mood stabilizer for people with bipolar depression and
other psychiatric disorders. Some studies suggest that people with depression
have decreased amounts of an active ingredient found in omega-3 fatty acids. A
recent small study also suggests that omega-3 fatty acids may prevent relapse
among people with bipolar illness.
Fish oil capsules containing omega-3 fatty acids are sold in stores. The
capsules are high in fat and calories and may produce gastrointestinal problems.
Another way to get more omega-3 fatty acids is simply to eat more fish.
Manic Depression
Bipolar
disorder
By Mayo Clinic staff
Overview
From high to low. From euphoria to depression. From recklessness to
listlessness. These are the extremes associated with bipolar disorder, which can
be a serious and disabling mental illness. The condition is also known as
manic-depressive illness — from manias on the one extreme to depression on the
other.
Bipolar disorder affects more than 2 million American adults, or about 1 percent
of the population age 18 and older. It often begins in adolescence or early
adulthood and may persist for life.
Its causes are elusive, and there's no cure. But it can be managed. Left
untreated, the condition usually worsens. The flares of bipolar disorder may
last for weeks or months, causing great disturbances in the lives of those
affected, their friends and their families.
Signs and Symptoms
Bipolar disorder is characterized by an alternating pattern of emotional highs
(mania) and lows (depression). The intensity of the signs and symptoms varies.
Bipolar disorder can range from a mild condition to a severe condition.
For many people, the manic signs and symptoms include:
Feelings of euphoria, extreme optimism and inflated self-esteem
Rapid speech, racing thoughts, agitation and increased physical activity
Poor judgment and recklessness
Difficulty sleeping
Tendency to be easily distracted
Inability to concentrate
Extreme irritability
In the depression phase, signs and symptoms include:
Persistent feelings of sadness, anxiety, guilt or hopelessness
Disturbances in sleep and appetite
Fatigue and loss of interest in your daily activities
Difficulty in concentrating
Recurring thoughts of suicide
Causes
Doctors and researchers don't know exactly what causes bipolar disorder. But a
variety of biologic, genetic and environmental factors seem to be involved in
causing and triggering episodes of the illness.
Evidence indicates that differences in the chemical messengers between nerve
cells in the brain (neurotransmitters) occur in people who have bipolar
disorder. In many cases people with bipolar disorder may have a genetic
disposition for the disorder. The abnormality may be in genes that regulate
neurotransmitters.
Factors that may contribute to or trigger episodes of bipolar disorder include
drug abuse and stressful or psychologically traumatic events.
Risk Factors
Bipolar disorder tends to run in families. A family history appears to exist in
about 60 percent of cases of bipolar disorder. Researchers are attempting to
identify genes that may make people susceptible to bipolar disorder.
When to Seek Medical Advice
People with bipolar disorder often don't recognize how impaired they are when
experiencing a mood episode and how greatly the disorder is affecting their
lives and the lives of others. Friends, family and primary care physicians are
important in recognizing possible signs of bipolar disorder and urging the
person to seek professional help.
If a family member or friend shows the apparent signs of bipolar disorder,
encourage that person to seek the care of a psychiatrist.
Screening and Diagnosis
Your doctor may ask you or a family member who has accompanied you about your
signs and symptoms and to describe apparent episodes of mania and depression.
Diagnosis also involves ruling out other mental health conditions that may
produce some symptoms similar to bipolar disorder. These may include other mood
disorders, sometimes schizophrenia, attention-deficit/hyperactivity disorder or
borderline personality disorder.
You may also undergo tests to see if your mood swings are due to physical
causes, such as:
Substance abuse. Abuse of alcohol, marijuana and cocaine may affect your moods.
Thyroid disorders. A blood test for thyroid function can determine whether you
have a thyroid disorder, such as an under active thyroid.
Your doctor may also ask about your use of medications, alcohol and recreational
drugs, and your diet. Certain medications including corticosteroids, such as
prednisone, and medications used to treat depression, anxiety and Parkinson's
disease can cause mood swings. Abuse of alcohol and recreational drugs also can
cause mood swings. As well, deficiency of vitamin B-12 may alter moods.
Complications
Bipolar disorder isn't as black-and-white as it may sound.
Other problems, such as anxiety disorder or alcoholism, may affect people with
bipolar disorder. The length, severity and frequency of mood swings vary from
person to person. In about 15 percent of people with bipolar disorder, there is
rapid cycling, with more frequent and shorter periods of mood disturbance.
It's also possible for mania and depression to be present at the same time. In
this mixed state, you may experience combinations of agitation, disturbances in
sleep and appetite, suicidal thoughts and psychosis. Psychosis is a major mental
disorder in which the personality is disorganized and contact with reality is
impaired, often including auditory hallucinations and delusions — firmly held
erroneous beliefs
Treatment
Medication and psychotherapy are the main treatments. Occasionally,
electroconvulsive therapy (ECT) also is used.
Medication.
Most people
with bipolar disorder take medication to regulate their moods. Lithium
(Eskalith, Lithobid) has been widely used as a mood stabilizer. In April 2002,
the American Psychiatric Association suggested using lithium or lamotrigine
(Lamictal) as first-line treatment for people in the acute depressive phase of
bipolar disorder who were not already on a mood stabilizer medication. Also used
widely as a mood regulator are the antiseizure medications valproic acid
(Depakene) and divalproex (Depakote). Sometimes, doctors also use antidepressant
medications to treat bipolar disorder. These may include paroxetine (Paxil),
fluoxetine (Prozac, Sarafem), sertraline (Zoloft) or bupropion (Wellbutrin,
Zyban), among others. In other circumstances, doctors may use antipsychotic
medications such as risperidone (Risperdal), olanzapine (Zyprexa) or quetiapine
(Seroquel), among others. You may need to take medications for several weeks
before they reach their full effect.
Psychotherapy.
This approach
is often used with medication. Your therapist will help you detect patterns
leading up to episodes of bipolar disorder, trying to identify triggers for the
episodes. These patterns might include your use of medications or anything that
happens to you physically or emotionally. Psychotherapy helps provide strategies
for managing stress and coping with uncertainties. This, along with basic
education about the nature of the disorder, helps you understand why you may
well need to keep taking medication over many years.
ECT.
Doctors use this form of treatment mainly for episodes of major depression
associated with suicidal tendencies or when using medication has proved to be
ineffective. In this treatment, electrodes are taped to your head. Then, while
you're anesthetized and after you've received a muscle relaxant, a small amount
of electrical current is passed through your brain for less than a second. This
current produces a brain seizure, but because of the muscle relaxant your body
remains calm. ECT profoundly affects brain metabolism and blood flow to various
areas of the brain. But how that correlates to easing depression remains
unknown. ECT works quickly — usually showing a response after several
treatments, generally within the first week — and significantly lowers the risks
of untreated depression, including suicide.
Self-Care
Bipolar disorder isn't an illness that you can treat on your own. But you can do
some things for yourself that will bolster your treatment program:
Take your medications. Even if you're feeling well, resist the temptation not to
take your medications. If you stop, you may again encounter signs and symptoms
of bipolar disorder.
Pay attention to warning signs. You and your caregivers may have identified a
pattern to your episodes of bipolar disorder and what triggers them. Call your
doctor if you feel you're facing an episode. Involve family members or friends
in watching for warning signs.
Avoid drugs and alcohol. Drugs, especially stimulants including diet drugs, and
alcohol may be part of what triggers episodes of bipolar disorder.
Check first before taking other medications. Call the doctor who's treating you
for bipolar disorder before you take medications prescribed by another doctor.
Sometimes other medications trigger episodes of bipolar disorder or may interact
with medications you're taking for bipolar disorder.
Coping Skills
Self-help organizations have become potent allies for people who are coping with
mental illness or who care about someone with such an illness. For bipolar
disorder or other mental illnesses, self-help groups include the National Mental
Health Association (NMHA) and the National Alliance for the Mentally Ill (NAMI).
The NMHA is based in Washington, D.C., and has hundreds of affiliates across the
United States. The group educates the public and the policy makers about mental
health issues. The association's online resources include discussion groups and
screening for depression.
The NAMI provides support and education to people with severe mental illness and
their families. Founded in 1979, the group has more than 1,200 state and local
chapters. The chapters rely on volunteers, most of whom have had mental illness
in their families.