Showing posts with label Bipolar disorder. Show all posts
Showing posts with label Bipolar disorder. Show all posts
Bipolar Disorder Brain - What Changes Does Manic Depression Cause in the Brain?
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With modern day brain imaging, it becomes clear that bipolar is not a disorder, but a brain illness, as real as cancer or a cold. While science is nonetheless investigating the differences between the brain of a regular individual and the brain of a bipolar individual here are four differences in between the two.
1.) Ventral Striatum
The ventral striatum permits the brain to procedure rewards, such as feeling pleased after consuming or having sex. If a person suffers from bipolar, this component will be overactive and have a 30% loss in the amount of gray matter.
The ventral striatum also aids in judgment, such as what is regarded as typical or moral. Because bipolar persons suffer a reduction in this portion of the brain, they will be prone to overspending or sexual promiscuity, in particular when manic.
two.) Prefrontal Cortex
The prefrontal cortex allows the brain to approach and regulation emotion, an critical component of impulse control. For example, when 1 feels angry, they don't go out and hit the 1st individual they see.
In those with bipolar disorder, there is a 20% to 40% reduction in gray matter material in the prefrontal cortex, causing rash behavior and anger control issues.
3.) Amygdala
The amygdala controls facial expressions and tones of voice. For example, if you see a person you like on the method, neural transmissions will occur in your brain, telling you to smile. In the bipolar brain, there is a loss of gray matter in this region, causing a delay reaction in facial expressions.
four.) Hippocampus
In those with bipolar disorder, the hippocampus has lost branches that connect neurons, leading to a loss of an capability to tell the difference in between danger and reward, causing a state of anxiety.
Manic Depression - How to Recognize it?
manic depression is a common psychiatric disorder in the modern world. This causes a number of major changes and disturbances in the physical health and lifestyle people. Manic depression is more popularly known as bipolar disorder.
mood is very common characteristic of people suffering from bipolar disorder. People with bipolar disorder can be sad and hopeless, but sometimes at the top of the world. The mood swings of bipolar disorder between 2 people of the opposite sex -. Extreme happiness and extreme sadness
people with bipolar disorder typically face a mixed state. This means that they can confront the symptoms of both mania and depression. Manic depression is manifested by cycles of mood swings. Between these cycles affected person lead a normal life. Manic depression can lead to financial, marital and family problems. It can generate suicidal thoughts too. It can also lead to aggressive behavior in a person. In order to treat his problem some people turn to drugs and alcohol.
General signs of manic depression begin to emerge in the late twenties. That is why sometimes it is considered as normal behavior for teenagers. At the age of 25-40, the symptoms become apparent and can be easily identified.
there is no racial boundaries for this disease. Both men and women can suffer from depression. Depression is a long-term illness. But it can be treated with early diagnosis and appropriate treatment.
If you or your loved one has passed through some of the above symptoms, then it's a smart idea to visit a psychiatrist as soon as possible.
Depression self-evaluation – Goldberg Depression Scale
Instructions
You might reproduce this scale and use it on a weekly basis to track your moods. It also might be used to show your doctor how your symptoms have changed from one visit to the next. Changes of five or more points are significant. This scale is not designed to make a diagnosis of depression or take the place of a professional diagnosis. If you suspect that you are depressed, please consult a mental health professional as soon as possible.
The 18 items below refer to how you have felt and behaved during the past week. For each item, indicate the extent to which it is true, by checking the appropriate response next to the item.
Responses:
- Not at all (0)
- A little (1)
- Somewhat (2)
- Moderately (3)
- Quite a lot (4)
- Very much (5)
Questionnaire
1. I do things slowly.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
2. My future seems hopeless.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
3. It is hard for me to concentrate on reading.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
4. The pleasure and joy has gone out of my life.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
5. I have difficulty making decisions.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
6. I have lost interest in aspects of life that used to be important to me.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
7. I feel sad, blue, and unhappy.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
8. I am agitated and keep moving around.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
9. I feel fatigued.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
10. It takes great effort for me to do simple things.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
11. I feel that I am a guilty person who deserves to be punished.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
12. I feel like a failure.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
13. I feel lifeless -- more dead than alive.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
14. My sleep has been disturbed -- too little, too much, or broken sleep.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
15. I spend time thinking about HOW I might kill myself.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
16. I feel trapped or caught.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
17. I feel depressed even when good things happen to me.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
18. Without trying to diet, I have lost, or gained, weight.
- Not at all
- Just a little
- Somewhat
- Moderately
- Quite a lot
- Very much
Scoring
- If you score points was less than 9 then depression is not indicated.
- Between 10 and 17 – perhaps some slight depression.
- Between 18 and 21 – perhaps the brink of depression.
- Between 22 and 35 – less than indicated moderate depression.
- Between 36 and 53 – moderate to severe depression can be.
- Over 54 – maybe suffering from severe depression.
About Developer
Ivan K. Goldberg, M.D specializes in the treatment of individuals with treatment-resistant depression. The founder of Depression Central , he is a psychiatrist and clinical psycho-pharmacologist in private practice in New York City. Formerly on the staff of the National Institute of Mental Health and the Departments of Psychiatry of the Columbia- Presbyterian Medical Center, and Columbia University's College of Physicians and Surgeons, he now devotes his time to evaluating and providing advanced innovative treatment for individuals whose depression or bipolar disorder has not responded to standard drug treatments.
Sources and Additional Information:
Sleep Deprivation as Cure for Depression
History of Approach
Nearly 30 years have passed since Anna Wirz-Justice, MD, first prescribed a night without sleep for a severely depressed 80-year-old woman. "She used to just sit around all day, feeling suicidal," says the Swiss neurobiologist. "She hardly spoke or moved.''
The remedy worked. By the next morning, the elderly woman "was talking and moving around as if she were actually another person," Wirz-Justice says. "She told me that at about two or three in the morning, she felt like a black cloud had been lifted from her shoulders."
Was Wirz-Justice on to something? She and other researchers thought so -- at first. There is no denying that sleep deprivation temporarily eases depression. Up to 60% of depressed people will show a 30% improvement after just one night awake, according to a review article published in the January 1990 issue of the American Journal of Psychiatry. People who feel the most depressed in the morning and improve later in the day seem to benefit the most from a night without sleep.
But there was a problem: Patients tended to relapse into depression as soon as they did get a good night's sleep. Moreover, habitual sleep deprivation may be linked to long-term health problems such as high blood pressure and diabetes. The challenge then became to find a way of relieving depression by tinkering with sleep-wake cycles.
Does it Work?
If a depressed mother stays up all night, or even the last half of the night, it is likely that by morning the depression will lift. Although this sounds too good to be true, it has been well documented in over 1,700 patients in more than 75 published papers during the last 40 years. Sleep deprivation used as a treatment for depression is efficacious and robust: it works quickly, is relatively easy to administer, inexpensive, relatively safe and it also alleviates other types of clinical depression. Sleep deprivation can elevate your mood even if you are not depressed, and can induce euphoria. This throws a new light on insomnia.
This remarkable result is not well known outside a small circle of sleep researchers for three good reasons. First, sleep deprivation is not as convenient as taking a pill. Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making. Finally, depression recurs after the patient, inevitably, succumbs to sleep, even for a short nap. Nonetheless this is an incredibly important observation; it shows that depression can be rapidly reversed and suggests that something is happening in the sleeping brain to bring on episodes of depression. All this offers hope that studying sleep deprivation may lead to new, unique and rapid treatments for depression.
This remarkable result is not well known outside a small circle of sleep researchers for three good reasons. First, sleep deprivation is not as convenient as taking a pill. Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making. Finally, depression recurs after the patient, inevitably, succumbs to sleep, even for a short nap. Nonetheless this is an incredibly important observation; it shows that depression can be rapidly reversed and suggests that something is happening in the sleeping brain to bring on episodes of depression. All this offers hope that studying sleep deprivation may lead to new, unique and rapid treatments for depression.
How does it Work?
Neuroscientists have been trying to solve this puzzle. The first hint of what may be happening during sleep came from J. Christian Gillin, at the University of California at San Diego. Using imaging, he found that a small area of the cerebral cortex in the front of the brain — the anterior cingulate cortex — which was consistently overactive in depressed patients, quieted to normal levels of activity after the patients were deprived of sleep. And when the patients were allowed to sleep, the activity in this area returned to the elevated levels.
Helen Mayberg at Emory University has shown that electrical stimulation of the anterior cingulate cortex, which disrupts normal activity, also reduces depression. Some patients reported feeling immediate relief and calm after the procedure.
This tells us where in the cortex to look, but we also need to understand the changes that occur in the cortex during sleep. As you fall asleep, neurons in the brain stem that project throughout the cortex and keep it activated stop firing. The reduced stimulation from the brain stem disconnects the cortex from sensory input and there is a major shift in the pattern of electrical activity in the cortex. During the early part of the night the cortex is in a state of slow-wave sleep punctuated by brief periods of rapid-eye movement sleep (REM), which become more frequent and longer lasting toward early morning.
One major class of antidepressants, tricyclics, blocks REM sleep, which suggests that sleep deprivation may work against depression the same way. This is consistent with the tendency for depressed individuals to sleep longer than they do when they feel normal. Additional support for this hypothesis comes from genetic studies of families with short REM latency — the tendency to enter REM early in the sleep cycle. This condition disrupts slow wave sleep and extends REM sleep. The risk of depression is much greater if you come from a family with this genetic background. While this is a rare genetic defect that can only account for a small fraction of all depressed patients, these special cases give us valuable clues to conditions that predispose some people to clinical depression.
Power of Hormones
Today, researchers are experimenting with ways to make use of the body's biological clock -- its circadian, or 24-hour, rhythms -- without asking patients to abandon rest altogether. The solution may lie in timing sleep to benefit from certain hormones that ebb and flow throughout the day.
For instance, thyroid stimulating hormone (TSH) helps control our metabolism and, indirectly, our levels of energy. An estimated 25% to 35% of depressed patients have low TSH levels. In recent years, researchers at the National Institute of Mental Health have found that sleep inhibits the release of TSH, while staying awake through the night and the early morning hours boosts it.
Some researchers are trying to manipulate the body's hormonal tides by having patients stay awake through the early morning hours for about a week. Doctors at the University Hospital of Freiburg in Germany tried this experiment on a group of depressed patients who felt better after one night without sleep: They told the patients to go to sleep at 5 p.m. that evening and rest until midnight the next night -- a total of 31 hours. Then the patients gradually eased back to a normal sleep cycle over the course of the week. One night they slept from 6 p.m. until 2 a.m., the following night from 7 p.m. until 3 a.m., until finally they returned to an 11 p.m. to 6 a.m. sleep cycle. Remarkably, the majority -- 75% -- didn't relapse into depression, according to results published last fall in the European Archives of Psychiatry and Clinical Neuroscience.
Methods
There are two methods of using sleep deprivation as a treatment for depression: total or partial deprivation.
Partial deprivation - sleeping the first half of the night only, and waking up halfway through - proved more effective than going to sleep later, or sleeping only the second half of the night. It is thought that partial sleep deprivation, sleeping up to 4 hours a night, will have the same antidepressant benefits as total sleep deprivation. Whereas with total sleep deprivation, the benefits are felt the following day, but are not long-lasting, sleeping four hours can be done continuously, over several days or even weeks, so naturally the benefits here are superior.
Even in patients with bipolar disorder can benefit. Research shows patients with bipolar disorder after sleep deprivation, are pulled from their depressed state to manic state. Manic states can cause sleep deprivation, lasting weeks and even months, so the cycle continues. The patient feels great, lighter in mood, and feel no need for sleep. Of course one should limit this, because of other health risks in prolonged sleep deprivation. Partial deprivation, up to 4 hours sleep is definitely the way to go for long-term treatment.
The ideal way to try for yourself, seems to be to stay awake a full night the first night, then limit yourself to 4 hours a night after that. Try this for a week or two, and see how you feel. I think in most cases, you will have positive results.
If you know someone suffering with severe depression, who barely has energy to talk to you, and no matter how you try to animate them, you have no success, try visiting them in the evening and keeping them awake all night. You will find the next morning their mood will be elevated, they will be more lucid and talkative, and more likely to want to move around and do things. Try then to convince them to use an alarm clock and wake themselves up after only four hours, they'll see for themselves how much better they feel.
The optimum time for sleep appears in some studies, to be from 10pm-2am, 11pm-3am, or12-4 am, underlining the fact that sleeping only the first half of the night provides the best results. In other reports, however, 2-6am 3-7am was optimal. It would depend presumably on your normal bedtime.
Sleep deprivation treatment was popular in the 1970s, but with the discovery of new and effective antidepressant medications, it was soon deemed old-fashioned and unhelpful. Nowadays doctors are reconsidering and endorsing this treatment, finding it helpful even alongside these medications, as the body seemed to accept medication more easily. Many psychiatrists were convinced by remarkable transformations of severely depressed, psychotic and even suicidal patients, back to relative normality after only a few hours. Antidepressant medication alongside sleep deprivation, has proven to help prevent relapse into the depressed state, although these studies are still ongoing.
But Is It Practical?
Doctors admit that sleep deprivation regimen is tough to follow. Patients should probably try such sleep manipulation only under supervision and perhaps in a group to make the experience more enjoyable, says Edward DeMet, PhD, who studies sleep deprivation at the Veterans Affairs Medical Center in Long Beach. "Obviously, if you need to be driving the next day, you shouldn't do this," he says.
There are other ways to manipulate sleep to improve depressive symptoms. For instance, patients who go one night without sleep and who are exposed to bright light in the morning appear to prolong the emotional benefits of that sleepless night. People who try sleep deprivation while taking antidepressant medicine are also less likely to relapse, according to a study by Wirz-Justice and colleagues published in the August 1999 issue of the journal Biological Psychiatry.
Because antidepressants such as Prozac or lithium often take weeks to work, sleep deprivation may be most useful as a temporary tool that gives people a lift before the drugs take effect.
"It's much easier to pop a pill in the morning than stay up all night," says Wirz-Justice, a professor at the Psychiatric University Clinic's Chronobiology and Sleep Laboratory in Basel, Switzerland. "But sleep deprivation is very cheap and it's very fast. For patients who are severely depressed, the experience for that one day lets them know it's possible to get better. They finally have hope."
Sources and Additional Information:
Cyclothymia (cyclothymic disorder)
Cyclothymia (si-kloh-THIGH-me-uh), also called cyclothymic disorder, is a mild form of bipolar disorder. Like bipolar disorder, cyclothymia is a chronic mood disorder that causes emotional ups and downs.
With cyclothymia, you experience periods when your mood noticeably fluctuates from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat blue. Between these cyclothymic highs and lows, you may feel stable and fine.
Compared with bipolar disorder, the highs and lows of cyclothymia are less extreme. Still, it's critical to seek help managing these symptoms because they increase your risk of bipolar disorder. Treatment options for cyclothymia include psychotherapy, medications, and — most important — close, ongoing follow-up with your doctor.
Symptoms
Cyclothymia symptoms include an alternating pattern of emotional highs and lows. The highs of cyclothymia are characterized hypomanic symptoms, which resemble those of mania, but are less severe. The lows consist of mild or moderate depressive symptoms.
Cyclothymia symptoms are generally similar to those of bipolar disorder, but they're less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you're going to feel — and you can't just will yourself to live life on an even keel.
Hypomanic phase of cyclothymic disorder
Signs and symptoms of hypomanic episodes of cyclothymia may include:
Signs and symptoms of hypomanic episodes of cyclothymia may include:
- Unusually good mood or cheerfulness (euphoria)
- Extreme optimism
- Inflated self-esteem
- Poor judgment
- Rapid speech
- Racing thoughts
- Aggressive or hostile behavior
- Being inconsiderate of others
- Agitation
- Increased physical activity
- Risky behavior
- Spending sprees
- Increased drive to perform or achieve goals
- Increased sexual drive
- Decreased need for sleep
- Tendency to be easily distracted
- Inability to concentrate
Depressive phase of cyclothymic disorder
Signs and symptoms of depressive episodes of cyclothymia may include:
Signs and symptoms of depressive episodes of cyclothymia may include:
- Sadness
- Hopelessness
- Suicidal thoughts or behavior
- Anxiety
- Guilt
- Sleep problems
- Appetite problems
- Fatigue
- Loss of interest in daily activities
- Decreased sex drive
- Problems concentrating
- Irritability
- Chronic pain without a known cause
When to see a doctor
If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymic disorder generally doesn't get better on its own. If you're not sure where to start with treatment, see your primary health care provider. He or she may refer you to a mental health provider with experience in cyclothymia or bipolar disorder.
If you have any symptoms of cyclothymia, seek medical help as soon as possible. Cyclothymic disorder generally doesn't get better on its own. If you're not sure where to start with treatment, see your primary health care provider. He or she may refer you to a mental health provider with experience in cyclothymia or bipolar disorder.
If you're reluctant to seek treatment, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader, or someone else you trust. He or she can help you take the first steps to successful treatment.
If you have a loved one you think may have symptoms of cyclothymia, have an open and honest discussion about your concerns. You can't force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.
Suicidal thoughts
If you're considering suicide right now, call 911 or your local emergency services number. If you just can't make that call, pick up the phone and reach out to someone else — immediately:
If you're considering suicide right now, call 911 or your local emergency services number. If you just can't make that call, pick up the phone and reach out to someone else — immediately:
- Contact a family member or friend.
- Contact a doctor, mental health provider or other health care professional.
- Contact a minister, spiritual leader or someone in your faith community.
- Go to your local hospital emergency room.
- Call a crisis center or hot line.
If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.
Diagnostic Criteria
Diagnostic criteria are as follows:
- Symptoms present for at least 2 years, the patient has had periods of hypomanic symptoms and periods of low mood that don't fulfill the criteria for Major Depressive Disorder.
- The longest period the patient has been free of mood swings is 2 months.
- During the first 2 years of this disorder, the patient has not fulfilled criteria for Manic, Mixed, or Major Depressive Episode.
- Schizoaffective disorder doesn't explain the disorder better, and it isn't superimposed on Schizophrenia, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.
- The symptoms are not directly caused by a general medical condition or the use of any substances, including prescription medications.
- These symptoms cause the patient clinically important distress or impair work, social or personal functioning.
Causes
It's not known specifically what causes cyclothymia. As with many mental disorders, research shows that it may result from a combination of:
- Heredity — cyclothymia tends to run in families. One is 2-3 times more likely to have the disorder if someone in the immediate family has it or if an identical twin has it. In a study by Bertelsen, Harvard, and Huage (1977), if an identical twin had depression, 59% of the identical twins had it also. Heritability for women ranges from 36-44%; for men, 18-24%.
- Your body's biochemical processes, such as changes in brain chemistry. Serotonin: Serotonin regulates other hormones like norepinephrine and dopamine, so when serotonin is low, the other chemicals may fluctuate, causing irritability, impulsivity and mood irregularities such as dysthymia and depression. Cortisol: Depressed individuals can have high cortisol levels. Cortisol is a stress hormone, and mood disorders often occur during stressful points in one’s life. Elevated stress hormones can affect functioning of the hippocampus, an important centre for memory and cognitive processes. Overproducing cortisol can also impair the brain’s ability to regenerate neurons in the hippocampus.
- Environment and stressful events, as perceived by the individual. Job loss, relationship failure, identity change, natural disaster, learned helplessness and hopelessness, extreme feelings, negative thinking patterns.
- Parenting styles.
Risk factors
Cyclothymia is thought to be relatively rare. But true estimates are hard to pin down because people may be undiagnosed or misdiagnosed as having other mood disorders, such as depression.
Cyclothymia typically starts during adolescence or young adulthood. The condition affects about the same number of men and women.
Tests & diagnosis
The person's own description of the behavior usually leads to diagnosis of the disorder.
Prognosis
This disorder usually has an insidious onset in adolescence or early adult life. It often develops with prolonged periods of cyclical, often unpredictable mood changes (e.g., the person may be regarded as temperamental, moody, unpredictable, inconsistent, or unreliable). This disorder usually has a chronic course, and has a 15%-50% risk that the person will eventually develop Bipolar I or II Disorder.
Most people do not need long-term therapy.
Treatment
The most important first step in the treatment of this disorder is to prevent alcohol or illicit drug abuse. Medication often is ineffective when the individual is still abusing alcohol or illicit drugs.
A combination of antimanic drugs, antidepressants, or psychotherapy are used to treat cyclothymic disorder. Medications used to treat this condition are called mood stabilizers.
- Lithium. Lithium has been used for years in patients with bipolar disorder, and it may also help patients with cyclothymic disorder.
- Antiseizure drugs. Valproic acid (Valproate), carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine (Lamictal) are the most established antiseizure drugs. Other antiseizure drugs used for bipolar disorders include gabapentin (Neurontin), zonisamide (Zonegran), and topiramate (Topamax).
- Antipsychotics.
- Antidepressants are not recommended because they can trigger a manic episode.
It has been repeatedly demonstrated that physical exercise can help with mood regulation and emotional stability
Patients may not respond to medications as strongly as do patients with bipolar disorder.
Sources and Additional Information:
Can your Medicines Cause Depression?
There are multiple scientific studies, more or less substantial, providing data that certain medicine might trigger or influence in certain way the depression.
Some medications prescribed for various medical conditions do cause such feelings as sadness, despair, and discouragement. And those are feelings that are often associated with depression. Other medicines prescribed for medical problems can trigger mania (excessive elation and joy). That's usually associated with bipolar disorder. There are also many psychiatric medications which paradoxically might actually make depression, patient suffers from, worse. These include highly sedating medications such as antianxiety medications or antipsychotic medications and certain mood stabilizers, which not only are sedating, but can slow down thinking processes and lead people to feel more withdrawn and less motivated to go about their daily activities.
Medications that cause mania or depression appear to alter brain chemicals in some way. And even though the medications may be necessary to treat the condition, the side effect appearance might be unacceptable for the patents.
There are just examples of certain medications that can cause symptoms of depression Note that for some medications the various researches might present different, sometimes completely opposite results, but nevertheless you should be aware on the potential negative effects to be sensitive to your mental condition changes, while you take them. You should understand that every individual reaction might be completely different on the taken drugs, and in some cases not an individual medication make the difference, but combination of various prescribed medications causing the cumulative effect on your well-being.
So, be aware on the following drugs to be considered as might be causing the depression in adults:
- Accutane, which is prescribed for the treatment of acne, has been suspected to cause depression.
- Antihypertensives, such as clonidine (Catapres).
- Barbiturates, such as phenobarbital, pentobarbital (Nembutal), and secobarbital (Seconal).
- Benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), or lorazepam (Ativan).
- Calcium channel blockers, such as verapamil (Calan).
- Corticosteroids, such as prednisone.
- Hormonal medications, such as birth control pills (oral contraceptives) and hormone therapy used to treat the symptoms of menopause.
- Medications used to treat Parkinson's disease or other neurological disorders, such as restless legs syndrome.
- Medications used to treat seizures, such as phenytoin (Dilantin).
- Pain medications, such as meperidine (Demerol) or codeine.
Symptoms of depression can also be caused by the use of or withdrawal from alcohol and illegal drugs, such as cocaine, amphetamines (methamphetamines, crystal meth, or crack), heroin, and cannabis (marijuana).
Sources and Additional Information:
Genetic Causes of Depression
It has long been known that depressive illnesses can run in families, but until fairly recently it was not fully known whether people inherited a susceptibility to these illnesses or if something else such as the environment was the true culprit. Those who research depression have been able to determine that to some extent depressive illnesses can be inherited. What appears to be inherited is a vulnerability to depression. This means that if we have close relatives who have clinical depression, we may inherit a tendency to develop the illness. It does not mean that we are destined to become depressed.
Genes that we inherit from our parents determine many things about us such as our gender and the color of our eyes and hair. Our genes also determine which illnesses we may be vulnerable to at some point in our lives. Every cell in the human body contains somewhere between 50,000 and 100,000 genes. They are all made up of something called deoxyribonucleic acid, or DNA. Genes are located on chromosomes within the nucleus of each cell. All of the cells in the body, except sex cells, contain 46 chromosomes, and genes are typically located in a specific place on a particular chromosome. Except for identical twins, no two people in the world have the exact same genetic makeup.
Research on the heredity of depression within families shows that some individuals are more likely to develop the illness than others. If you have a parent or sibling that has had major depression, you may be 1.5 to 3 times more likely to develop the condition than those who do not have a close relative with the condition. You would also have a higher chance of developing bipolar disorder. Because close relatives of those with clinical depression have such a vulnerability to developing the condition themselves strongly suggests that it can be an inherited illness.
Bipolar disorder has a strong genetic influence. Of those with bipolar disorder, approximately 50% of them have a parent with a history of clinical depression. When a mother or father has bipolar disorder, their child will have a 25% chance of developing some type of clinical depression. If both parents have bipolar disorder, the chance of their child also developing bipolar disorder is between 50% and 75%. Brothers and sisters of those with bipolar disorder may be 8 to 18 times more likely to develop bipolar disorder, and 2 to 10 times more likely to develop major depressive disorder than others with no such siblings.
Twin Studies
Much of what we know about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins are very helpful to researchers since they both have the exact same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence. If it happened that when one twin becomes clinically depressed the other always develops depression, then clinical depression would likely be entirely genetic.
However because the rate of both identical twins developing depression is not closer to 100% this tells us that there are other things that influence a person's vulnerability to depression. These may include environmental factors such as childhood experiences, current stressors, traumatic events, exposure to substances, medical illnesses, etc.
However because the rate of both identical twins developing depression is not closer to 100% this tells us that there are other things that influence a person's vulnerability to depression. These may include environmental factors such as childhood experiences, current stressors, traumatic events, exposure to substances, medical illnesses, etc.
Research has also been done with fraternal twins. Unlike identical twins who have the same genetic code, these siblings share only about 50% of their genetic makeup and do not necessarily look alike. Studies have shown that when one fraternal twin becomes depressed, the other also develops depression about 19% of the time. This is still a higher rate of depression when compared to overall rates for the general public, again pointing towards a genetic influence in the development of clinical depression.
A Gene for Depression?
Research on the genetic causes of clinical depression has attempted to identify one or more specific genes that may lead to the development of a depressive illness. Although there have been a number of studies that appear to name a particular gene as the culprit there has been little consistency among their results. However, the outcome of some research has suggested that there may be specific genes that cause clinical depression to develop within certain families and not in others.
At this time there is much that we do not know about how genes may predispose a person to a depressive illness. Research has yet to identify a clear link between a specific gene and a vulnerability to depression in everyone. Rather than the possibility of only a single gene being responsible for the development of clinical depression, it appears to be more likely that a number of genes acting together may cause a person to become vulnerable to depression.
Just because a person inherits a gene that predisposes him or her to a depressive illness, it does not mean that he or she is destined to develop major depression or bipolar disorder. It is believed that a genetic influence is only partially responsible for causing depression. Other factors may also play a role.
Testing for Genetic Disposition to Depression
The team, based at the Neuroscience and Psychiatry Unit (NPU), in the Faculty of Medical and Human Sciences, has set up a website (www.newmood.co.uk) where would-be volunteers can see how prone they may be to depression by identifying the emotions on people's faces and taking a gambling test.
The team aims to recruit more than 1000 UK
Professor Bill Deakin explains: "Anxiety is a contagious emotion. When you see other people who are anxious, as a primate you feel anxious as well. Our brains are wired to see anxiety - it makes sure we are safe. This is a fascinating test and, during further testing, we will be able to see which parts of the brain light up, or work harder, when you see a fearful face. Depressed people are more likely to see sadness or fear in a neutral face.
"The gambling test, where volunteers choose from pairs of spinners to 'win' money, will show us which parts of the brain light up when you are working for a reward. Depressed people are less affected by reward and more likely to give up easily as the test goes on."
Volunteers for this research study will be asked to fill in a confidential questionnaire and provide a mouth swab for genetic analysis. The team will then compare the DNA with the questionnaire group data.
In the other EU NewMood centres, rats and mice are also being tested for their predisposition to depression using similar reward and anxiety measures. When offered sweet-tasting drinks, depressed animals show no preference, much as humans lose pleasure in eating and often lose weight when they are depressed. And when given the opportunity to explore a new location depressed animals are more wary and take longer to emerge from dark corners, much as depressed humans avoid social situations.
"All humans have the same genes and they are very similar to those in all mammals - we turn out differently from each other because we inherit different versions of the same genes which can vary in their activity" Professor Deakin says. "We can see what genetic traits towards depression these animals have, then compare them with the same genes in the human DNA.
"Depression is a common trait like height or body build and, just like those, we suspect there are lots of genes involved. By measuring the important possible factors that can lead to a tendency to depression across a large number of individual people, we hope to find which ones act together to cause depression. Ultimately, this will help us to develop new ways of preventing and treating this illness."
Recent Studies – Genetic Link Discovery (Chromosome 15)
Researchers announce progress has been made on discovering why some people appear to be genetically predisposed to developing severe depression. A region on one chromosome appears to offer significant promise.
The research is lead by Douglas Levinson, MD, professor of psychiatry and behavioral sciences at the Stanford University School of Medicine.
“This finding has a very good chance of leading to a discovery of a gene that could yield important information about why some people develop depression,” said Levinson.
If problematic genetic variations could be identified, it would open the door to a whole new world of investigation, and eventually, treatment possibilities.
The team’s results are reported in two papers that will be published in the February issue of the American Journal of Psychiatry.
Levinson’s group, comprising researchers from six universities, achieved this breakthrough by studying 650 families in which at least two members suffered from repeated bouts of severe depression that began in childhood or early adult life.
The first of the studies was a genome-wide scan that looked for evidence of genetic “linkage” within families between depression and DNA markers on the various chromosomes. The linkage study identified regions worthy of more intensive examination.
The second study was a more detailed look at the most suspicious of these regions, located on chromosome 15. Levinson said the team studied six DNA markers in this region in the first study, and an additional 88 in the second.
“We found highly significant evidence for linkage to depression in this particular part of chromosome 15,” he said. “This is one of the strongest genetic linkage findings for depression so far.”
“It’s an important paper,” said Peter McGuffin, MD, dean of the Institute of Psychiatry at King’s College in London
Researchers learned that depression is influenced by genetics by studying patterns of depression in twins and families. No single gene is thought responsible for determining the risk for developing depression.
Instead, multiple genes are probably interacting to create what amounts to a genetic baseline level of risk. On top of that baseline, environmental factors are likely mixed in as well, things such as non-genetic physiological problems or psychological traumas.
Some 10 to 15 percent of people suffer from severe depression at some point in their lives, and 3 to 5 percent have it more than once. Women are twice as likely to develop depression as men, although the reason is not yet known.
“We don’t think depression is entirely genetic, by any means, but there are important genetic factors,” said Levinson.
“If we can succeed in finding one or more genes in which there are specific DNA sequence variations that affect one’s risk of depression, then we would be able to understand what type of gene is it, what it does in the brain and by what mechanism it could make one more or less predisposed to depression.”
Knowing more about which genes are the major factors causing a predisposition for depression would also help researchers sort out the environmental factors that contribute to depression, Levinson said.
And knowing more about either genetic or environmental factors could help in developing more effective therapies to treat depression. “The treatments we have now are lifesavers for some people, but there are others who have only a partial response or no response at all,” he said.
“Understanding the biology would help the search for better treatments.”
Recent Studies – Genetic Link Discovery (Chromosome 12)
The mutant gene codes for the brain enzyme, tryptophan hydroxylase-2, that makes serotonin, and results in 80 percent less of the neurotransmitter. It was carried by nine of 87 depressed patients, three of 219 healthy controls and none of 60 bipolar disorder patients. Drs. Marc Caron, Xiaodong Zhang and colleagues at Duke Unversity announced their findings in the January 2005 Neuron, published online in mid-December.
“If confirmed, this discovery could lead to a genetic test for vulnerability to depression and a way to predict which patients might respond best to serotonin-selective antidepressants,” noted NIMH Director Thomas Insel, M.D.
The Duke researchers had previously reported in the July 9, 2004 Science that some mice have a tiny, one-letter variation in the sequence of their tryptophan hydroxylase gene (Tph2) that results in 50-70 percent less serotonin. This suggested that such a variant gene might also exist in humans and might be involved in mood and anxiety disorders, which often respond to serotonin selective reuptake inhibitors (SSRIs) — antidepressants that block the re-absorption of serotonin, enhancing its availability to neurons.
In the current study, a similar variant culled from human subjects produced 80 percent less serotonin in cell cultures than the common version of the enzyme. More than 10 percent of the 87 patients with unipolar major depression carried the mutation, compared to only one percent of the 219 controls. Among the nine SSRI-resistant patient carriers, seven had a family history of mental illness or substance abuse, six had been suicidal and four had generalized anxiety.
Although they fell short of meeting criteria for major depression, the three control group carriers also had family histories of psychiatric problems and experienced mild depression and anxiety symptoms. This points up the complexity of these disorders, say the researchers. For example, major depression is thought to be 40-70 percent heritable, but likely involves an interaction of several genes with environmental events. Previous studies have linked depression with the same region of chromosome 12 where the tryptophan hydroxylase-2 gene is located. Whether the absence of the mutation among 60 patients with bipolar disorder proves to be evidence of a different underlying biology remains to be investigated in future studies.
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