|
Bipolar disorder is the medical name
for manic depression. The terms may be used interchangeably. Bipolar disorder is a mental illness, but it' s more appropriately described
as a neurobiological brain disorder involving extremes in mood.
It's 1 of the 3 major affective (mood) disorders. Most medical researchers believe that bipolar disorder has genetic roots.
The diagnosis of bipolar disorder is recognized thru at least one, but usually more, manic episodes
or mixed
episodes. It's common for those
experiencing bipolar disorder to have experienced major depressive disorder as well.
Bipolar
Disorder a Misunderstood Disease
Few Americans think it's a mental illness, know its symptoms
THURSDAY, Oct. 9 (HealthDayNews) A new survey found 78% of Americans polled failed to name bipolar disorder as a mental illness & 38% couldn't name a single symptom associated w/the disease.
The survey was released Oct.
9 by The Nation's Voice on Mental Illness (NAMI) & Abbott Laboratories to mark the first national Bipolar Disorder Awareness Day.
The day includes free mental
health screenings & referrals for treatment of bipolar disorder, along w/efforts to
provide people with info about bipolar disorder, also known as manic-depressive
illness.
Bipolar disorder affects more than 2.3 million people in the US. The biochemically based mood disorder features mood swings from mania to depression to normal mood.
"The impact of untreated bipolar disorder on a person's life is huge," Richard C. Birkel, NAMI executive director, says
in a prepared statement.
"Early detection & treatment
can prevent years of illness-driven choices that produce devastating individual losses. Bipolar Awareness Day offers screening, education, information, hope for the millions of Americans living with bipolar disorder," Birkel says.
Among the survey findings:
- Women aged 35 - 54 have the
greatest awareness (39%) of bipolar disorder, followed by college-aged students at 35%. Awareness of bipolar disorder in the average population is 22%.
- People age 55 & older
have an awareness rate of 12%.
- Awareness about bipolar disorder among whites is 24%, among Hispanics it's 23% & among blacks
it's 10%.
More information
Here's where you can learn more about bipolar disorder. And here's a list of the free screening sites across the country.
Robert Preidt
SOURCE:
NAMI, news release, Oct. 9, 2003 Last updated 10/9/2003.
click here to access this article:
click here to access our additional page
concerning Bipolar Disorder
  
Criteria for Determining Manic Episodes
A distinct period
of, abnormally & persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary.)
During the period
of mood disturbance, 3 (or more) of the following symptoms have persisted (4 if the mood is only irritable) & have been present to a significant degree:
- decreased need for sleep (i.e., feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e., attention
too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal-directed activity (either
socially, at work or school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that
have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments - important consideration for other disorders as well)
(minor or temporary depression)
Depressive Reaction involves the normal depressed feelings that arise because of a specific life situation or life transition. Depressive reaction is also called an "adjustment disorder w/depressed mood."
The symptoms can
be severe, but they usually don't need treatment & will slowly disappear over time, anywhere between 2 weeks & 6 months.
Dysthymia:(a minor form of longer-term depression)
(click above to read a more in depth description of
Dysthymia)
Similar to depressive
reaction in its symptoms & degree of suffering, it lasts longer though, at least 2 years. Dysthymia presents a chronic feeling of ill being or lack of interest in activities that were formerly enjoyable,
but to a lesser level than that required for Major depression.
Unipolar Major Depressive Disorder
Introduction
Major depressive disorder
(MDD) is a painful, chronic,
debilitating & potentially lethal condition that can
be effectively managed with several safe & relatively
easy to use, forms of treatment. Current data suggest that MDD is a syndrome, originating
from complex interactions between vulnerability genes, stressful & traumatic life events & general health status.
It's believed that all current treatments for depression assist in regaining function, but don't eliminate or reverse underlying vulnerability factors, explaining why treatment often needs to be administered
chronically to avoid relapse & to prevent recurrence.
Treatment options
for MDD include various forms
of psychotherapy, a wide array of medications, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS) & vagal nerve stimulation
(VNS).
First-line treatment
can be initiated with antidepressant
agents, or psychotherapy alone. A large number of factors can influence the selection of treatment for MDD;
therefore, the choice should be made on an individual basis.
For example, a recent study by Nemeroff et al suggested that individuals
with a history of early parental loss, or childhood abuse, may require concomitant psychotherapy, with or without medication treatment.1
The most pragmatic approach
is to choose the safest available treatment with the side effect profile most compatible with the patient’s specific symptoms.
The clinical factors
that can influence choice of treatment include:
-
-
the presence of psychosis or atypical features
-
general health status
-
age
-
prior treatment history (in particular, nonresponse to, or intolerance of, prior treatments)
-
current severity of illness
-
symptom profile
For example, individuals with MDD & psychotic features may respond more favorably to
either ECT, or the combination of an antidepressant & an antipsychotic,
rather than to an antidepressant drug alone.
Guidelines for treatment
of MDD suggest that a
staged approach be taken, with each step building on prior
steps & taking into account the degree of improvement or tolerability associated with a prior step.
Figure 1 presents published guidelines from the British National Institute for
Clinical Excellence (NICE).2
Most
guidelines suggest careful assessment, including
a review of systems, with physical examination preceding
treatment selection. For mild
depression, the NICE guidelines suggest the possibility
of “watchful waiting” for 2 weeks, or the use of psychological approaches.
First-line treatment includes either psychotherapy, or the combination of an antidepressant & psychotherapy.
Figure 1. The Stepped Care Model *
 |
|
Step 5: Inpatient
care, crisis teams
|
Risk to life, severe self-neglect
|
Medication, combined treatments, ECT
|
Step 4: Mental
health specialists, including crisis teams
|
Treatment-resistant, recurrent, atypical & psychotic depression
& those at significant risk
|
Medication, complex psychological interventions, combined
treatments
|
Step 3: Primary care team, primary care mental
health worker
|
Moderate or severe depression
|
Medication, psychological interventions, social support
|
Step 2: Primary
care team, primary care mental health worker
|
|
Watchful waiting, guided self-help, computerized CBT, exercise, brief psychological interventions
|
Step 1: GP,
practice nurse
|
|
|
|
|
|
*Reproduced with permission of the National Institute for Health and Clinical Excellence. Adapted from NICE.
2004, Clinical Guideline 23.
Cognitive Behavior Therapy
Cognitive therapy
is the most extensively researched psychological treatment
for unipolar depression.
Cognitive therapy, focused on dysfunctional beliefs, when
incorporated with components of behavior therapy, is cognitive behavior therapy (CBT).
Gloaguen et al
examined 48 randomized controlled trials that included 2765
patients with MDD or dysthymia.3
The treatment of patients receiving CBT was reported to be superior to wait-listed or placebo-control subjects & other therapies, including
supportive & nondirective psychotherapies, interpersonal
psychotherapy (IPT) & relaxation therapy; CBT wasn't better than simple behavior therapy.
Combined psychological & pharmacological therapies may be useful in minimizing
relapse & recurrence.
Concurrent therapy is only as effective as monotherapy for the treatment of mild to moderate depressive
disorder, but may show a potential treatment advantage when
depression is severe. Sequencing of pharmacotherapy
& psychotherapy shows some benefit in the prevention of relapses & recurrence.
Variants of cognitive
therapy that have been modified to specifically address
residual symptoms in patients appear to be the most effective.4
Interpersonal Therapy
Interpersonal psychotherapy (IPT) was developed in the 1970’s by Klerman
et al as a time-limited, weekly outpatient treatment for MDD.5 IPT
proved more effective than placebo, but there
were no differences between the efficacy of IPT & medication.
Combined therapy
(IPT plus antidepressant medication) & medication alone aren't different. Thus, there's no adjunctive effect for IPT in major depression.6
Antidepressants
Antidepressant drugs tend to be grouped based on pharmacological properties,
although the historical distinction between monoamine oxidase inhibitors (MAOI's) & tricyclic antidepressants (TCA's) tends to
still be employed in describing these older compounds. Newer
drugs tend to be grouped based on their relative effects
on blocking the reuptake of the monoamine neurotransmitters norepinephrine (NE), serotonin
(5-HT) & dopamine (DA).
Table 1 lists common TCA's & Table 2 lists newer drugs.
Monoamines are
released from the terminals of nerves that modulate emotion
circuits in the limbic system. When these neurotransmitters
are released into the synapse, they're rapidly taken back up into the monoamine
nerve cell via proteins called transporters or reuptake
pumps. When the reuptake is blocked by a drug, the neurotransmitter stays in the synapse longer, increasing some of their effects on target limbic-system neurons.
Transporters for
NE, 5-HT, and DA are structurally distinct proteins &
certain drugs are capable of blocking the ability of one or more of these transporters to take back the monoamine intrinsic to that neuron.
Drugs that are
called “selective reuptake inhibitors” tend
to be much more powerful in blocking one transporter &
are less likely to block other transporters, unless very high doses are used.
For example, escitalopram blocks only the 5-HT transporter, even at very high doses,
while paroxetine blocks the 5-HT transporter at low- to
mid-dose levels; at high-dose levels, paroxetine may also
begin to block the NE transporter.7
Venlafaxine & duloxetine are often described as “dual action” drugs because they are both likely to block both the 5-HT & NE transporters
at commonly used doses. Another characteristic that defines
a drug as a “selective” reuptake inhibitor is
the absence of pharmacological effects on various monoamine receptors. This is the reason
why the older TCAs are not described as “selective,”
even though some of them only block NE reuptake (see Table 1).
As presented in Table 3, TCAs block histamine, acetylcholine,
and NE receptors, leading to side effects such as sedation, dry mouth & orthostatic hypotension that aren't present with newer,
truly selective agents.
While NE, 5-HT,
and DA neurons overlap considerably in the brain areas they
modulate, there are well established differences in their distribution. The full significance of this isn't currently understood, but this knowledge has led investigators to search for differences
in therapeutic profile of drugs that are selective serotonin
reuptake inhibitors (SSRIs) & those that have “dual action” on both 5-HT and NE (selective norepinephrine and serotonin reuptake inhibitors – SNRIs).
While levels of monoamines increase within hours of ingestion of the first dose of an antidepressant, the therapeutic response doesn't begin in most patients
until several weeks later.
Current theory
suggests that increased synaptic levels of monoamines
is the first step in a cascade of effects that may ultimately result in alterations in a variety of cellular functions of limbic circuit
neurons; as these circuits begin to function more normally,
there is a corresponding improvement in the symptoms of depression.8
Similar to the selection
of treatment in general, a large number of factors
can influence the choice of an antidepressant. Selection should be based on safety, tolerability, comorbid medical & psychiatric conditions,
cost, ease of administration & an assessment of any
drug-drug interactions.
While the TCA's are as effective as newer drugs, as a class, TCAs are associated
with moderate rates of side effects, often limiting the ability to achieve a therapeutic dose due to their many receptor-blocking properties.
Because TCA's & MAOI's are comparably effective as SSRI's,
NICE guidelines recommend that first-line antidepressant treatment use an SSRI, as
SSRI's have fewer safety concerns.
TCA side effects are listed in Table 3 & those of SSRI's in Table 4.
There are some data
suggesting that SSRI's aren't as effective in the treatment of neuropathic pain.9,10 Meta-analysis of treatment studies in chronic pain suggest that SNRI's & TCA's are more effective than SSRI's; therefore, this should be considered when
treating a patient with MDD & cooccurring neuropathic pain.
The onset of clinically evident antidepressant effect may take 2 weeks or longer after the treatment is begun. An adequate trial of an antidepressant is defined as an adequate dose, over an adequate time period (8-12 weeks), with an adequate blood
level.
When stopping treatment,
tapering off the medication is preferable to reduce the risk of discontinuation syndromes,
especially for those antidepressants with short half-lives.
Long-term prophylactic / maintenance antidepressant therapy is indicated
when depression is recurrent.
NICE guidelines
suggest that patients who've had 2 or more depressive episodes in the recent past & who have experienced significant functional
impairment during the episodes, should continue antidepressant
treatment for 2 years.
For instance, suddenly discontinuing SSRI's can lead to somatic & psychological withdrawal symptoms, “SSRI discontinuation syndrome.” This is more common in shortacting SSRI's than those
with a long half-life, such as fluoxetine.
Seasonal
Affective Disorder
Seasonal Affective Disorder is an extreme form of the "winter blues" depression that occurs at the same time each year. This disorder was only recently recognized as a specific disorder. Since 1982 much has been learned about it & how to treat it.
Those experiencing Seasonal Affective Disorder undergo extreme differences in mood, as if they were split between a summer person & a winter person.
Identifying symptoms
are:
-
Sluggishness
-
Trouble functioning normally
- Impaired functioning
-
-
Difficulty enjoying life
-
-
Loss of energy
-
Inertia
-
-
-
Difficulty getting up in
the Morning
-
-
Carbohydrate cravings
-
-
-
Decreased sex drive
-
Vague physical complaints
-
Marked cravings
for Junk Food
Although a different kind of Seasonal Affective Disorder can occur in the summer, its most common form, winter depression, begins gradually in late August or early September & continues through March or early
April.
Sufferers have been known to
increase their sleep by as much as 4 hours a night & gain more than 20 pounds as they attempt to hibernate the winter away.
Researches suggest that Seasonal Affective Disorder may affect as many as 11 million
people in the US each year. An additional 25 million suffer a milder form, referred to as the winter blues. 4 times as many women experience this disorder
than men & it does seem to run in families.
Causes for Season Affective Disorder
The Chemical or Neurotransmitter, "serotonin" is produced less & less in the body, when the sun doesn't shine as much. Serotonin helps to control moods & sleep.
Geographical location plays
a role in susceptibility - People in Canada & the Northern US are 8 times more likely to fall victim to Seasonal Affective Disorder than those in the sunny southern areas, like Florida.
Seasonal Affective Disorder usually develops in those that are in their early 20's w/the risk
for developing it decreasing w/age.
 Treatment
for Seasonal Affective Disorder
Other forms of treatment
- Taking a walk at lunchtime when the sun is
high. Being outdoors as often as possible
- Exercise as much as possible
- Take winter vacations in places w/sunny longer
days
- Increase the natural light in your home by
trimming low-lying branches near the house & hedges around windows
- Paint your walls w/lighter colors
- Keep warm & enjoy the fun aspects of
winter, such as fires, books & music
- If all else fails, moving to a sunnier climate may be a consideration
- Massage can be a helpful therapy
Electrical emissions
into the atmosphere, negative ions, improve a persons mood & health.
In the last 30 years, scientists have developed small devices that emit negative
ions into the atmosphere of a room. The negative ionizer seems particularly helpful for people w/Seasonal
Affective Disorder (one study showed a 58% reduction in depression) & may be a good supplement to light therapy & medications.
Nutrition & Diet
People with Seasonal Affective Disorder are apt to overeat in the winter, w/special cravings for sweets & starches.
One Seasonal Affective Disorder expert recommends that patients avoid snacking on carb rich
foods & trying to balance their diets as much as possible.
Light Boxes Help Lift the Winter Blues
They ease depressive symptoms caused by seasonal affective disorder, research
finds
By E.J. Mundell
HealthDay
Reporter
SUNDAY,
Jan. 9 (HealthDayNews) -- Few people relish the cold, short days of winter.
For
many, there's good reason: Experts believe that about 1 in 5 Americans suffers from either mild or severe forms of seasonal affective disorder (SAD), which can lead to depression, overeating, weight gain & fatigue.
Fortunately,
this is one condition where drugs aren't the best answer. A new study confirms that simply sitting next to a light-emitting box for a half-hour a day greatly
reduces SAD symptoms.
"Bright light treatment is definitely
the treatment of choice for SAD," said lead researcher Randall Flory, a professor of psychology
at Hollins University, in Roanoke, Va.
Flory's
study, presented at a recent meeting of the American Psychological Society, also found that room air ionizers -- which
increase levels of negatively charged particles circulating in air -- can help ease the symptoms of SAD.
According
to Flory, about 14% of Americans admit to feeling "blah" during the winter months.
"They have the lesser form of SAD, which we just call the 'winter blues,'" he said. "It's not as debilitating as full-blown SAD."
Another
6% to 7% of people may experience full-blown SAD, which can include clinical depression, overeating & related weight gain (up to 40 pounds per season), excess sleep followed
by daytime fatigue, a heightened sensitivity to pain & social withdrawal.
Premenopausal women are 4 times more likely to be affected by SAD than men,
Flory said, suggesting links between SAD & the female hormones estrogen & progesterone.
While popular antidepressants such as Prozac, Zoloft & other selective serotonin reuptake inhibitors (SSRIs) have shown some effectiveness in treating SAD, non-medicinal methods are proving
even more powerful, he said.
In
their study involving 140 women observed over 5 successive winters, the Roanoke researchers compared the effectiveness
of two non-pharmaceutical treatments:
- 30
minutes per day of home exposure to light-emitting boxes
- air-cleaning
devices that also produce negative ionization of airborne particles.
Light
boxes were the clear winner, Flory said, although the air ionizers were also somewhat effective. The results suggest
that a combination of winter conditions - fewer hours of strong sunlight, as well as weaker negative ionization of air - work
together to affect humans in a physiological way.
"From
previous studies, we know that just about everybody, whether they have SAD or not,
shows lowered levels of serotonin in the brain in winter compared with summer," Flory said.
SSRIs work by adjusting brain serotonin levels, so it makes sense that they fight SAD.
But Flory believes most patients are better off using light boxes, since they have virtually no side effects & are much
cheaper than prescription drugs over the long term.
Use
of a standard light box for 5 years works out to "about $60 per year,"
Flory noted, "compared to about $300 to $500 per year for Prozac or another of the SSRIs."
Michael
Young, a SAD expert & director of clinical training at the Illinois Institute
of Technology in Chicago, agreed that "light boxes are certainly the most effective treatment" for seasonal depression.
New
variations on light boxes are giving patients more choices, he said, including devices called "dawn simulators." These
devices - hooked up to a bright light in the bedroom - cause light to slowly grow in intensity during the early morning hours,
much as it would on a spring day.
"There's
been less research done on dawn simulators compared to light boxes, but the research that is out there seems to have
gotten positive results," said Young, who is also president of the non-profit Society for Light Treatment and Biological Rhythms.
He
stressed that scientists still aren't sure why some individuals are more deeply affected by winter than others.
"For
example, there are many of us that have the physiological changes but not the psychological ones - they'll say 'Yeah,
winter is crummy, I sleep more, I want to eat sweets all the time, but, hey, that's the way it goes.' They aren't depressed."
Others
experience those physical signs, plus the debilitating depression that marks severe SAD. Young believes some people may simply be more neurologically vulnerable
to season-to-season changes than others.
For
most, light boxes provide an easy, harmless solution, the experts agree.
"You
just sit three for a half hour a day, that's all it takes," Flory said. "It's not even necessary that it's there in front
of you --- only that the light somehow enters your eye. In fact, when we do studies, the light box is over to the side while
people watch a movie on television."
More
information
To
learn more about SAD, visit the National Mental Health Association (www.nmha.org ).
A Mood Journal
With the Mood Disorders or Affective
Disorders, it's sometimes helpful to keep a "mood journal." A mood journal can detect
patterns in sleeping, eating & exercising habits that may produce a certain mood pattern.
Keeping track of situations,
anxious times, extreme fears & other triggering factors can clue you into what sets off certain types of moods so that one can identify triggers &
change their behavior.
More Articles about Mood or Affective Disorders
What is a Nervous Breakdown?
Derek Wood RN, BSN, PhD Candidate
What is Bipolar Disorder?
Derek Wood RN, BSN, PhD Candidate
What Is Depression (Major Depression)?
Derek Wood RN, BSN, PhD Candidate
Depression: Causes, Symptoms, and Treatment
Joseph M. Carver PhD
Teen Suicide
Richard O'Connor PhD
Antidepressant Medication
Richard O'Connor PhD
What Is Cyclothymia?
Derek Wood RN, BSN, PhD Candidate
Aggressive Healing: Taking An Active Role In Your
Treatment
Sean Bennick
Six Simple Steps to Help Fight Depression
Richard O'Connor PhD
In Harm's Way: Suicide in America
National Institute of Mental Health
Teenage Suicide: Identification, Intervention and
Prevention
Educational Resource Information Center
Overcoming Depression and Finding Happiness
Chuck T. Falcon
Depression: What Every Woman Should Know
National Institute of Mental Health
Six Tips for Living with a Depressed Person
Richard O'Connor PhD
Incremental Disclosure: Talking About Your Mental
Illness
Sean Bennick
What Is Dysthymic Disorder (Dysthymia)?
Derek Wood RN, BSN, PhD Candidate
NIMH Medications Booklet: Index of Medications
National Institute of Mental Health
Going to Extremes: Bipolar Disorder
National Institute of Mental Health
Bipolar Disorder
National Institute of Mental Health
Depression: Causes of Depression
iSyke
Depression in Children and Adolescents: A Fact
Sheet for Physicians
National Institute of Mental Health
NIMH Medications Booklet
National Institute of Mental Health
Undoing Depression: Facts About Depression
Richard O'Connor PhD
Depression Among Children
Richard O'Connor PhD
Older Adults: Depression and Suicide Facts
National Institute of Mental Health
The Biological Basis of Affective Disorders and
Their Treatments: Clinical Paper
Derek Wood RN, BSN, PhD Candidate
The Loss of Joy: Anhedonia
Richard O'Connor PhD
Suicide Facts
National Institute of Mental Health
What Is Schizoaffective Disorder?
Derek Wood RN, BSN, PhD Candidate
Real Men. Real Depression.
National Institute of Mental Health
College Depression: What Do These Students Have
in Common?
National Institute of Mental Health
College Depression: What Do These Students Have
in Common?
National Institute of Mental Health
A New Look at the Body
Ronald L. Hoffman MD, CNS
Mood Disorders
National Mental Health Information Center SAMHSA's
Women Hold Up Half the Sky
National Institute of Mental Health
What Is Dementia?
Derek Wood RN, BSN, PhD Candidate
Overcoming Depression
Stuart Sorenson RMN
Depression Research at the National Institute of
Mental Health
National Institute of Mental Health
Depression Can Break Your Heart
National Institute of Mental Health
Suicide and the Exceptional Child
Educational Resource Information Center
Women and Depression Fast Facts
National Mental Health Information Center SAMHSA's
Understanding "Earned Depression"
Stuart Sorenson RMN
Frequently Asked Questions about Suicide
National Institute of Mental Health
Major Depression in Children and Adolescents
National Mental Health Information Center SAMHSA's
Depression
National Institute of Mental Health
Supporting Girls in Early Adolescence
Educational Resource Information Center
Bipolar Disorder: What Is Bipolar Disorder?
iSyke
Premenstrual Dysphoric Disorder (PMDD)
Donnica L. Moore MD
Depression: Evaluation and Treatment of Depression
iSyke
Depression and Diabetes
National Institute of Mental Health
Positive Thinking
Chuck T. Falcon
Let's Talk About Depression
National Institute of Mental Health
Suicide and Sudden Loss: Crisis Management in the
Schools
Educational Resource Information Center
Depression in a Social World
Rod Cowen
Depression and Parkinson's Disease
National Institute of Mental Health
Depression: Understanding Depression
iSyke
Undoing Depression: When Parents Are Depressed
Richard O'Connor PhD
What to do When a Friend is Depressed
National Institute of Mental Health
Prioritizing: Getting Somewhere
Richard O'Connor PhD
What to Do When an Employee is Depressed: A Guide
for Supervisors
National Institute of Mental Health
Depression and HIV/AIDS
National Institute of Mental Health
Depression: The Unwanted Cotraveler
National Institute of Mental Health
The Invisible Disease: Depression
National Institute of Mental Health
|
 |
|
Postpartum Depression: (Is that what they call "the baby blues?")
It's important to distinguish between the normal "baby blues" & true depression. The baby blues are characterized by a short period of volatile emotions, commonly occurring between the 2nd & 5th postpartum days & affecting between 80 & 90 % of new mothers.
In contrast, postpartum depression (PPD) usually begins at 4 to 8 weeks postpartum (but sometimes later in the 1st
year) & can persist for more than a year. PPD affects from 10 to 16 % of new mothers or 500,000 women a year in the US.
Some studies
have shown that postpartum depression not only affects the mother,
but also the baby.
Postpartum depression interrupts the bonding process between mother & infant. Studies
are being performed now to determine whether these infants are likely to later experience developmental problems, including behavioral disturbances, ill health, insecure attachments & depression because of the interruption of bonding w/their mother.
Women most likely to develop postpartum depression are those that:
- Gave birth to infants w/physical problems
- Have difficult temperaments
Other important determining factors
are the social situation of the mother, as to whether she was experiencing great stress about her financial or career situation
or problems that existed w/her partner or father of the child.
The problem that has arisen
in the past is that many mothers feel guilty or shamed at their feelings while experiencing postpartum depression & are afraid to get
help.The percentage of those who recover w/treatment is very high. Treatments include:
- Or a combination of the 3 above
The best approach is to prevent
PPD in the first place & social support is one of the most vital factors in prevention. Here are some suggestions:
- respond to your baby's crying
- set aside time for each other
Symptoms of Postpartum Depression
- Difficulty sleeping or sleeping excessively,
even when baby is awake
- Extreme concern or worry about the baby or a lack of interest or feelings for the baby
- Anger toward the baby, your partner, or other family members
- Fear of harming your baby. These thoughts may be recurrent, & you may be afraid to be left alone in the house w/your baby.
- Difficulty concentrating or remembering
- Lack of energy or extreme fatigue
- Loss of interest in hobbies or other usual activities
- Numbness or tingling in your arms or legs
- Calling pediatrician constantly because of concerns over your baby, w/an inability to be reassured
- Exaggerated high & low moods
If you're experiencing
even a few of the symptoms above, you should call your doctor, so that he/she can reassure you, or so that you can come up
w/a treatment plan together.
Get Postpartum Help
As a new mom, you
need help w/household chores & meal preparation for at least 3 - 4 weeks so you can establish a rewarding interaction w/your
baby & establish feedings.
Today many partners
arrange to take 1 or 2 weeks of vacation time right after the baby's birth, & a mother, mother-in-law or friend may also
pitch in for a few days. While not to be underrated, such short-term support may not give you sufficient time to become acquainted w/your new baby.
That's why we urge
parents to consider other sources of home help. Hiring a teenager or older woman for 3 hours a day 3 to 5 days a week can
remarkably improve your life & your baby's. In addition, postpartum doulas are available in many cities. Ask your healthcare
provider or childbirth educator for a referral.
Seek Breastfeeding Help
Other women who've
succeeded in breastfeeding can be helpful to a new mother. Many communities also have lactation consultants. La Leche League,
at (800) LA LECHE, can provide answers & referrals.
Respond to Your
Baby's Crying
When infant crying
becomes stressful for you, try keeping your baby close by using a sling-type carrier. One study showed that when 3 week-olds were carried for
3 extra hours a day, at times unrelated to crying or feeding, they cried 50 % less (particularly
in the evening hours) than a group who had not been carried the extra 3 hours.
Another study showed
that if a mother intervened w/in 90 seconds after a baby began to cry, the crying would stop quickly. If she waited longer
than that, a prolonged period of calming was often necessary before the crying stopped.
Set Aside Time for Each Other
It's important for you & your partner to talk often about your feelings & needs. A 5 minute rule may be helpful:
- Each evening, one partner takes 5 minutes to speak about feelings & concerns of the day, while the other partner just listens attentively.
- After 5 minutes, reverse the process so each person receives
a turn.
-
For some parents,
visualization, meditation & relaxation breathing techniques help; others prefer physical activity to reduce stress.
Relaxation processes such as imagery & self-hypnosis can also help to reduce tension on a daily basis. You can't be relaxed & tense at
the same time!
more info about postpartum depression
click here
Dads Have Postpartum Depression, Too
Depression in Father Doubles Risk of Child's Later Behavior Problems
By Daniel DeNoon
WebMD Medical News
June 23, 2005 -- Postpartum depression doesn't just happen to women.
Fathers, too, can be depressed in the weeks following the birth of a child. And that depression can mean trouble for the child, report Paul Ramchandani, MD, consultant in child & adolescent psychiatry at the University
of Oxford, U.K. & colleagues.
"We found a doubling of risk
of behavioral problems in children of fathers who had been depressed 8 weeks after the birth," Ramchandani tells WebMD. "The
thing that is striking is there is the same effect for fathers as has been established for mothers."
The researchers analyzed data
collected as part of the Avon Longitudinal Study of Parents & Children. The study, based on questionnaires & psychological
tests, included 8,431 fathers, 11,833 mothers & 10,024 children.
Data were collected 8 weeks
after the birth of a child, 21 months after the birth & when the child was 3 years old.
The effect of a father's postpartum depression is not quite the same as that of a mother's depression. (these two links take you to WebMd's website articles.)
"The mothers' depression effect is slightly higher than in fathers," Ramchandani says. "Depression in mothers seems linked to a range of later problems in both boys & girls. The father effect seems confined to boys &
to behavior problems - but this isn't definitive."
Postpartum Depression:
A Family Problem
The findings don't surprise
Shari I. Lusskin, MD, director of reproductive psychiatry at NYU School of Medicine. Postpartum
depression, Lusskin says, isn't a mother's problem; it's a family problem.
"For a change, this study
turns the spotlight away from women onto the rest of the family constellation," Lusskin says. "That is very important. Women
get saddled w/all the blame, which further stigmatizes postpartum depression & leads
to women not getting diagnosed or treated. So now we are spreading the blame."
Nobody is really to blame,
Lusskin is quick to point out. Mothers & fathers don't get depressed because they're bad parents.
Treatment for Mom &
Dad
"Depression is a medical condition,
not a moral condition," Lusskin says. "If you feel that your mood isn't what it should be after the birth of a child, or if
you feel your partner's mood is abnormal, seek help & seek help early. The sooner you get treated, the better &
the fewer consequences for the mother, the father & the child."
Ramchandani, too, argues that
the focus should be on the family.
"This study flags one thing:
There is an effect of fathers' depression," he says. "At the time of childbirth we focus on mothers. But actually we should be paying attention to the wider family.
The birth of a child is a fantastic thing, but it's also a time of intense change & that impacts the whole family."
Treatment, Lusskin says, should
involve both partners -- not just the one who seems to be depressed.
"If you seek help, advise
your doctor to meet your partner whenever possible, to assess the partner's emotional well-being & involve the partner
in your recovery," she says. "A woman may be depressed but if her partner is even more depressed & nonfunctional, she has to take care not only of herself but her partner & can't rely on the partner to help w/her
own depression."
Even if a person's partner
isn't depressed, involving your significant other in postpartum-depression treatment minimizes mixed messages
& unintentional interference w/treatment.
"For example, if you're going
to give a woman antidepressant medications during breastfeeding, it's good to explain to her partner why you're making this
risk / benefit choice, so the partner doesn't misunderstand & sabotage treatment," Lusskin says.
a personal observation from me, kathleen, a mother of 5...
with my experiences of mental disorders throughout
my life, i sat back to think about whether i had experienced post partum depression after any of my pregnancies.
in an honest attempt to convey my own personal experience - i must say
that i was depressed after my pregnancies, to a point, as well as throughout my pregnancies... the reason?
people have babies for different reasons. you'd think that people have
babies because they love each other & want to start a family. i honestly believe in my situation that i believed that
it was my "duty" as a wife, my "lot" in life because i was a woman -
to bear children.
when i was 18 & wanted to go to college, my father laughed at me
& retorted, "i won't help you go to college! girls aren't supposed to go to college. they're supposed to get married &
have children, so go do that!"
i did just that. mad as hell, i met a guy & married him 6 months
later. in my anger, i put myself in one helluva bad situation. it's just a fact that i honestly believed that if i had a baby
that my marriage would be better. i believed that if i just had his baby, that i would be happy, he would be happy & we
would live happily ever after.
i did have unrealistic expectations about pregnancy. i thought my husband
would spoil me, be so in love with me because i was having his baby. i thought it would be the perfect time in my life. it
wasn't.... it drove us farther apart. everything i expected was wrong.... totally unrealistic.
then when the baby was born, it wasn't a boy like he wanted. he was disappointed
in me for not having a boy. don't get me wrong. i loved being a mother & i loved having the baby to love - but that baby
didn't make my marriage better at all.
these expectations were becoming more & more apparent to be so unrealistic
that i was depressed about it all. i think this was a huge factor in my depression being post partum. eventually i just settled
for the fact that life wasn't like i thought it should be.
my reasoning for telling you this is...
what i didn't realize in my depression
was that the negative situation in my marriage, in my own sense of self & my low levels of self esteem, were damaging
to my baby.
why didn't i realize that throughout my pregancy my baby was
exposed to high levels of stress, anger, arguments between my husband & myself & my incredible loneliness, aching
unfulfilled needs were tragically felt by the baby growing within my womb....? no one told us that when we were growing up
- that's why...
click here to read about the importance of attachment relationships, if you are experiencing post partum depression it is very
important to seek help. you're not the only one affected by post partum depression.... & depression during your pregnancy
- click here to learn more about that..... & believe me... it's your responsibility as your baby's mother to give your baby
the best start in life possible... take post partum depression seriously!
god bless
kathleen
Cyclothymic Disorder (click here to read a more in depth description of Cyclothymia)
Cyclothymic Disorder is a chronic bipolar disorder consisting of short periods of mild depression &
short periods of hypomania (lasting a few days to a few weeks), separated by short periods
of a normal mood.
Individuals w/Cyclothymia
(thymia: from the Greek word for the mind) are never free of symptoms of either depression or hypomania for more than 2 months at a time. Diagnostic criteria is as follows:
- For at least 2 years, there has been the experience
of many periods of hypomanic symptoms & many periods of low mood that don't fulfill criteria for Major Depressive Disorder
- The longest the patient has been free of mood swings
during this period is 2 months.
- During the first 2 years of this disorder, the patient hasn't fulfilled
criteria for Manic, Mixed, or Major Depressive Episode.
Description of depressive episode
If 5 (or more) of the following symptoms have been present during the same 2-week period & represent a change
from previous functioning:
- at least 1 of the symptoms is either (1) "depressed mood" (2) loss of interest or pleasure
Note: Don't include symptoms that are
clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
- depressed mood most of the day, nearly every day - this includes feeling sad or empty, on the verge of crying - as noticed by the individual themselves or by others
Note: In children & adolescents, can be
irritable mood.
- a very visible diminished interest or pleasure in all, or most of ones'
activities most of the day, occurring nearly every day
- a change in eating habits - significant weight loss when not dieting or weight gain, meaning a change of more than 5% of body weight in a month; or
decrease or increase in appetite nearly every day. Note: In children look for the failure to meet expected weight gains.
- insomnia or hypersomnia nearly every day
- an inability to physically function at a normal level of movement, not merely subjective feelings of
restlessness or being slowed down, but a marked experience of lethargy
- fatigue or loss of energy nearly every
day
- feelings of worthlessness or excessive or inappropriate guilt, can sometimes be delusional, but being experienced nearly every day - these episodes are of an extreme nature, not
merely self-reproach or guilt about being sick
- diminished ability to think or concentrate, or indecisiveness, nearly every day - this includes impaired brain functioning that makes the individual
unable to think clearly or make proper decisions - impaired brain function can be caused by chemical imbalances in brain due to long depressive episodes, traumas or chronic anxiety disorders - this diminished inability to think can be treated with medication to maintain a proper balance of chemicals in the brain
- recurrent
thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
|
|
|
|
|
|
|
|
|
|
|
|
