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Depression and Manic Depression or Bi-Polar Disorder


Depression and Manic Depression or Bi-Polar Disorder Manic disorder is when people cannot stop being active and their gestures become wild and uncontrolled. – PowerPoint PPT presentation

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Title: Depression and Manic Depression or Bi-Polar Disorder

Depression and Manic Depression or Bi-Polar
  • Manic disorder is when people cannot stop being
    active and their gestures become wild and
  • Depressive disorder is when a person experiences
    lack of motivation, a sense of pointlessness and
    a feeling of weepiness, loss of appetite, sleep
    disturbance etc.

Uni-polar and bi-polar disorder
  • Usually when somebody has mania, it is
    accompanied by depression.
  • This is called bi-polar disorder.
  • Very rarely, mania occurs alone, but many people
    experience only depression.
  • These are called uni-polar disorders.
  • Seligman called depression the common cold of
    psychological problems.
  • Most healthy people feel down for some of the
    time but it usually passes fairly quickly.

The symptoms of clinical depression Cognitive
  • Low self esteem
  • Guilt
  • Self-dislike
  • Loss of libido
  • Negative thoughts
  • Suicidal thoughts
  • Poor memory
  • Lack of ability to think and concentrate

Symptoms of clinical depression Behavioural
  • Decrease in sexual activity
  • Loss of appetite
  • Disordered sleep patterns
  • Poor care of self and others
  • Suicidal attempts

Symptoms of clinical depression Emotional
  • Sadness
  • Irritability
  • Apathy (no interest or pleasure in activity

Symptoms of clinical depression Physical
  • Loss of weight
  • Loss of energy
  • Aches and pains
  • Sleep disturbance
  • Menstrual changes

2 types of depression
  • At first, depression was classified into two main
  • Endogenous This means coming from within and
    usually the person does not
  • know the reason for the depression. There is
    usually a biochemical link.
  • Exogenous This means coming from the outside.
    There is a cause for this depression.

Bi-polar disorder and depression
  • Bi-polar disorder, or manic-depression, varies in
    length and duration.
  • Periods of depression are followed by periods of
  • Some people have long periods of being normal,
    whereas others have one mania followed by a
    depression, followed by a mania in quick
  • Depression can occur at any age.
  • Manic depression usually appears in the early
  • Depression is more common in women.

Manic depression
  • Manic depression is equally common in men and
    women, but manic depression is much less common
    than depression.
  • Jamieson (1989) demonstrated that there are more
    creative and artistic people who suffer from
    manic depression than the general population.
  • Of the award-winning writers and artists, 38
    have been treated for manic depression, whereas
    in the general population it is only 1.

Explanations of Depression
  • The Behavioural Model The focus is on
  • Lewinson (1974) argued that when a person is
    depressed, their friends pay attention to them
  • This attention is reinforcement.
  • If someone continues to be depressed, their
    friends eventually avoid them and this makes the
    person even more depressed, and so they become
    caught in a cycle of depression.

Seligmans learned helplessness experiment
  • The Cognitive Behavioural Model
  • Seligman (1967) performed an experiment in which
    he gave electric shocks to dogs. The dogs were
    unable to escape.
  • Subsequently, they were provided with an escape
    route, but all the dogs did was to continue to
    whine while they were being shocked.
  • It took hundreds of trials to show the dogs that
    they could escape before they actually did.

Learned helplessness
  • This inability to see the way out of a bad
    situation Seligman termed learned helplessness.
  • He extrapolated (widened the field) that if
    humans experience many negative events which they
    feel powerless to change, they develop feelings
    of learned helplessness.

Criticisms of Seligmans conclusions
  • This theory has been criticised because if it
    were true, depressed people would blame the
    external world for their depression.
  • Most depressed people feel guilty and blame
    themselves, and have a tendency to say all the
    good things that have happened to them are
    because of luck, rather than their own efforts.

  • Questionnaires were given out to people to see if
    there was any difference in cognition between
    depressed and non-depressed people.
  • They found once a depression passes, both groups
    of people have the same attitude towards life.
  • Beck said people who have a tendency towards
    depression also have a tendency to think more
  • He attributes this to experiences in childhood
    and adolescence, and says depressed people
    develop a cognitive triad self, the world, the
  • Essentially, the self will experience many bad
    things in life because of its unworthiness, the
    world is full of pain and the future is bleak,
    dark and depressing.

Cognitive explanations
  • Haaga and Beck (1992) altered the theory that
    depressed people always have a negative view of
  • Depressed people tend to think negatively when
    they are under stress, whereas non-depressed
    people have a more constructive attitude towards
    stressful situations.
  • There are two main causes of depression
    rejection by others, and failure to reach goals.

Psychodynamic explanation
  • Psychodynamic Model Freud, in a book called
    Mourning and Melancholia observed the
    similarities between grief and depression.
  • He believed depression was a reaction to loss,
    either real or imagined, and that this loss was
    connected to childhood feelings of loss and

Psychodynamic explanation
  • He also believed the greater the loss in
    childhood, the more difficult it is to cope with
    rejection and loss in adulthood.
  • Freud further suggested that hostile feelings
    towards parents are often repressed. When you
    are rejected in adulthood, the anger boils over
    and is usually, though not always, directed
    towards the self.
  • Ultimately, the inward-directed anger appears in
    the form of suicide.
  • Very often when people die we become very angry
    with them but as this anger is unacceptable, we
    repress it. It is frequently directed against
    the self.

Psychodynamic explanation of manic depression
  • Psychodynamic theory sees manic depression, or
    bipolar disorder as a battle between the superego
    and the ego.
  • When the superego dominates (this is what
    authority figures taught you you should and
    shouldnt do), you feel worthless because you
    cant live up to these expectations.
  • This is when you experience depression.
  • The manic phase begins when the ego dominates and
    tells you that you are wonderful and far from
    being the nasty person you thought you were.
  • This causes elation (great happiness).

Main criticisms of the psychodynamic model
  • People do not always experience death as
    rejection and do not always feel angry.
  • If anger is always turned inwards, why do some
    depressed people show irritability towards
  • Not all people who experience loss in childhood
    become depressed in adulthood.

The medical or biological explanation
  • Medical Model There is evidence that mood
    disorders are linked to families.
  • If one parent has a mood disorder the chances of
    a child developing a disorder is ten times more
    than the general population.
  • Identical twins who both suffer from manic
    depression is 72.
  • This is the highest percentage of any
    psychological disorder.
  • Adoption societies also show that depression is
    more likely if the biological parents suffer from
    the same mood disorders.

Heritability or inheritance
  • Heritability or inheritance
  • The disorder runs in families. More than
    two-thirds of people with bipolar disorder have
    at least one close relative with the disorder or
    with unipolar major depression.
  • Studies seeking to identify the genetic basis of
    bipolar disorder indicate that susceptibility
    stems from multiple genes.
  • Scientists are continuing their search for these
    genes, using advanced genetic analytic methods
    and large samples of families affected by the

Twin studies
  • There is increasing evidence for a genetic
    component in the causation of bipolar disorder,
    provided by a number of twin studies and gene
    linkage studies.
  • The monozygotic concordance rate for the disorder
    is 70. This means that if a person has the
    disorder, an identical twin has a 70 likelihood
    of having the disorder as well.
  • Dizygotic twins have a 23 concordance rate.
  • These concordance rates are not universally
    replicated in the literature recent studies have
    shown rates of around 40 for monozygotic and
    lt10 for dizygotic twins (see Kieseppa, 2004 and
    Cardno, 1999).

2007 gene linkage study
  • A 2007 gene-linkage study by an international
    team coordinated by the NIMH has identified a
    number of genes as likely to be involved in the
    etiology of bipolar disorder, suggesting that
    bipolar disorder may be a polygenic disease.

How to help people with bi-polar disorder
  • Bipolar disorder cannot be cured, instead the
    emphasis of treatment is on effective management
    of acute episodes and prevention of further
    episodes by use of pharmacological and
    psychotherapeutic techniques.
  • Hospitalization may occur, especially with manic
    episodes. This can be voluntary or (if mental
    health legislation allows it) involuntary (called
    civil or involuntary commitment).
  • Following (or in lieu of) a hospital admission,
    support services available can include drop-in
    centers, visits from members of a community
    mental health team or Assertive Community
    Treatment team, supported employment and
    patient-led support groups.

  • Medication
  • The mainstay of treatment is a mood stabilizer
    medication these comprise several unrelated
    compounds which have been shown to be effective
    in preventing relapses of manic, or in the one
    case, depressive episodes. The first known and
    "gold standard" mood stabilizer is lithium.

  • Treatment of the agitation in acute manic
    episodes has often required the use of
    antipsychotic medications, such as Quetiapine,
    Olanzapine and Chlorpromazine.
  • More recently, Olanzapine and Quetiapine have
    been approved as effective monotherapy for the
    maintenance of bipolar disorder.
  • A randomized control trial in 2005 has also shown
    olanzapine monotherapy to be as effective and
    safe as lithium.

Biochemical influences
  • Biochemical influences There are 2
    neurotransmitters which are known to influence
    mood (noradrenaline and serotonin).
  • What has been found is that too much
    noradrenaline results in mania
  • and too little in depression.
  • Animals given drugs to decrease noradrenaline
    become sluggish and inactive, which are
    conditions associated with depression.
  • Lithium carbonate is a drug for treating mania
    and this decreases noradrenaline.
  • In increased quantities, noradrenaline gives rise
    to mania.

Biochemical influences
  • When noradrenalin and serotonin are broken down
    by enzymes, which then make compounds, these
    compounds are found in large quantities in the
    urine of depressed people.
  • When people are depressed, noradrenaline and
    serotonin are lower.
  • However, when people are in a manic state,
    noradrenaline is higher and serotonin is lower.
  • Ketty argues that serotonin limits the production
    of noradrenaline.
  • When serotonin production goes down, it cannot
    limit the production of noradrenaline and so
    noradrenaline goes up.

Anti-depressant drugs
  • The main argument against this is that
    anti-depressant drugs do not work immediately.
  • Anti-depressants take a few weeks to work, but
    the drugs should change the production of
    neurotransmitters immediately.
  • A further complication is that not everyone
    benefits from anti-depressant drugs.
  • Some depressed people do not produce lower or
    higher levels of neurotransmitters, so they are
    not always responsible for depression and the
    exact role they play is not known.

External factors and biochemical factors
  • The question is, is it the neurotransmitters that
    alter moods, or do the neurotransmitters increase
    due to mania or depression?
  • It was found that Seligmans dogs, in the
    learned helplessness experiments, had lower
    levels of noradrenaline.
  • This could not have been inherited and is clearly
    the result of environmental changes.

Sex differences in depression
  • Women are 2 to 3 times more likely to have
    symptoms of clinical depression than men.
  • Of all the mental disorders women suffer from,
    depression is the highest.
  • Why is this?
  • Depression is associated with the menstrual
    cycle, childbirth and the menopause.
  • Postnatal depression affects 1 in 10 women.

The effects of cortisol, a hormone associated
with stress
  • A biological explanation has emerged from
  • Levels of the hormone cortisol are found to be
    high in those suffering from depression and
    techniques known to suppress cortisol secretion
    have been found to be successful in depressive
    patients (Carroll, 1982).

The influence of the endocrine system
  • A study by Nemeroff et al, 1992, has shown that
    there is marked adrenal gland enlargement in
    those suffering from major depression.
  • Endocrine (hormonal) changes could account for
    depression relating to pre-menstrual, post-natal
    and menopausal phases.
  • In the case of post-natal depression, psychotic
    elements often appear, such as fantasies and loss
    of control with reality.
  • Some mothers with severe post-natal depression
    may harm or even kill their newborn child.

Hormonal changes
  • Pre-menstrual depression occurs in the week prior
    to menstruation.
  • 25 of women are affected.
  • An oestrogen-progesterone imbalance has been
  • In pre-menstrual depression, oestrogen levels are
    too high and progesterone levels are too low.
  • At menopause, oestrogen levels drop.
  • Depressive states appear to occur more frequently
    during periods of hormonal change.
  • A possible explanation is that hormonal changes
    interact with a genetic predisposition to
    depression, together with excessive tiredness and
    a stressful domestic situation.

Explanations for sex differences
  • Cochrane (1995) suggests that one of the reasons
    women may become more depressed is that in
    childhood they are more likely to be sexually
    abused than boys.
  • Clinical depression is associated with sexual
    abuse in childhood.
  • Women also experience the empty nest syndrome,
    which is when the children leave home.
  • Women may also experience learned helplessness
    because many see themselves as having no control
    over their lives.
  • Another reason for the imbalance is that men
    often do not admit to being depressed.