Especially painful events, such as the loss of a loved one through death or divorce, can naturally make someone feel disheartened and sad. The individual withdraws from the outside world until he or she can recover an inner sense of the missing loved one's presence, then re-emerge and begin interacting with other people again.
This normal depressive state is generally only transitory. It often helps the person to recover, as well as to discover better ways of approaching the future. Postpartum depression and the let-down feelings that some people experience at the end of a creative effort are examples of this kind of depression.
It is important to recognize that mood disorders such as depression fall on a continuum. There is also a consensus that normal depressive episodes, dysthymia (see next sidebar),
and major depression are all examples of increasingly intense levels of the same disorder.
In addition to major depression, which consists of one or more major depressive episodes that contrast with a person's normal way of functioning, mental health professionals distinguish another, less severe form of depression known as dysthymia, or dysthymic disorder.
Dysthymia is characterized by depressive symptoms that are less incapacitating than those of major depression but are chronic (experienced almost every day) and do persist for several years (at least two). It is also common for dysthymia to evolve into major depression.
People who suffer from dysthymia are relatively functional, though their low self-esteem, low energy,
loss of appetite, and lack of sleep interfere with some of their everyday responsibilities.
SYMPTOMS, TREATMENTS, AND CAUSES OF DEPRESSION
Depression is characterized by many
symptoms, the most important of which is probably the generalized
loss of meaning that people who have it experience. To them,
life no longer seems like a coherent whole, but rather like a
fragmented series of events. Their social relationships and daily
activities no longer seem meaningful and gradually deteriorate.
In a sense, these symptoms are the opposite of the manic phase
Being depressed is very different from experiencing passing sadness,
as we all do. A depressive episode can last several weeks, months,
or even years and seriously interfere with the work and social
life of the person going through it.
There are now many options for the effective treatment of
depression. They fall into two major categories: treatment with
antidepressant drugs, and various forms of psychotherapy.
Depression can be treated with medications called antidepressants,
which improve patients' moods by correcting certain imbalances
in the neurotransmitters in their brains.
By correcting these imbalances, these various
categories of antidepressants help patients to start sleeping
and eating normally again, regaining their energy and pleasure
in life, and thinking positively. These effects normally take
two to three weeks to begin, but in order to minimize the risk
of relapse, antidepressants must be prescribed for about four
to six months.
Antidepressants are effective in about 75% of people with severe
depression. Antidepressants do not result in dependency, but
like all medications, they do have side effects that vary from
person to person. These effects will influence the decision
of which antidepressant to prescribe, and in what dosage.
Psychotherapy lets patients work on the psychological and social
issues that may be associated with their depressive episodes.
This form of therapy can help patients to achieve profound
changes. But it is a long process, where a great deal clearly
depends on the therapist's skill and the natural rapport between
the particular therapist and the particular patient.
There are several different types of psychotherapy, but two
have proven especially effective in treating depression: cognitive
behavioural therapy and interpersonal therapy.
Cognitive behavioural therapy attempts to
change the dysfunctional thoughts and behaviours that accompany
depression. Depression often causes people to have distorted
thoughts about themselves and their relations with other people
and with the world in general. In this form of therapy, the
therapist teaches the patient exercises that help him or her
to develop new thought schemas. This kind of therapy can provide
effective help to people who suffer from mild to moderate depression.
It can also help to prevent relapses.
In interpersonal psychotherapy, the basic
premise is that most people have problems in their interpersonal
relationships, and that if these problems can be solved, then
the symptoms of their depression can be stabilized as well.
For example, the therapist may try to help the individual to
deal more effectively with feelings of grief or mourning, or
to adapt to a new role, or to reduce interpersonal conflicts
at work, or to overcome interpersonal deficits such as a lack
of communication skills, and so on.
For people who are dealing with mild forms of depression, psychotherapy
may provide good results all on its own. People suffering from
moderate or severe depression will often improve considerably when
treated with antidepressants. But in general, it is combined therapies
that are the most effective: the medication quickly relieves the
patient's symptoms, while the psychotherapy helps him or her to
discover new approaches to dealing with the stresses of daily life.
Even though there are some treatments that, alone or in combination, may prove
effective in treating depression, an understanding of the multiple
factors that can cause depression may eventually help us to prevent certain
forms of it.
Electroshock treatment is
also used to alleviate symptoms of depression. In this treatment,
the patient is given either an anaesthetic or a muscle relaxant,
and small electric shocks are then applied to his or her
brain for one or two seconds. The exact mechanisms by which
this treatment works are not fully understood, but it appears
to promote the production of certain neurotransmitters whose
levels are abnormally low in depressed individuals.
In general, electroshock treatment is tried when treatment
with medication has proven ineffective. Electroshock treatment
generally causes only temporary memory loss and is effective
both for depressive persons and for people experiencing manic
episodes. It often enables patients to go back to living a
productive life faster than medication does.
Daryl, a 25-year-old
dancer, had been hired by a dance company to perform in
a major production. The
first signs of his mania appeared suddenly one night after
a rehearsal, when he started telling his wife some
nasty things about the director of the company.
A week later, a colleague called Daryl's wife to complain
that he had upset the rehearsals by constantly offering unsolicited
advice to the company director and the other dancers.
From then on, Daryl's wife realized that his personality
had changed. Normally very obliging, he had now become very
difficult. He made some very hurtful complaints to her about
their sex life. Shortly after that, he was fired from the
dance company for having cursed out his colleagues. At home,
he kept babbling a mile a minute and barely took the time
to get dressed, eat a meal, or sleep. He kept going on spending
sprees and making extravagant purchases.
At that point, two weeks after his first symptoms had appeared,
Daryl agreed to be hospitalized. He began lithium treatment
and responded fairly well to it.
Daryl's father had also had a long history of manic episodes
and had lost several jobs after confrontations with his bosses.
Subsequently, he too began being treated successfully with
Source: Robert L. Spitzer, reported
by Elliot S. Gershon and Ronald O. Rieder
SYMPTOMS, TREATMENTS, AND CAUSES OF MANIC
us experience fluctuations in mood. In response to various
situations, our mood may change over the course of the
month, the week, or even the day. In healthy people, these
mood changes even out fairly quickly. But in people with
bipolar disorder (formerly known as “manic
they are out of proportion to actual events.
In fact, these mood swings become so intense that the people
who experience them no longer realize that their manic exuberance
has crossed the line into excess, or that their depression has
left them mentally paralyzed. These people become slaves to their
moods as they shift from episodes of depression to normalcy to
mania. The frequency and duration of these episodes can range
from a few weeks to several months.
The symptoms of the depressive phase of bipolar disorder are
the same as those of major depression. In contrast, when people are in a
manic phase, their mood
is exalted and euphoric.
Because the associated hyperactivity often impairs their judgment, these people
can cause serious problems for their friends and family, as well as for themselves,
of course (for instance, by going on spending sprees, or contracting huge debts,
or breaking the law). In other words, manic episodes are accompanied by impulsive
behaviour that can, if left untreated, eventually destroy a person's family,
career, and finances.
Luckily, just as in the case of depression,
drug treatment supported by psychotherapy can successfully stabilize
the individual's mood and enable him or her to function again.
The basic drug treatment for bipolar disorder is lithium,
a mineral salt that can stabilize mood and reduce the frequency
of manic and depressive episodes in about 80% of the people
who suffer from this disease.
Most people with bipolar disorder now manage to live normal
lives, without manic or depressive episodes, thanks to long-term
treatment with lithium.
If a patient does experience a depressive episode, it is
treated primarily with antidepressants.
Manic episodes are treated primarily with lithium or other
medications, such as neuroleptics and anticonvulsants.
Some interesting trials are now under way with tryptophane,
an amino acid, which may make it possible to reduce the total
dose of lithium and thus alleviate the side effects associated
with high doses of this substance.
and Psychosocial Interventions
Psychotherapy can help people with manic depression to better
understand their illness and thereby to develop better strategies
for coping with it.
Likewise, various forms of psychosocial interventions, such
as associations for people with bipolar disorder, can help
to improve their mood substantially, by providing them with
information and support.
Indeed, there are many different tools that can help people
with bipolar disorder to manage their disease more effectively
and live a normal life again. These tools include educating
patients and their families, identifying and managing the
side effects of their medication, and detecting early signs
of recurrence of the disease or sources of stress that might
contribute to such a recurrence.