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

Geriatric Depression Scale - Self-report Assessment for Elderly

The Geriatric Depression Scale (GDS) is a 30-item self-report assessment designed specifically to identify depression in the elderly. The items may be answered yes or no, which is thought to be simpler than scales that use a five-category response set. It is generally recommended as a routine part of a comprehensive geriatric assessment. One point is assigned to each answer and corresponds to a scoring grid. A score of 10 or 11 or lower is the usual threshold to separate depressed from non-depressed patients. However, a diagnosis of clinical depression should not be made on the GDS results alone. Although the test has well-established reliability and validity, responses should be considered in conjunction with other results from a comprehensive diagnostic work-up. A short version of the GDS containing 15 questions has been developed. The GDS is also available in a number of languages other than English.

Purpose

Depression is widespread among elderly persons, affecting one in six patients treated in general medical practice and an even higher percentage of those in hospitals and nursing homes. Older people have the highest suicide rate of any group, and many medical problems common to older people may be related to, or intensified by, a depressive disorder. Recognition of the prevalence of depression among older people prompted the development of the geriatric depression scale in 1982-83. Yes/no responses are thought to be more easily used than the graduated responses found on other standard assessment scales such as the Beck Depression Inventory, the Hamilton rating scale for depression, or the Zung self-rating depression scale.

While it is not found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR ) produced by the American Psychiatric Association, the GDS is widely recommended for clinical use and is included as a routine part of a comprehensive geriatric assessment. It is also increasingly being used in research on depression in the elderly.

Geriatric Depression Scale

Precautions

Depression scales are either interviewer-administered or by self-report means. The GDS is a self-report assessment developed in 1982 by J. A. Yesavitch and colleagues. A self-report assessment is easier and quicker to administer, though an interviewer-administered test is generally more sensitive and specific—another reason for using more than one tool to obtain an accurate diagnosis.

There is some controversy over whether the GDS is reliable for depression screening in individuals with mild or moderate dementia. Several studies have shown good agreement with observer ratings of depression, whether or not the patient had dementia. However, persons with dementia may deny symptoms of depression. It also appears that less educated people are more likely to score in the depressed range on the GDS 15-item short form. These caveats notwithstanding, the GDS can be usefully applied in general medical settings in combination with other clinical assessments, observation, and interviews with elder patient and their families.

Both symptom pattern and symptom severity must be considered when trying to identify depression. These dimensions are taken into account in the development of symptom scales and, while clinical judgment takes priority, a scale such as the GDS can help in identifying persons with depression, whether they are making satisfactory progress with treatment, or when they may need further assessment or referral.

Description

Yesavitch and his coworkers chose 100 statements that they determined were related to seven common characteristics of depression in later life. These included:

• somatic concern


• lowered affect (affect is the outward expression of emotion)


• cognitive impairment


• feelings of discrimination


• impaired motivation


• lack of future orientation


• lack of self-esteem

The best 30 items were selected after administration of the 100 items to 46 depressed and normal elders. Those items were then administered to 20 elders without depression and 51 who were in treatment for depression. The test was 84% sensitive and 95% specific for a depression diagnosis. Repeated studies have demonstrated the value of GDS.

Geriatric Depression Scale

Long Mood Assessment Scale

1. Are you basically satisfied with your life?

2. Have you dropped many of your activities and interests?

3. Do you feel that your life is empty?

4. Do you often get bored?

5. Are you hopeful about the future?

6. Are you bothered by thoughts you can t get out of your head?

7. Are you in good spirits most of the time?

8. Are you afraid that something bad is going to happen to you?

9. Do you feel happy most of the time?

10. Do you often feel helpless?

11. Do you often get restless and fidgety?

12. Do you prefer to stay at home, rather than going out and doing new things?

13. Do you frequently worry about the future?

14. Do you feel you have more problems with memory than most?

15 Do you think it is wonderful to be alive now?

16 Do you often feel downhearted and blue?

17 Do you feel pretty worthless the way you are now?

18 Do you worry a lot about the past?

19 Do you find life very exciting?

20 Is it hard for you to get started on new projects?

21 Do you feel full of energy?

22 Do you feel that your situation is hopeless?

23 Do you think that most people are better off than you are?

24 Do you frequently get upset over little things?

25 Do you frequently feel like crying?

26 Do you have trouble concentrating?

27 Do you enjoy getting up in the morning?

28 Do you prefer to avoid social gatherings?

29 Is it easy for you to make decisions?

30 Is your mind as clear as it used to be?

Scoring

A scoring grid accompanies the GDS. One point is given for each respondent's answer that matches those on the grid. For example, the grid response to "Are you basically satisfied with your life?" is "no." If the elderly person responds in the negative one point is scored; if the response is "yes," then no point is scored.

1. no 6. yes 11. yes 16. yes 21. no 26. yes

2. yes 7. no 12. yes 17. yes 22. yes 27. no

3. yes 8. yes 13. yes 18. yes 23. yes 28. yes

4. yes 9. no 14. yes 19. no 24. yes 29. no

5. no 10. yes 15. no 20. yes 25. yes 30. no

Results

For the 30-item assessment, a score of 0–9 is considered normal; 10–19 indicates mild depression, and a score over 20 is suggestive of severe depression. The maximum number of points that can be scored is 30.

Geriatric Depression Scale

Short Mood Assessment Scale

1. Are you basically satisfied with your life?

2. Have you dropped many of your activities and interests?

3. Do you feel that your life is empty?

4. Do you often get bored?

5. Are you in good spirits most of the time?

6. Are you afraid that something bad is going to happen to you?

7. Do you feel happy most of the time?

8. Do you often feel helpless?

9. Do you prefer to stay at home, rather than going out and doing new things?

10. Do you feel you have more problems with memory than most?

11 Do you think it is wonderful to be alive now?

12 Do you feel pretty worthless the way you are now?

13 Do you feel full of energy?

14 Do you feel that your situation is hopeless?

15 Do you think that most people are better off than you are?

Scoring

1. no   6. yes   11. no

2. yes  7. no    12. yes

3. yes  8. yes   13. no

4. yes  9. yes   14. yes

5. no   10. yes  15. yes



Results

For the 15-item assessment, a score of 0–4 is considered normal; 5-8 indicates mild depression, 8-11 indicates moderate depression, and a score over 12 is suggestive of severe depression. The maximum number of points that can be scored is 15.

Sources and Additional Information:

http://www.minddisorders.com/Flu-Inv/Geriatric-Depression-Scale.html

http://www.stanford.edu/~yesavage/GDS.html

http://www.mhsfopcls.com/downloads/ger_dep_scl.pdf

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

Wakefield Self-Report Questionnaire: How do I know if you are depressed?

The boundary between sadness that we all experience from time to time and the illness, depression, is not well defined. Some people may seek treatment for relatively mild feelings of sadness, while others may avoid treatment even though they are severely depressed.

The Wakefield Self-Report Questionnaire permits people who may be depressed to obtain a depression rating score by answering 12 simple questions.

Read these statements carefully, one at a time, and post the score near the question that will be matching with the score opposite the response that best indicates how you feel. It is very important to indicate how you are now, not how you were, or how you would hope to be.

     A.   I feel miserable and sad______

            0) No, not at all

            1) No, not much

            2) Yes, sometimes

3) Yes, definitely

     B.   I find it easy to do the things I used to do______

0) Yes, definitely

1) Yes, sometimes

2) No, not much

3) No, not at all

     C.   I get very frightened or panicky feeling for apparently no reason at all______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

                

     D.   I have weeping spells, or feel like it______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

          

     E.   I still enjoy the things I used to______

            0) Yes, definitely

1) Yes, sometimes

2) No, not much

            3) No, not at all

      F.   I am restless and can’t keep still______

            0) No, not at all

            1) No, not much

            2) Yes, sometimes

            3) Yes, definitely

     G.   I get off to sleep easily without sleeping tablets______

            0) Yes, definitely

            1) Yes, sometimes

            2) No, not much

            3) No, not at all

    

     H.   I feel anxious when I go out of the house on my own______

             0) No, not at all

            1) No, not much

            2) Yes, sometimes

            3) Yes, definitely   

               

     

     I.   I have lost interest in things______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

 

     J.   I get tired for no reason______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

     K.  I am more irritable than usual______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

     L.   I wake early and then sleep badly for the rest of the night______

0) No, not at all

1) No, not much

2) Yes, sometimes

3) Yes, definitely

Now summarize your scores per each individual answer and find out your total score.

TOTAL SCORE          _______

In the Wakefield Self-Report Questionnaire, most depressed people score 15 or above, whereas most non-depressed people score between 0 and 14. It is important to realize that a rating scale such as the Wakefield does not diagnose clinical depression. The Wakefield measures the frequency and intensity of symptoms often associated with depression. Some high scores may be attained by individuals with other emotional problems or physical illnesses. Therefore, use the test as a guide, and consider consulting a doctor for an evaluation if your score is 15 or more.

Scores lower than 15 may still warrant consultation with a doctor if your distress or dysfunction is substantial. Repeating the Wakefield approximately two weeks after its first use may be helpful, and if your score is still below 15 but rising, you should strongly consider consulting a doctor.





Source:

http://www.namigc.org/content/fact_sheets/mentalillnesses/Depression/web-wakefield%20self%20report%20questionnaire%200304.htm

Individual Personality and Depression

Individuals with certain personality styles - those who are aggressive and those who have low dependency on other people - are at higher risk for recurrent bouts of major depression, according to a new University of Washington study.

The study comes from the laboratory of UW psychology professor Neil Jacobson, who found that people at risk for relapsing reported lower levels of satisfaction or pleasure from their activities than did people who remained well. The study also indicated that a patient's level of negative or dysfunctional thinking at the end of treatment was not predictive of relapse.

"Depression is a recurrent disease for a lot of people just like cancer," said Gollan, professor assistant, "People who receive cognitive behavioral psychotherapy for depression tend to feel less depressed when they complete it. However, other factors in their lives beyond their mood need to be identified if we are to help them stay well. We need to consider who people are and how they interact with others to understand how patients remain nondepressed."

Researchers are anxious to identify risk factors for recurrent depression because relapse rates among patients who respond to treatment are alarmingly high. Studies have shown that between 50 percent and 80 percent of patients successfully treated with cognitive behavioral therapy suffer a relapse, often within two years of remission. Cognitive behavioral therapy is the standard treatment for depression, often in conjunction with anti-depressant medication.

Depression is the most common mental health problem in the United States, affecting an estimated 17 million people. Individuals with clinical or major depression, the most serious form of the disorder, often can't function, perform at work, need to be hospitalized and may attempt suicide.

In the new study, Gollan and Jacobson followed 78 patients who had recovered from major depression for two years to monitor changes. The patients all received 20 sessions of cognitive behavioral therapy for their depression and were considered symptom-free for at least two months before being accepted into the study. The researchers utilized a variety of interview questionnaires and self-report forms to measure depression, dysfunctional attitudes and pleasant activities at the beginning and end of treatment and every six months during the two-year follow-up. Personality styles were measured before and after treatment.

At the end of the study, 34 people, or 44 percent, had relapsed. Gollan said there seems to be different subsets of people who are at-risk for recurrent bouts of depression. One of those groups is made up of individuals who have a low dependency on other people. People with low dependency are usually independent people who may have little or no social support system, she said.

"Low dependency increases risk for relapse while moderate dependency encourages recovered patients to seek out social relationships that may function, over time, to reduce relapse risk," she said.

People who exhibited aggressive, hostile styles at the end of treatment also were more likely to relapse, "perhaps because they don't make good friends and turn off people," Gollan explained. "In their professional careers they have channeled aggression in productive, socially acceptable ways to their advantage and use people to their advantage. They also are pathologically independent and independence may be a risk factor if you have depression."

She added that clinicians working with depressed patients need to pay more attention to the enjoyment and satisfaction people get from activities rather than on the type and number of activities they engage in.

"We need to focus on how the activities feel," Gollan said. "We don't know why, but it is becoming clear that people are less at risk for relapse when they do things they enjoy rather than working on overcoming their negative thinking patterns. The treatment should be tailor-made to the depressed patient."

Depression

Other studies extend the personality factor influence on the potential development of the depressive disorder. It was found that people with the following types are in greater risk of developing depression than others:

1. People with high levels of anxiety.


2. Extremely shy people, when it is expressed in forms of “social avoidance” and “personal reserve”.


3. People with high levels of self-criticism and low self-esteem.


4. People with high interpersonal sensitivity.


5. Perfectionists.


6. People, who are extremely self-focused.

Researches show that people who fit the first four factors description are in substantially greater risk to depression, especially non-melancholic depression. Perfectionists are protected to certain degree from the depression, however, if the depressive disorder episodes occurs, they will be significantly longer than for non-perfectionists. Self-focused individuals are likely to be in greater risk for brief depressive episodes. While melancholic depression development was not found to be in any correlation with patients’ temperament or personality.

Another study reviewed the possible personality changes after depression is over, and concluded that personality traits of people who suffer a period of major depression remain unchanged.

"Our findings do not support the scar hypothesis," says Dr. M. Tracie Shea, associate professor of psychiatry and human behavior at Brown University, Providence, Rhode Island. "Essentially, our findings were that when people get better, they look fine. There aren't changes in the personality traits from prior to the onset of major depression."

In their report, Shea and her colleagues point to numerous studies in which people with a history of depression were characterized by having high levels of certain personality traits, including dependency on others, lack of social self-confidence, submissiveness, irritability, and social introversion.

"Our findings suggest these traits might represent a vulnerability to becoming depressed, rather than being an outcome of depression. Personality changes that might be present during an episode of major depression will resolve following full recovery -- they will not be lasting," she asserts.

Social Causes of Depression

Depression is one of the most prevalent psychological disorders. Depression can be caused by several factors, including interpersonal relationships. Interpersonal relationships are the relationship between individuals and the reactions and emotions of each individual expressed directly and discreetly to each other. Common interpersonal relationships include (a) within the family, such as between the parents and between parents and children; (b) the social environment where differences in ethnicity and social class come into play; and (c) interactions between genders across age groups for both females and males.

Many people suffer from depression at one point in their life. It is inevitable, the feeling of hopelessness, sorrow, or being alone. These are all common emotions associated with depression. For a select few, depression can be hard to overcome, and this is where depression becomes a disorder that requires active treatment. Those 'selected few' account for over 100 million people worldwide and result in 75% of all psychiatric hospitalizations. Yet the question remains, why did these people become depressed? How did they become depressed? One of the answers that lead to the cause of depression would be a person's interpersonal relationship with their surroundings and the people around them. There are many interpersonal instances that can have the ability to lead to the onset of depression, such as the family environment, the socialization setting, and the discrimination against gender in certain cultures and instances.

Family

One could argue that out of all the interpersonal cases that can contribute on the onset of a depressive disorder, the ambiance of a family has the most weight and impact on a depressed individual. In the case of spouses, the well being of one spouse will have a notable impact on the other spouse and on the welfare of their marriage. For example, in 30% of all marriage problems, there is one spouse that can be described as clinically depressed. The reason why a spouse might have a unipolar mood disorder could be due to their relationship being "characterized by friction, hostility, and a lack of affection".

Martial distress can also be caused by the impact of having a child. When a woman is pregnant, she can experience a whole range of emotions due to the changing of interpersonal relationship with husband and the building of a new relationship with the unborn child. For example, the building of a new interpersonal relationship with the child can be very tasking and become a major stressful life event that can cause a mood disorder to develop.

Aside from the martial distresses of spouses, the impact of depressed parents can have an effect on their children as well. In a study on the relation between depressed adolescences and depressed mothers, they found that the depressed children of depressed mothers had more negative interpersonal behavior as compared with depressed children of non-depressed mothers. This is reinforced when a study shows that the parents of depressed children are less warm and caring and more hostile than parents of non-depressed children. Because of this negative interpersonal relation between kids and their parents, children can develop a negative view of their family. This negative view can lead to the feeling of lack of control and having a high risk of conflict, rejection, and low self-esteem.

Cummings (1995) stated that any changes in a family environment due to parental depression increase the risk of developing a mood disorder in children. The result of this can be found as early as preschoolers and infants, due to the insecure attachment they develop with their parents. The emotional distress of children can also have an effect on their parents, causing depression that in turn will also affect the children, theoretically creating a never-ending cycle unless they seek treatment. Sometimes It is not the depressed parents that lead to the onset of depression in their children, but rather it is the change in the family environment that stems from the parents' depression that causes the children to become depressed. Some studies suggest that martial troubles are a better predicator for the onset of depression than the depression of the parents or the children themselves.

Experiencing depression while as a child or an adolescent can also lead to reoccurring slips as an adult. Depressed persons often perform poorly in marriage and relationship with family members and they also might respond negatively to others, which have the ability to create stressful life events, which as a result might drive the person further into depression. Depressed people are dependant on other people and constantly seek reassurance in such a way that drives people away. Hammen and Brennan (2001) found that 13% of the sons and 23.6 % of the daughters who were depressed had depressed mothers as compared to 3.9% of the sons and 15.9% of the daughters who were depressed lacked a depressed mother.

Many people believe that children and parents suffer differently from depression, but not so. Depressed children can be like depressed parents, expressing sadness, anger, shame, and self-directed hostility. Just like adults, depressed children tend to blame themselves for bad events and accredit the environment for good events--they do not give themselves credit when due. This is why oftentimes, children will feel guilty if their parents get divorced and they believe that they were at fault but realistically, it was the parents' martial distress that was the cause of the divorce, not the children's depressive mood disorder.

Socialization

As in the family environment, socialization is key to maintaining healthy relationship and feeling well deserved and part of someone's life. Depression can have an adverse effect on the social capacity of depressed persons, affecting their social functioning and ability to react and deal with stressful situations. Gotlib and Hammen (1992) discussed the social functioning of people with depressive disorders and found that people with the symptoms of depression are found to test low in social activities, close relationships, quality close relationships, family actives, and network contact, yet they test high in family arguments.

One major part in the development of mood disorders in a social setting would be how well one could deal with stressful events. Normally, this is called coping strategies and it allows a person to manage their troubles and not be overwhelmed. Oftentimes, people can become depressed when unable to deal with "drama" from their friends-especially in children. Depressed children reported significantly higher level of hopelessness, lower general self-esteem, and lower coping skills than non-depressed children. Their ability to be unable to cope with stress can lead to fewer and less adaptive coping techniques.

Social settings can also include one-on-one interactions and the rejection that occurs. In a study performed by Joiner, Alfano, and Metalsky (1992), they tested whether a depressed individual would have an affect on other people in one-on-one interactions and they found that affected people did have such an influence on other people. This influence could be described as responding negatively to their constant searching of reassurance and rejecting them, which in turn will "confirm" the affected person's belief that he or she is unworthy as a person.

A depressed individual can impact their social settings by exhibiting a lack of self-esteem, becoming more sensitive to the opinions of others, and more importantly (and interestly), become less physically active. This means that they will not want to go out, that they do not want to exert themselves. A prime example of this would be an athletic in school that becomes depressed. He does not want to participate in athletic activities because he is depressed, but his coach forces him to. As a result, he performs poorly, and his teammates heckle him for his poor performance. As an affected person, the athletic becomes overly sensitive to his teammates' heckling and his self-esteem plummets and he drops out of sports and begins to withdraw and fight with everybody he knows.

The social class can also have a subtle effect on depression. Brown and Harris (1978) reported that the females with children in the working class were more prone to depression than females with children in the middle class. This can be attributed to the working class mother having to leave home to work, having to leave her child alone. This interpersonal relation can cause excessive worry and guilt that the women is not being a good mother as compared to the middle class mom, who can afford to stay at home and take care of the children/her family.

Okazaki (1997) found that Asian Americans are more depressed in a social and academic setting because they have to face more pressure than their white American peers due to the fact that they are part of a visible minority that has different culture values than others. This interpersonal relationship between the two "cultures" can be defined as competitive and stressful due to the fact that in America, white people "have it made" while as other ethnic groups have to work twice as hard to get their foot in the door. This extreme indicator of stress can lead to the dejection of many ethnic groups because they might have failed at succeeding in a competitive environment.

Gender

There are a lot of interpersonal relations when it comes to gender, such as the discrimination against gender in an academic setting. This is very prominent in females, where girls can face increased expectations to conform to the standards set forth by society, to pursue feminine type activities and occupations. It appears that parents tend to have "lower expectations" for girls when it comes to school. As a result of that lowered expectations, parents tend to not push their daughters toward a high-profile job, instead attempting to make their daughter conform to the stereotype of society, like become a teacher or a nurse. In fact, in 1986-1987, women only garnered 15% of the bachelor's degrees awarded in engineering as compared to 76% and 84% for education and nursing, respectively.

Breaking the social norm can also lead to depression; the more intelligent a girl is, the more likely she is to become depressed. This positive correlation could be attributed to the more intelligent girls being able to out-perform the boys yet get punished for doing so. Being depressed as a female adolescent can have consequences in the long run in terms of social functioning, career, and enjoyment of life. Theoretically, if one were to be depressed in high school, then their grades would suffer. If their grades were to suffer, then their chances of entering a good college would dwindle. If they cannot enter a top-notch college, then they might not be able to get the career they want, and with that they would not be able to enjoy their job and feel like they have missed out on life.

The different experiences of each gender can also be the cause of a mood disorder. The experience can vary by the age of the children, adolescences, or adults. For example, after the age of 15, females are twice as likely to become depressed as compared with men and in another study of 11-year olds, only 2.5% males met the criteria for major depression while only 0.5% females met the criteria, however in a study of 14-16 year olds, 13% of the females met the criteria while 3% of the boys did. This abrupt rise of depressive disorders in females during the mid-to-late adolescence years can be attributed to the more concerns a girl has as compared to boys. These concerns and worries can range from their achievements or lack of, body dissatisfaction, sexual abuse, and low self-esteem.

This is reinforced when another study found that between the ages of 15-18, the prevalence of depression in girls will increase to twice the prevalence of boys (20.69 to 9.58) but will taper off during 18-21 years of age for both genders (15.05 and 6.58).

Do not be mistaken that females are the only gender that that can become depressed; a good number of males can develop a unipolar mood disorder. In the average lifetime, 49% of all males will experience a depressive episode (as compared with 63% of all females). Males will become sad and dejected for different reasons, such as intimate relationships. When an intimate relationship ends, males are more likely to become depressed at the loss than females. This could be attributed to the male's primal desire to have a mate so he will be able to continue his family name.

Depression has been around for a long time, spanning over thousands of years, dating back to the time of Saul I, yet even though Depression is a disorder that is hard to understand. Even with all the studies conducted, there is still not much to regarding the causes of depression. There are so many ways one would be able to become depressed, but the most common and most prevalent way thus far would be the interpersonal relationships of a person and their family, social lives, and the relationship between their gender and the discrimination they suffer at the hands of others. Perhaps a better understanding of those relationships can open up new avenues where new options for treatment can be conceived and new ways of interacting to people to create a equality amongst people where they will not feel depressed.

Author: Gregory S. Beattie

Source: http://www.personalityresearch.org/papers/beattie.html