Psychotic Major Depression Symptoms

What is Psychotic Major Depression? -

Its a subset of major depression, where the depression has a co-existing form of psychosis. Its defined as a flawed view of reality.

You may find that some of the symptoms of psychosis include delusions, visual hallucinations or auditory hallucinations.

Psychotic Depression Symptoms -

(1) He/She is concerned that something is terribly wrong with his or her body, will claim that something is wrong with his or her physical health.
(2) Paranoid delusions and delusions of guilt are the most common signs of this illness.
(3) Some of experience delusional guilt believe that they are being punished for past misdeeds.
(4) Word salad or meaningless speech
(5) Schizophrenia are loose associations, flight of ideas and echolalia which is repeating what others say.

Depression with Psychotic Features Treatments -

(1) There are a variety of different medications that are used to treat individuals that suffer from this severe form of depression.
(2) With perfect cures, patients can stabilize the varying moods that the individual experiences.
(3) The medications used for this form of depression include antidepressants, antipsychotic medications, and special neuroleptic medications.

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:

http://counsellingresource.com/quizzes/goldberg-depression/index.html

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=973&cn=5

http://depressioninfos.com/blog/tag/dr-ivan-goldberg/

http://www.psycom.net/ikg8.html

Agitated Depressive Disorder

Agitated Depression a state of clinical depression in which the person exhibits irritability and restlessness. This term is applied to depressive disorders in which agitation is prominent. Agitation occurs in many severe depressive disorders but in agitated depression, it is particularly severe. Agitated depression is seen more commonly among the middle aged and elderly than among younger patients. However, there is no reason to suppose that agitated depression differs in other impotent ways from the other depressive disorders.

Definition of Agitated Depression

A major depression with agitation that may be driven by hypomania.

Although many people experience symptoms such as feeling slowed down and lethargic when they are depressed, others may experience just the opposite. They may feel anger, agitation and irritability. This is what "agitated depression" refers to.

Agitated depression was once called melancholia agitata. It is now also known as mixed mania.

Agitation occurs in many severe depressive disorders, but in agitated depression it is particularly severe. There is no reason to suppose that agitated depression differs in other important respects from other depressive disorders.

Diagnostic Criteria for Agitated Depression

• Major Depressive Episode


• At least two of the following symptoms:


• Motor agitation


• Psychic agitation or intense inner tension


• Racing or crowded thoughts

Agitated depression meets the criteria for major depressive episode but not those of a mixed bipolar disorder according to the DSM-III-R.

Agitated Major Depressive Disorder Symptoms

It is not tough to identify the symptoms of agitated depression. People that suffer from this type of depression are not able to sit still and keep on restlessly moving here and there all the time. It is due to the outburst of emotional energy caused because of agitated depression. Those that suffer from this type of depression tend to complain a lot and develop the feelings of being misunderstood by others. At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode:

• Tearing of cloths

• Motor agitation

• Intense inner tension

• Racing thoughts

• Never ending baseless thoughts

• Continuous talking

• Hand wringing


• Pacing


• Pulling or rubbing on hair, skin, or clothing


• Outbursts of complaining or shouting


• Difficulty in explaining problem

Agitated depression in bipolar I disorder

The occurrence of agitated depression in bipolar I disorder is not rare and has significant prognostic and therapeutic implications. Whether the co-occurrence of a major depressive syndrome with one or two of these symptomatic clusters makes up a "mixed state" remains unclear.

Clinical Forms of Agitated Depression

1. Psychotic agitated depression
   
   Proposed name: Melancholia


2. Non-psychotic agitated depression
   
   Meets the RDC criteria


3. Excites anxious depression
   
   Provisional name: Psychic agitation and racing or crowded thoughts.

Complications for Agitated depression

The complications that have been mentioned in various sources for Agitated depression includes getting involved in risky activities, dysfunction in family and work, and even suicide or homicide.

Treatment

Agitated depression can be difficult to treat because the behavior patterns associated with this form of depression lend to the inability to consistently take medication. It is important to get properly diagnosed by a mental health care professional who can supervise your treatment closely. Psychotherapy is also useful in treating agitated depression. It is usually necessary to have long term treatment as a combination drug and psychotherapy. The drug therapy has to be fine tuned to your specific needs. This can take up to a month to see results and a cessation of side effects in most people but it is highly effective.

The common treatment approaches are:

1. Medicines - Antidepressants and anticonvulsant like divalproex, aripiprazole, clozapine or olanzapine is largely used in treatment of agitated depression.


2. Psychotherapy - In most of the cases psychotherapy is preferred to treat agitated depression.


3. Combination of medicines and psychotherapy - When drug therapy and psychotherapy is used in combination then effect is much better for curing agitated depression.


4. Electroconvulsive therapy - Electricity is passed to the brain through electrodes to overcome from agitated depression.

Sources and Additional Information:

http://www.depression-guide.com/agitated-depression.htm

http://www.happymoods.info/what-is-agitated-depression

http://www.survivingdepression.net/types/agitated.html

http://www.total-health-care.com/depression/agitated-depression.htm

http://www.wrongdiagnosis.com/a/agitated_depression/complic.htm

Computer-assisted psychotherapy (CAT) for depression

Introduction

Computer-assisted psychotherapy (CAT) for depression is developing rapidly. Several existing software programs can carry out many of the therapeutic tasks involved in depression treatment. Such programs help users to detail their problems, draw up a day-to-day treatment plan specific to their needs, rate their progress, practice coping with setbacks and do relapse prevention.  

1

The prospect of using computers to deliver psychotherapy has been intriguing a number of investigators who have been studying innovative methods of bringing technology into clinical practice. The most dramatic form of CAT is virtual reality exposure therapy in which patients are immersed in a virtual environment to help extinguish fears of flying, heights, social situations, or other anxiety-provoking situations. Other commonly used CAT methods are multimedia applications that use video, audio, and interactive exercises to convey therapy concepts and to build coping skills. Handheld devices encourage patients to monitor themselves and to use behavioral methods to manage symptoms.

Computer-assisted psychotherapy programs are often based on cognitive-behavioral therapy (CBT) what is then called computerized CBT (CCBT). Anxiety and other mental health disorders can also be treated with computer-assisted psychotherapy. 

Benefits and Challenges

An important argument for using computers in psychiatric treatment is the possibility that effective software could have a significant positive impact on cost and availability of mental health services.” It was noted that the number of patients with Axis I disorders who could benefit from psychotherapies with demonstrated effectiveness far outstrips the pool of available therapists. It has also been observed that many distressed individuals do not receive therapy for their disorders. For example, more than one-half of individuals with major depression do not enter treatment. Several possible impediments to receiving treatment have been described, including insufficient financial resources, negative attitudes about psychiatric illnesses, and lack of access to therapy.

If computer tools could be used to decrease the amount of therapist time required for successful treatment, more patients could be treated with available resources. Access to therapy could be influenced through

1) reduced cost of services,

2) provision of computerized therapy in settings outside the therapist’s office (home, school, or work), and

3) provision of alternative therapies that might reach individuals who do not seek treatment through ordinary channels.

It has been noted that some patients may find it more acceptable to work with a computer (or a computer assisted treatment program that combines computerized therapy with visits to a clinician) than engage in traditional clinician-administered.

The rationale for computer-assisted therapy also draws on the unique features of computers that could prove to be advantageous in treating psychiatric disorders. Potential strengths of computer-assisted therapy programs are listed below. One possible asset of computer programs may be an ability to engage patients in the treatment process. The predictions of traditional therapists that patients will refuse computer-assisted treatment or have a negative response to being referred to a “machine” have not been borne out by actual experiences. Patients typically enjoy working on computers and report that the experience is beneficial.  Newer programs have used features such as multimedia, virtual reality, interactive voice response, and portable palmtop computers to create stimulating and engaging therapeutic experiences.

Although some of the early investigations of computerized therapy focused on programs designed to substitute for clinician administered treatment, most contemporary research has been directed at finding ways in which computers can assist therapists or enhance the therapy process.  Instead of pitting machine against human therapist, these investigators have suggested that clinicians can learn to incorporate computer tools into their practices to improve the overall therapy experience.

So, computer-assisted therapy may offer a solution of providing cost-effective psychological services to individuals experiencing barriers to treatment. Although in computer-assisted psychotherapy a human touch is missing, computers have significant strengths that can be used to advantage in depression treatment:

• earlier access to treatment,


• more treatment time than clinicians can usually give,


• ease of treatment scheduling at home,


• lower treatment cost,


• confidentiality is greater and stigma avoided,


• consistency of treatment instructions is greater,


• self-help enhances a sense of control over one’s own destiny,


• built-in outcome measures and systematic feedback.

Clinical applications

Although currently available, CAT programs have been effective in research studies; they have limitations in clinical practice. CAT programs do not perform full psychiatric assessments, make diagnoses, or develop comprehensive treatment plans; nor do they screen for and manage impulsivity or other potentially dangerous behavior, such as suicidality. And, of course, they cannot display the empathic concern, wisdom, flexibility, and creativity of human therapists. Thus, in clinical applications, CAT programs appear to be best suited as components of an overall treatment strategy that is prescribed and guided by a professional.

CAT is just beginning to take hold in psychiatric practice. Although a vigorous effort is under way to produce and test programs for psychiatric treatment, and the use of computers in society is steadily increasing, most clinicians are either unfamiliar with CAT or have not yet tried to use these programs to augment traditional therapy. The time may be near when clinicians who want to use technology in psychotherapy will have access to useful and effective programs that can enhance learning, make treatment more efficient, and bring a valuable new dimension to the psychotherapeutic process.

Therapists of the future may be able to conduct their daily work with a variety of empirically tested computer tools. These adjuncts could be completed before or after a session, either in waiting rooms or at home, or even in specially designed therapy suites that provide advanced technology (such as virtual reality and fully realized multimedia treatment programs). Further development of port­able devices that have better function­ality and connectivity, that offer more realistic and engaging programming, and that weave together the human and technological components of treatment could provide a myriad of opportunities for realizing the promise of the computer as a therapeutic “assistant.”

Sources and Additional Information:

http://www.finddepressiontreatment.com/depression-software.html

http://wiki.medpedia.com/Clinical:Computer-Assisted_Psychotherapy

http://jppr.psychiatryonline.org/cgi/reprint/6/4/315.pdf

http://bjp.rcpsych.org/cgi/content/full/191/6/471

http://www.sharpbrains.com/blog/2008/09/03/the-future-of-computerized-cognitive-therapy/

45 Lifestyle Recommendations on How to Get Through Depression

On a day-to-day basis, separate from, or concurrently with therapy or medication, people suffering from depression have their own methods for getting through the worst times as best they can. The following comments and ideas on what to do during depression were solicited from people in the alt.support.depression newsgroup. These recommendations might work for you, or might not. Just keep trying them, modifying them for your own lifestyle and personal preferences, until you find the set of techniques that work for you most efficiently.

1. Write. Keep a journal. Somehow, writing everything down helps organizing better your thoughts and feelings, keeping the misery from running around in circles.

2. Listen to your favorite "help" songs (a bunch of songs that have strong positive meaning for you and relief for the depression nightmare).

3. Read (anything and everything). Go to the library and check out fiction you've wanted to read for a long time. You also might find useful reading books about depression, spirituality, and morality; or on the people who suffered from depression but still managed to do fairly well with their lives, like Winston Churchill and Martin Luther, for example.

4. Sleep for a while. Even when busy, do your best to get a good sleep. Notice if what you do before sleeping changes how you sleep in terms of length and rest quality. Follow the pattern, which helps you and verify how consistent the results are.

5. If you might be a danger to yourself, don't be alone. Find people. If that is not practical, call them up on the phone. If there is no one you feel you can call, suicide hotlines can be helpful, even if you're not quite that badly off yet. You will get professionals and trained volunteers to talk to you and may be show a different angle to your troubles, to start with.

6. Hug someone or have someone hug you. Personal touch is so important, and we almost lost it in our high-tech individualistic society.

7. Remember to eat. Notice, how eating certain things (e.g. sugar or coffee) may influence on our mood and feelings. Keep “comfort food” always handy in the house to be able to get it as needed.

8. Make yourself a fancy dinner, maybe invite someone over.

9. Take a bath or a perfumed bubble bath. Go to spa, massage, or hot springs resort. You may find that spending just couple of hours there may change your mood and bring calmness to your life.

10. Mess around on the computer. Talk to friends in social networks, blog, answer surveys, watch cartoons, and look if you can find relief in virtual life.

11. Rent comedy videos. Try to concentrate on the fun of what you are watching.

12. Go for a long walk. Look around, notice people, nature, birds. Watch the sky and the moon at night.

13. Dance. Dance alone at home, or go out with friends. Experiment with different music and its influence on your well-being. Try 5-rithms, Ecstatic, or Zen Dancing, as it is the best if you want to dance alone.

14. Eat well. Try to alternate foods you like with the stuff you know you should be eating.

15. Spend some time playing with a child. There is no other activity, more rewarding emotionally.  

16. Buy yourself a gift. O yes, shopping therapy works excellent for some people. Do not have money – try windows shopping, or browse goodies on eBay or Amazon. Do not worry that you might not actually need the staff. If you just want it – buy it. That works pretty good as clothes for women, or electronic gadgets for men.

17. Phone a friend. Hopefully, you do have a close friend who will be able to listen to your troubles, or an opposite, will talk you out of your problems.

18. Read the newspaper comics page. Stupid jokes? So what? May be that what you need at the moment?  

19. Do something unexpectedly nice for someone or for yourself. Break the boring routine, go out, and be creative.

20. Get involved in physical activities, get exercise at home, play active sport on WII. Get out to the fitness club and work to feel your body. Maybe, you get better, when depressive state will evaporate with your dew.

21. If you have garden or backyard, get there, pull the weeds, or cut the grass. Therapeutic gardening is a scientifically proved approach to get better with depression.

22. Sing. If you are worried about responses from critical neighbors, go for a drive and sing as loud as you want in the car. There's something about the physical act of singing old favorites that's very soothing. Maybe the rhythmic breathing that singing enforces does something for you too. Lullabies are especially good.

23. If you cannot force yourself to any activities, try again. Pick a small and easy task, like sweeping the floor, and do it. This helps you feel better because you actually accomplish something, instead of getting caught up in abstract worries and huge ideas for change. For example say "hi" to someone new if you are trying to be more sociable.

24. If you can meditate, it's really helpful. But when you're really down you may not be able to meditate. Your ability to meditate will return when the depression lifts. If you are unable to meditate, find some comforting reading and read it out loud.

25. Bring in some flowers and look at them.

26. If you're anxious about something you're avoiding, try to get some support to face it.

27. Getting Up. Many depressions are characterized by guilt, and lots of it. Many of the things that depressed people want to do because of their depressions (staying in bed, not going out) wind up making the depression worse because they end up causing depressed people to feel like they are screwing things up more and more. So if you've had six or seven hours of sleep, try to make yourself get out of bed the moment you wake up...you may not always succeed, but when you do, it's nice to have gotten a head start on the day.

28. Volunteer work. Doing volunteer work on a regular basis seems to keep the demons at bay, somewhat... it can help take the focus off of yourself and put it on people who may have larger problems (even though it doesn't always feel that way).

29. In general, it is extremely important to try to understand if something you can't seem to accomplish is something you simply CAN'T do because you're depressed (write a computer program, be charming on a date), or whether its something you CAN do, but it's going to be hell (cleaning the house, going for a walk with a friend, getting out of bed). If it turns out to be something you can do, but don't want to, try to do it anyway. You will not always succeed, but try. And when you succeed, it will always amaze you to look back on it afterwards and say "I felt like such shit, but look how well I managed to...!" This last technique, by the way, usually works for body stuff only (cleaning, cooking, etc.). The brain stuff often winds up getting put off until after the depression lifts.

30. Do not set yourself difficult goals or take on a great deal of responsibility.

31. Break large tasks into many smaller ones, set some priorities, and do what you can, as you can.

32. Do not expect too much from yourself. Unrealistic expectations will only increase feelings of failure, as they are impossible to meet. Perfectionism leads to increased depression.

33. Try to be with other people, it is usually better than being alone.

34. Participate in activities that may make you feel better. You might try mild exercise, going to a movie, a ball game, or participating in religious or social activities. Don't overdo it or get upset if your mood does not greatly improve right away. Feeling better takes time.

35. Do not make any major life decisions, such as quitting your job or getting married or separated while depressed. The negative thinking that accompanies depression may lead to horribly wrong decisions. If pressured to make such a decision, explain that you will make the decision as soon as possible after the depression lifts. Remember you are not seeing yourself, the world, or the future in an objective way when you are depressed.

36. While people may tell you to "snap out" of your depression, that is not possible. The recovery from depression usually requires antidepressant therapy and/or psychotherapy. You cannot simple make yourself "snap out" of the depression. Asking you to "snap out" of a depression makes as much sense as asking someone to "snap out" of diabetes or an under-active thyroid gland.

37. Remember: Depression makes you have negative thoughts about yourself, about the world, the people in your life, and about the future. Remember that your negative thoughts are not a rational way to think of things. It is as if you are seeing yourself, the world, and the future through a fog of negativity. Do not accept your negative thinking as being true. It is part of the depression and will disappear as your depression responds to treatment. If your negative (hopeless) view of the future leads you to seriously consider suicide, be sure to tell your doctor about this and ask for help. Suicide would be an irreversible act based on your unrealistically hopeless thoughts.

38. Remember that the feeling that nothing can make depression better is part of the illness of depression. Things are probably not nearly as hopeless as you think they are.

39. If you are on medication:

     a. Take the medication as directed. Keep taking it as directed for as long as directed.

     b. Discuss with the doctor ahead of time what happens in case of unacceptable side-effects.

     c. Don't stop taking medication or change dosage without discussing it with your doctor, unless you discussed it ahead of time.

     d. Remember to check about mixing other things with medication. Ask the prescribing doctor, and/or the pharmacist and/or look it up in the Physician's Desk Reference. Redundancy is good.

     e. Except in emergencies, it is a good idea to check what your insurance covers before receiving treatment.

40. Do not rely on your doctor or therapist to know everything. Do some homework; find the information on your depression type and everything associated. Note that not everything you are reading is true, or absolutely true, or should be true for you. Apply your critical thinking to all the information acquired.

41. Feel free to seek out a second opinion from a different qualified medical professional if you feel that you cannot get what you need from the one you have, or you want be absolutely confident that your diagnosis is correct.

42. Skipping appointments, because you are "too sick to go to the doctor" is generally a bad idea…

43. Do not try to keep everything in your head, write them down, or record audio reminders on your mobile phone. Try concentrating and working out one task at a time. Trying to do too many things can be too much. Have a short list of things to do "now" and a longer list of things you have decided not to worry about just yet. When you finish writing the long list, put it aside for a while. Also, keep a list of what you have already accomplished too, and congratulate yourself each time you get something done. Don't take completed tasks off your to-do list. If you do, you will only have a list of uncompleted tasks. It's useful to have the crossed-off items visible so you can see what you have accomplished.

44. Get a pet. Pet therapy works excellent for some people. The most popular doctors are definitely cats and dogs.

45. Make your own list of recommendations and share with other people. Every depression is unique and individual, as all people are different. But you will be surprised of how much common you can find with other human beings. 

Bipolar Disorder

Overview

Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Statistics

About 5.7 million Americans, or 2.6% of the American population over the age of 18, have bipolar disorder.

Symptoms

The manic phase may last from days to months and can include the following symptoms:

• Agitation or irritation


• Elevated mood



• Hyperactivity


• Increased energy


• Lack of self-control


• Racing thoughts




• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)


• Little need for sleep


• Over-involvement in activities


• Poor temper control


• Reckless behavior



• Binge eating, drinking, and/or drug use


• Impaired judgment


• Sexual promiscuity


• Spending sprees




• Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

• Difficulty concentrating, remembering, or making decisions


• Eating disturbances



• Loss of appetite and weight loss


• Overeating and weight gain




• Fatigue or listlessness


• Feelings of worthlessness, hopelessness and/or guilt


• Loss of self-esteem


• Persistent sadness


• Persistent thoughts of death


• Sleep disturbances



• Excessive sleepiness


• Inability to sleep




• Suicidal thoughts


• Withdrawal from activities that were once enjoyed


• Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.

How does bipolar disorder affect someone over time?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.


2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.


3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.


4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.  Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.  Rapid cycling affects more women than men.

Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.  Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.

Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

Treatment

For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.

There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.

Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.

Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.

Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

Risk factors for bipolar disorder

Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

Genetics

Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had:

• Missed work because of their illness


• Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders


• Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:

• History of psychiatric hospitalization


• Co-occurring obsessive-compulsive disorder (OCD)


• Age at first manic episode


• Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain structure and functioning

Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.  Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.  This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

Tests & diagnosis

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

• Ask about your family medical history, particularly whether anyone has or had bipolar disorder


• Ask about your recent mood swings and for how long you've experienced them


• Observe your behavior and mood


• Perform a thorough examination to identify or rule out physical causes for the symptoms


• Request laboratory tests to check for thyroid problems or drug levels


• Speak with your family members to discuss their observations about your behavior


• Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

Prognosis

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.

Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

• Alcohol and/or drug abuse as a strategy to "self-medicate"


• Personal relationships, work, and finances suffer


• Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

When to contact a doctor

Call your health provider or an emergency number right way if:

• You are having thoughts of death or suicide


• You are experiencing severe symptoms of depression or mania


• You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

If you have suicidal thoughts



Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

• Contact a family member or friend.


• Seek help from your doctor, a mental health provider or other health care professional.


• Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.


• Contact a minister, spiritual leader or someone in your faith community.

Sources and Additional Information:

https://health.google.com/health/ref/Bipolar+disorder

http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

http://en.wikipedia.org/wiki/Bipolar_disorder

http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=symptoms

http://health.nytimes.com/health/guides/disease/bipolar-disorder/background.html

Historical retrospectives of depressive disorder

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time.

Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950s and 60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job.

The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it can also be used to describe other types of psychological depression, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide have depression or another mood disorder.

Major Depressive Disorder

In the 1970s and 80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree that:

1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.


2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished activity and participation.


3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.


4. Depressive disorders are a huge public-health problem, due to its affecting millions of people.

·         The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism.

·         In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in two categories of problems, as often as coronary artery disease.

·         Depression can increase the risks for developing coronary artery disease, HIV, asthma, and some other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these conditions.

5. Depression is usually first identified in a primary-care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently under-diagnosed.


6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.

Major Depressive Disorder

Sources and Additional Information:

http://www.medicinenet.com/

http://en.wikipedia.org/wiki/Major_depressive_disorder

Repetitive Transcranial Magnetic Stimulation for Depression Treatment

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that uses a powerful electro-magnet placed on the scalp of a person to alter brain activity. Originally developed as a diagnostic tool for mapping brain function, TMS appears promising as a treatment for a variety of complex neuropsychiatric conditions, particularly major depression.

TMS induces an electromagnetic current in the underlying cortical neurons, which may explain its therapeutic effects. Repetitive TMS, using varying frequencies and intensities, can increase or decrease excitability in the cortical area directly targeted by the stimulation. Recent studies combining TMS and neuroimaging techniques, such as magnetic resonance imaging, demonstrate that the effects of TMS are not limited to the cortex but spread to functionally related subcortical structures. This finding provides a basis for using TMS to treat the pathologic neural activity that may underlie neuropsychiatric illness.

Repetitive transcranial magnetic stimulation, known as rTMS, can produce longer lasting changes for treatment of various neurological conditions (e.g. migraine, stroke, Parkinson's disease, dystonia, tinnitus) and psychiatric conditions (e.g. major depression, auditory hallucinations).

rTMS (Repetitive transcranial magnetic stimulation

Clinicians and physicians are excited about the therapeutic applications of repetitive transcranial magnetic stimulation (r TMS) because it is non-invasive, unlike other implanted devices such as the Vagus Nerve Stimulation (VNS) System, and does not have the pain and potentially devastating side effects of Electroconvulsive Therapy (ECT or "shock therapy").

Effects on the Brain

The exact details of how TMS functions are still being explored. The effects of TMS can be divided into two types depending on the mode of stimulation:

• Single or paired pulse TMS. The pulse(s) causes neurons in the neocortex under the site of stimulation to depolarise and discharge an action potential. If used in the primary motor cortex, it produces muscle activity referred to as a motor-evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, 'phosphenes' (flashes of light) might be detected by the subject. In most other areas of the cortex, the participant does not consciously experience any effect, but his or her behavior may be slightly altered (e.g. slower reaction time on a cognitive task), or changes in brain activity may be detected using Positron Emission Tomography or fMRI. Effects resulting from single or paired pulses do not outlast the period of stimulation. A review of TMS can be found in the Handbook of Transcranial Magnetic Stimulation.

• Repetitive TMS (rTMS) produces effects which last longer than the period of stimulation. rTMS can increase or decrease the excitability of corticospinal or corticocortical pathways depending on the intensity of stimulation, coil orientation and frequency of stimulation. The mechanism of these effects is not clear although it is widely believed to reflect changes in synaptic efficacy akin to long-term potentiation (LTP) and long-term depression (LTD).

Risks

Single pulse TMS is regarded as safe although seizures following single pulse TMS stimulation have been reported in some patients with stroke or other disorders involving the central nervous system. Seizures from single or paired pulse TMS are rare, especially in patients without pre-existing conditions that affect the central nervous system such as epilepsy. rTMS has been reported to cause seizures in normal individuals at certain combinations of stimulation frequency and intensity. Guidlines have since been instituted regarding the maximum safe frequency and intensity combinations of rTMS.



Common adverse effects of TMS are:

• Discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin. Discomfort is rarely a problem for single pulse TMS but some people may find rTMS quite uncomfortable.


• Rapid deformation of the TMS coil produces a loud clicking sound which scales with stimulator intensity. The sound has been characterized as deceptively mild sounding and has the potential to affect hearing, given sufficient exposure (particularly relevant for rTMS). Hearing protection may be offered to prevent this.


• rTMS in the presence of EEG electrodes can result in electrode heating and, in severe cases, skin burns.

rTMS (Repetitive transcranial magnetic stimulation

FDA approval

In January 2007 FDA advisory panel said clinical trials failed to establish that the device was clinically effective. Although TMS-treated patients were twice as likely as sham-treated patients to show clinical benefit, some panel members said this effect was "small," "borderline," "marginal," and "of questionable clinical significance."

However, two years later, in October 8, 2008, a TMS device, NeuroStar, manufactured by Neuronetics Inc. has been approved for use by the Food and Drug Administration (FDA) in the United States for use in adult patients with major depression who have previously tried medication and not improved satisfactorily.

Most TMS use is currently done off label or under research protocols approved by hospital ethics boards and, in the US, often under Investigational Device Exemption from the U.S. Food and Drug Administration (FDA). The requirement for FDA approval for research use of TMS is determined by the degree of risk as assessed by the investigators, the FDA, and the local ethics authority.

Main Differences between ECT and TMS

• ECT, also known as electroshock therapy, uses an electric shock to induce seizure. TMS uses a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness.


• ECT is extremely effective in treating severe depression. TMS is not so powerful. It is used to treat milder depression, and it works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments.


• TMS is much safer than ECT. Unlike ECT, TMS does not require sedation and is administered on an outpatient basis.

Treatment

Patients undergoing TMS must be treated four or five times a week for four weeks.



Because your psychiatrist needs to determine how to most effectively administer treatment, your first session could last up to an hour and a half. You will be provided and asked to wear protective earplugs, as the system emits a tapping sound during operation.

Your psychiatrist will first perform a test to identify your motor threshold. The motor threshold is the amount of magnetic field strength that results in a movement of your right thumb. This test is important because it identifies the magnetic field strength that will be used in your treatment. This field strength is customized for each patient to deliver the correct treatment dose.



After this initial procedure, the doctor will determine the place on the head where the TMS treatment will be applied and the treatment coil will be moved to that location. This will allow you to receive optimal treatment.



The physician will then administer TMS Therapy over a 40-minute period. In 30-second intervals, the device will deliver rapid “pulses” of the magnetic fields. These will feel like tapping on your scalp. Some patients may find this tapping uncomfortable. Your physician may be able to make adjustments to reduce this discomfort.

Conclusion

The efficiency of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has been assessed in a number of acute treatment trials during the last 10 years. Little is known about the long-term impact of the treatment on the disorder and its effectiveness when applied for repeated relapses of depression over time. The majority of patients achieved a significant improvement in each treatment course with significant improvements achieved in patients treated with both low-frequency right-sided rTMS and high-frequency left-sided rTMS. While some of the trials produce controversial results, the widely accepted approach suggests that rTMS may have value in the treatment of episodes of depressive relapse with little reduction in efficacy over time.

Sources and Additional Information:

http://www.healthyplace.com/depression/tms/electromagnetic-stimulation-shows-promise-for-treatment-resistant-depression/menu-id-68/

http://en.wikipedia.org/wiki/Repetitive_transcranial_magnetic_stimulation

http://www.webmd.com/depression/news/20081008/fda-oks-tms-depression-device

http://www.psycom.net/tms.html

http://www.depression-guide.com/rtms.htm