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Mood Disorders - Unipolar and Bipolar depression

Depression is a very common mental disorder. It can be reactive — as a response to some kind of stress or trauma, or it can appear as part of another illness.

Unipolar Depression

The symptoms of unipolar depression falls into the following categories:

Emotional — sadness, melancholy and self-involvement
Motivational — lack of will, passivity
Cognitive — lack of self-esteem
Somatic — sleep disturbances, loss of appetite and subsequent loss of weight

Possible causes

Genetic — more evidence from twin studies for bipolar rather than unipolar
Neurochemical — depletion of noradrenaline may cause the lack of motivation. Antidepressants are usually MAO inhibiters (MonoAmineOxidase — a chemical indicated in the suppression on the ‘happy’ chemicals such as serotonin) and help build the mood enhancing chemicals in the brain.
Brain anatomy — depressed people seem to have relatively little activity in the left frontal cortex
Environmental — factors such as ‘learned helplessness’ can contribute to feelings of depression and usually follows some kind of environmental stressor.

Bipolar Depression

Symptoms:

There are two phases to bipolar depression. The depressive phase is severe and is indicated by suicidal feelings, the manic phase is indicated by euphoria, hyperactivity, sleeplessness and socially unacceptable behaviours. In between phases there may well be periods of normality. The severe mood swings can be very disruptive to normal life. Many famous and creative people have been diagnosed with this condition, Winston Churchill and Spike Milligan to name two. It seems that periods of manic creativity are followed by periods of deep depression.

Possible causes include:

Genetic — Allen (1976) found that MZ twins are more likely to suffer from the illness than DZ twins.
Genetic and neurochemical — Egeland et al. studied the Amish people in America and found that part of chromosome 11, which leads to a lack of certain neurotransmitters, could be found in 3% of those studied. The gene responsible for the production of adrenaline also found on this chromosome.
Homeostatic trigger — Wehr et al. (1987) suggested that the swings between mania and depression may be caused by sleep phase alterations.
Environmental factors — Allen (1976) showed that whilst the genetic component is the major factor in bipolar depression, environmental factors do act as a trigger.

Treatment

The main treatment of this disorder reflects is biological origins. Sufferers are usually treated with Lithium for both the mania and the depression, although it may not work in 20% of the cases treated. This drug has serious side effects.

Anxiety Disorders

There are many forms of anxiety disorders and these include Obsessive Compulsive disorders, phobia’s and panic disorders.

Obsessive Compulsive disorder

Uncontrolled feelings often associated with what seems like a senseless ritual such as hand-washing or compulsive cleaning. These are often attempts to control feelings. Obsessions are often symptomatic of underlying feelings of anxiety, often the result of conflict. Superstitious behaviour is often the main symptom and obsessions are learned in the same way as other, more acceptable superstitious behaviours such as not walking under ladders.

Phobias

Phobias are symptomised by irrational and persistent fear, which seems to be out of all proportion to any danger. DSM-IV categorises three different kinds of phobia — agoraphobia (fear of open places) the most common and associated with panic attacks; social phobia ( fear of eating or talking in public places) and specific phobia’s such as Xenophobia (fear of strangers).

It is thought that most phobia’s are learned and therefore conditioned emotional responses. Treatment usually focuses on drugs to reduce anxiety and cognitive counselling or psychotherapy, which helps re-condition or re-interpret the events that may have caused the phobia.

Panic Disorder

Panic disorder is where anxiety may be experienced that has no specific cause. The sufferer experiences acute apprehension and a range of physical disorders such as racing heart, breathlessness and dizziness. In some cases, the sufferer may feel that they are suffering from a heart attack. Causes may be genetic (31% of MZ twins show genetic influence as opposed to none in DZ twins). Also seems that causal factors may be neurochemical — panic attacks can be induced using a drug called sodium lactate. Drugs are also effective in the control of panic attacks.

Antisocial personality disorder

Most of the other disorders involve the person feeling some kind of suffering, this disorder is associated with someone who does not feel any disturbance in their emotions, rather the opposite. These people are usually involved in some criminal activity and are a danger to society. It is only diagnosed in those over 18, although there is one childhood disorder that fits this description.

The symptoms include the following:

Emotional flatness and lack of understanding for others
Lack of conscience and lack adult moral reasoning
Antisocial behaviours that are motiveless or senseless
Behaviours in childhood such as truancy, lying and vandalism become more serious in adulthood.

Possible causes include the following:

Genetic — studies on twins found that MZ twins were more likely to show concordance than DZ twins
Neurochemical — Lykken (1957) found that sociopaths seemed unable to learn from painful experiences such as electric shocks and Schachter and Latane (1964) found that there subjects were under-aroused.
Neuroanatomical — Some studies have shown that the under-arousal may be due to a dysfunction of the limbic system, which involved in the processing of emotion. Robins (1966) found that sociopaths show an improvement in behaviour later on in life, possible due to maturity of the cerebral cortex.
Environment — the condition may arise from an inability to learn from punishment — due to under-arousal. It may also be due to social deprivation — most sociopaths grow up in low socio-economic household.
Treatment includes physical punishment, which is ineffective, imprisonment, also viewed as ineffective as it offers contact with other criminals and psychotherapy, also seen as ineffective, as there is a lack of the kind of maturity needed for the necessary insight.

Disassociative Disorders

These kind of disorders include Multiple Personality Disorder. The main symptom for this disorder is where there is more than one personality existing in one person. Each personality takes control of the functioning of the person and may not be aware of the others that may exist within the person. Possible causes may lie in some kind of emotional trauma in early childhood (97% of sufferers have endured childhood abuse). The subject creates a trance like state and is highly susceptible to hypnosis. The trance like states are usually in response to some kind of pressure, often being used as a coping strategy. Treatment is often difficult and is usually through psychotherapy. Some cases are never resolved.

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last update April 5, 2003