The Difference between Bipolar Disorder and Unipolar Disorder - Essay Example

Bipolar disorder Bipolar disorder involves cycles of depression and mania, or excitement. The difference between bipolar disorder and unipolar disorder, also called major depression, is that bipolar disorder involves energized or activated mood states in addition to depressed mood states. Mood swings cause impairment not only in ones mood, but also in ones energy level, sleep pattern, activity level, social rhythms and thinking abilities. Estimates for the lifetime risk of developing bipolar disorder range from 0.6 per cent to 1.2 per cent. Bipolar disorder is a serious mental illness distinguished by repeated episodes of despair, mania, along with mixed symptom states. These episodes cause unusual and severe shifts in mood, energy, and behavior that interfere drastically with normal, healthy functioning. Bipolar disorder is often a chronic, recurring condition. Sometimes, the mood switches are vivid and rapid, but most often they are steady. When a person is in the depressed phase, the individual can experience any or all of the symptoms of a depressive disorder. When in the overexcited cycle, any or all of the symptoms listed under mania may be experienced. Mania affects a person’s thinking, judgment, and social behavior in ways that cause serious problems and discomfiture. Bipolar disorder is usually subdivided into bipolar I and bipolar II disorders (Mitchell et al. 207–210). The usual form of bipolar disorder is referred to as bipolar I. Bipolar II is a syndrome in which the affected person has repeated depressive episodes interrupted by what is called hypomania. These exhilarated states in bipolar II do not fully meet the criteria for the complete manic episodes that occur in bipolar I. There are various symptoms observed an affected manic person. It is not necessary that all the symptoms should appear in a person who is affected. Some people experience a few symptoms and some many symptoms. Following are some of the symptoms of manic or depressed individuals: Persistently sad, anxious, or blank mood. Feelings of hopelessness, distrust. Feelings of guilt, insignificance, helplessness. Loss of interest or pleasure in hobbies and activities that were once enjoyed. Sleeplessness, early-morning awakening, or oversleeping. Decreased appetite and/or weight loss, or overeating and weight gain. Exhaustion, decreased energy, being slowed-down Thoughts of death or suicide, suicide attempts. Restlessness, irritability. Difficulty concentrating, remembering, making decisions. Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain (MedicineNet). Risk Factors for Bipolar Disorder Studies have shown that bipolar disorder is diagnosed in equal numbers of men and women. It is not known exactly why major depression seems to affect more women than men while mania affects both men and women equally. One of the obvious reasons may be that mania, with its very prominent symptoms it is much more easily recognized than depression. Depression may also go unrecognized in men especially under alcoholic conditions. Previous episode: If an individual have had major mania once before, there is high chances of developing it again. Heredity: Individuals with relatives who have had bipolar disorder have a greater chance of developing it themselves. Immediate relatives such as parents, siblings, children of those with bipolar disorder are estimated to be 8 to 18 times more likely to develop the condition than others who do not have any such family incidences (ISMHO). Other factors: There are several other factors that determine the occurrence of depression and mania. For instance, adverse environmental influences that may increase susceptibility of individuals to develop depression include recent or past life events and experiences of loss and failure such as: grief; problems in relationship; failure in school; social isolation; socioeconomic factors such as poverty and unemployment (Winefield; Rutter 316–331; Schofield & Bloch 405–406) and also taking care of a person with chronic physical or mental disorder. Negative thoughts and evaluations of the self are considered to be significant psychological factors that cause depression (Beck). Lack of effective coping responses to problems that an individual faces in life is also likely to add to the onset of depressive disorder, especially if the preferred coping style is aimed to avoid problem solving and reinforces feelings of helplessness and failure (Folkman et al 571–579, Peterson et al.). Proper treatments are available that greatly reduce the suffering caused by bipolar disorder, and can usually prevent its disturbing complications. However, bipolar disorder is often not recognized by the patient, relatives, friends, or even physicians. People with bipolar disorder may suffer for years without proper treatment. Also, many patients do not respond to at least one drug, and many show no response to several. This means that combination treatment is often the rule because a combination of different drugs with different methods of action can be more effective without increasing the risk of side effects. One of the drugs used is lithium for mania, but mood stabilizing anticonvulsants is also widely used. Psychotherapy, in combination with medication, often can provide additional benefit. As an addition to drug treatment, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family (Cilag, 1997). Therefore people those who suffer from manic/bipolar disorder may opt for a combination treatment along with psychotherapy. Bipolar disorder is rare in young children, but more common in adolescents. Detection can be problematic, particularly given that the presentation is similar to major depression. As a result, youth with bipolar disorder may not be diagnosed accurately until they reach a psychiatric inpatient unit (Burns et al. 199-254). Bipolar disorder affects more than two million Americans. Bipolar disorder can also badly affect spouses, family members, friends, and people in the workplace. It usually begins in late adolescence though it can start in early childhood. An equal number of men and women develop this illness and it is found among all races, ethnic groups and social classes (DBSA). A brief history of bipolar disease Bipolar disorder is perhaps one of the oldest known illnesses. It was first noticed as far back as the second century. Aretaeus of Cappadocia (a city in ancient Turkey) first recognized some symptoms of mania and depression, and felt they could be linked to each other. His findings went unnoticed and unsubstantiated until 1650, when a scientist named Richard Burton wrote a book, The Anatomy of Melancholia, which focused specifically on depression. His findings are still used today by many in the mental health field, and he is called the father of depression as a mental illness.  Jules Falret in 1854 coined term "folie circulaire" (circular insanity), and established a link between depression and suicide. His work led to the term bipolar disorder, as he was able to find a distinction between moments of depression and heightened moods. He recognized this to be different from simple depression, and finally in 1875 his recorded findings were termed Manic-Depressive Psychosis, a psychiatric disorder. Since Falret found the disease seemed to be found in certain families he was the first person to recognize very early that there was a genetic link (caregiver.com). The scientific revolution of the 18th century, the 19th century laid the groundwork for modern views of bipolar disorder. Falret and Baillarger suggested (independent of each other) that mania and depression were part of the same disease. Subcategories of bipolar disorder were also identified: Mendal (1881) described "hypomania" as "that form of mania that typically shows itself only in the mild stages abortively, so to speak" (quoted in Goodwin and Jamison, 1990), and a year later Kahlbaum re-described cyclothymia as episodes of both mania and depression that did not end in dementia (Holman). Francois Baillarger believed there was a major distinction between bipolar disorder and schizophrenia. He characterized the depressive phase of the disease. It was this achievement that allowed bipolar disorder to receive its own classification from other mental disorders of the time.  In 1913, Emil Krapelin established the term manic-depressive, with an exhaustive study surrounding the effects of depression and a small portion about the manic state. Within fifteen years, this approach to mental illness was fully accepted and became the prevailing theory of the early 1930’s (caregiver.com). Kraepelin was also the first to separate bipolar disorder from what he called "dementia praecox," which we now know as schizophrenia. He believed that schizophrenia had a "deteriorating course" in which mental function continuously declines, and bipolar disorder (which he termed "manic depression," which is now seen as comprising a variety of mood disorders, including bipolar disorder) patients experienced the illness in severe episodes followed by symptom-free intervals. Later, in 1924, Eugen Bleuler suggested that manic depression and dementia praecox were on a continuum or spectrum, and that a person could be at different points on that spectrum at different times. He also extended Kraepelins category of manic depression into subcategories that would lead to the future classification of subtypes within bipolar disorder (Holman). Treatments for bipolar disease Mental illness was believed to be caused by loss of status or money during the early Egypt.  The recommended treatment was to "talk it out", and to turn to religion and faith.  Suicide was accepted at this time. In the Old Testament, despair and cognition was the accepted cause of mental illness; faith the cure.  Homer believed that mental illness was caused by Gods taking a mind away.  He offered no treatment. Demon possession was the theory of Aeschylus to explain Mental illness and exorcism the cure. Socrates believed that mental illness was heaven-sent and not shameful in the least.  He believed it to be a blessing, and therefore no treatment was required. According to Aristotle, Melancholia was the cause of mental illness, and music was the cure. It was the belief of Hippocrates that both melancholia and natural medical causes contributed to mental illness.  He advised abstinence of various types, a natural vegetable diet and exercise as treatment. Celsus believed mental illness to be a form of madness to be treated with entertaining stories, diversion and persuasion therapy. Psychic functions of the brain were considered by Galen to be the foremost cause of mental illness.  Treatment consisted of confrontation, humor and exercise.  During the 18th and 19th centuries, hospitals and asylums assumed the care of the mentally ill.  The first hospital to accept and treat mentally ill patients was the Pennsylvania Hospital founded by the Quakers in 1752.  Treatment there was the same as for other patients…clean surroundings, good care and nutrition, fresh air and light…in short the mentally ill were treated as human beings. The real work on treatments started only in the 1940s and 50s. During this time medication was discovered that helped the severely mentally ill.  Great hope was placed in these drugs, though they did not offer a complete cure for the disorder, they were quite successful at ameliorating some of the symptoms.  These medicines, the anti psychotics, are still in use today.    ECT and insulin therapy was also discovered, and went a long way to helping especially those in depression.  ECT, in a refined and safer mode is also practiced today. The stigma of mental illness has not been eradicated, though the move to equate mental illness with physical illness has resulted in greater understanding on some fronts.  We still have a long way to go in this area (Bloom and Schafer). The modern day treatment s include mood stabilizer treatment that can dramatically halt the turbulent course of bipolar disorder, reduce the risk of suicide, increase life expectancy, increase productivity and functioning and 40-75% of patients who respond to mood stabilizers achieve a reasonable occupational status and ability to live independently (Goldberg et al. 379-384). Lithium is a tried and tested medication, efficacious in acute mania, prophylaxis of classical bipolar disorder (Groff et al. 16-19) and when the disorder has a mania/hypomania-depression euthymia course (Faedda et al. 1237-1239). It has proven, significant antidepressant properties when compared with Divalproex and Carbamazepine. However the high frequency of non-adherence to lithium treatment (30-50%) is often associated with adverse effects, particularly in the early stages of treatment. Cognitive impairment, tremor, acne, polyuria and polydipsia, muscle weakness and weight gain can be associated with noncompliance, particularly in adolescents, young adults and the elderly. (Gitlin et al. 363-368). In general, patients with bipolar disorder have been reported to have neurocognitive deficits; but, there exist confusion whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, two of the commonly used mood stabilizers in the treatment of bipolar disorder, have been associated with cognitive impairment. It was found that both lithium and valproate may be linked with immediate verbal memory impairment, sparing other cognitive functions. Besides, presence of a similar verbal memory shortage in the lithium and valproate groups hints that this deficit might be intrinsic to bipolar disorder or that the two medications influence immediate verbal memory similarly (Senturk et al. 136–144). Divalproex Sodium (DVPX) has emerged as an effective broad-spectrum alternative to Lithium. It is effective in acute mania (Bowden et al. 918-924), rapid cycling and mixed states, with comorbid substance abuse and in secondary bipolar disorder (Calabrese et al. 245-305). Gastrointestinal, sedative and hematological (thromobocytopenia and leucopenia) side-effects with Divalproex (DVPX) appear to be associated with serum levels above 700 mmols/l (Bowden et al 1098-1101). There are several other treatments present today such as Carbamazepine (CBZ), ECT, Typical neuroleptics, Benzodiazepines, Antidepressants etc. and it has definitely advances from the earlier treatments. These treatments have definitely made their impression in medical science today and have helped many who suffer from it. When compared to the earlier days when these diseases were left to the action of God, treatments today has advanced a lot. Still there is a long way to go in case of treatments for bipolar disorder. With the present day advancement in medical sciences and genetics, in future it would be possible that such disorders are diagnosed and treated at a very early stage even before the symptoms are shown. Medical science and its advancement has helped many of the dreaded diseases under control, it is proposed that the future research in the field of mental health will also be helpful for patients to diagnose and treat the disease and also find a complete cure for the disease. Work Cited Beck ,A.T. Depression: Clinical, experimental, and theoretical aspects. Harper & Row, (1967) New York. Bloom, A. and Schafer, D. History of Mental Illness and Early Treatment in a Nutshell (1998) [10 November 2007] Bowden, C.L., May, R.B., Sunder, T.R. Hematological Manifestations of Long-Term Valproate Therapy. (1993) Epilepsia. 34. 1098-1101. Bowden, C.L., Brugger, A.M., Swann, A.C., Calabrese, J.R. et al. Efficacy of Divalproex vs Lithium and Placebo in the Treatment of Mania. JAMA. (1994). 271:12. 918-924. Burns, B.J., Hoagwood, K., and Mrazek, P.J. Effective Treatment for Mental Disorders in Children and Adolescents, Clinical Child and Family Psychology Review, (1999) Vol. 2, No. 4,:199-254. Calabrese, J.R., Fatemi, S.H., Kujawa, M., Woyshville, M.J. Predictors of Response to Mood Stabilizers. J Clin Psychopharmacology. (1996). 16. 2. Suppl 1. 245-305. caregiver.com, Brief History of Bipolar Disorder. [10 November 2007] Cilag, J. (1997) Bipolar disorder, (1995). [12 November 2007] DBSA, Frequently Asked Questions February 07, 2006, Depression and Bipolar Support Alliance. [10 November 2007] Faedda, G.L., Baldessarini, R.J., Tohe, M., Strakowski, S.M., Waternaux, C. Episode Sequence In Bipolar Disorder and Response to Lithium Treatment. Am J Psychiatry. (1991) 148. 1237-1239. Folkman, S., Lazarus, R.S., Gruen, R.J. et al Appraisal, coping, health status and psychological symptoms. Journal of Personality and Social Psychology, (1986) 50(3): 571–579. Gitlin, M.J, Jamison, K.R. Lithium Clinics: Theory and Practice. Hosp Comm Psychiatry. (1984). 35:363-368. Goldberg, J.F., Harrow, M., Grossman, L.S. Course and Outcome in Bipolar Affective Disorder: A Longitudinal Follow-Up Study. Am J Psychiatry. (1995) 152: 379-384. Groff, P., Alda, M., Grof, E., Fox, D., Cameron, P. The Challenge of Predicting Response to Stabilizing Lithium Treatment: the Importance of Patient Selection. Br J Psychiatry. (1993). 163:16-19. Holman, M. (2006) Bipolar Disorder/Manic Depression: History, Symptoms, Effects and Treatments. [10 November 2007] ISMHO, (2004) All About Depression, [10 November 2007] MedicineNet, (2007) Depression, [10 November 2007] Mitchell P.B., Malhi, G.S. and Ball, J.R. Major advances in bipolar disorder. MJA 2004; 181: 207–210. Peterson, C., Maier, S.F. & Seligman, M.E.P. Learned helplessness: A theory for the age of personal control. (1993) Oxford University Press, New York. Rutter, M. Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, (1987) 57: 316–331. Schofield, H. & Bloch, S. Disability and chronic illness: The role of the family carer. Medical Journal of Australia, (1998) 169: 405–406. Senturk V, Goker C, Bilgic A, Olmez S, Tugcu H, Oncu B, Atbasoglu EC. Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate. Bipolar Disorders (2007): 9 (Suppl. 1): 136–144. Winefield, A.H. Unemployment and mental health. In Jorm AF, ed, Men and mental health. NHMRC, (1995) Canberra. Read More