Depressive and Bipolar Disorders in Psychology.

 Bipolar Disorder

American psychologist and professor of psychiatry Kay Redfield Jamison is one of the world's foremost authorities on bipolar disorder. She's spent her career researching, lecturing, and writing seminal books on the condition, a condition that she also happens to have had her entire adult life. In her memoir, An Unquiet Mind, Jamison details what it really means to be bipolar. She writes of not sleeping for days on end, of feeling long periods of euphoria, and filling whole notebooks with her racing thoughts and grandiose While in these manic states, she experienced a tremendously inflated sense of self-esteem and did impulsive things that felt good at the time but had painful consequences, like going on lavish shopping sprees, engaging in promiscuous behavior, racking up credit card debt, and emptying her bank accounts. 

Mood Disorder

But these episodes were followed by emotional crashes. crippling bouts of depression that sent her into a suicidal spiral. At the age of 28, Jameson tried to kill herself by taking an overdose of lithium, and lapsed into a coma, but thankfully emerged from it determined to find help through medication and therapy. Through her research and writing, Dr. Jameson has pioneered our understanding of bipolar disorder, depression, and the nexus of mental struggles that we now think of as mood disorders. And she's probably one of the best ambassadors we have for all those people who live successful, productive lives with mental illness. Just like the anxiety disorders we talked about last time, mood disorders are misunderstood. They're deluded by depictions of depression as something that can be treated with one day at a spa, or descriptions of people as manic-depressive just because they were sad yesterday and aren't today. 

As psychology students, our job is to understand what mood disorders really are, how they manifest themselves, and what might cause them. And as you've probably guessed, this terrain can be tough to explore. These disorders can take people from terrifying highs to pits of despair that seem all but bottomless. But in between, there's what Jameson has called a rich, imaginative life. all made possible by your moods. We've been talking a lot about terms and concepts that mean something different than what you think they mean, but this time, the term mood is not one of those. In a psychological context, moods are pretty much exactly what you think they are. Emotional states are even more subjective and harder to define than the emotions themselves. 

And while psychologists have defined about ten basic emotions, moods tend to fall into two broadly and infinitely variable categories. You got the good moods and the bad moods. Probably the most important distinction between emotion and mood is that moods are long-term emotional states rather than discrete fleeting feelings. Mood disorders, which are characterized by emotional extremes and challenges in regulating mood, tend to be longer-term disturbances. These include depressive disorders, typified by prolonged hopelessness and lethargy, and bipolar disorders, the most prominent of which involve alternating between depression and mania. Depression has been called the common cold of psychological disorders, which is not to say that it isn't serious. But it's common, and it's pervasive, and it's the top reason people seek out mental health help. 

We've all felt down before, obviously, often in response to a specific loss. A breakup, a lost job, or the death of a loved one. And the fact is, you probably should feel bad at times like those. It can actually be good for the mind and body to slow down to help digest the losses that you experience. But in general, sadness is temporary. It's when sadness and grief extend beyond the generally accepted social norms or plunge into a depth that causes serious dysfunction that you find yourself in the territory of depressive disorders. The DSM-5, our handy if super flawed user's guide to psychological disorders, officially diagnoses a major depressive disorder when a patient has experienced at least five signs of depression for more than two weeks. 

These symptoms include not just depressed mood, but also significant weight or appetite loss or gain, too much or too little sleep, decreased interest in activities, feeling worthless, fatigued, or lethargic, difficulty concentrating or making decisions, and recurrent thoughts of death or suicide. So while everyone experiences sadness, depression is a physiological as well as psychological illness. It messes with your sleep and appetite energy and neurotransmitter levels, all interfering with the way your body runs itself. Plus, in keeping with our definition of psychological disorders, to be considered a true disorder, this behavior needs to cause the person or others around them prolonged distress, the feeling that something is really wrong. Just as a person with severe generalized anxiety disorder may never want to leave the house, a clinically depressed person often feels so hopeless and overwhelmed that they have trouble living a normal life. 

And unlike bipolar disorders, depressive disorders tend to be all lows. You've probably heard of manic depression. It's the outdated term for bipolar disorders. These include those classically dark lows of depression, but also bouts of the opposite, of extreme mania in more severe cases. Someone suffering from bipolar disorder may flip back and forth between normal and depressive and manic phases within a single day week or month. And a true manic episode doesn't just mean being energetic or happy. It's a period of intense, restless, but often optimistic hyperactivity in which your estimation of yourself and your abilities and your ideas can often get skewed, like really really skewed. Some patients experience mania only rarely, but when they do, it can be destructive. 

Kay Jamison has testified to that. Once, during a manic episode, she bought up a drugstore's entire supply of snakebite kits, convinced of an imminent attack of rattlesnakes that only she knew was coming. In another, she purchased 20 books by the Penguin Publishing House because, she said, it would be nice if the penguins could form a colony. In other words, bad judgment is common. And it can get worse. Full-blown manic episodes often end up in psychiatric hospitalization, since the risk to self or others can become severe. When the highs eventually end, they're often followed by dark periods of depression. When left untreated, suicide or suicide attempts are common, another element of the disorder that Jameson herself can attest to. Like so many things in psychology, the cause of mood disorders is often a combination of biological, genetic, psychological, and environmental factors. 

We know, for example, that mood disorders run in families. matter, and you're more likely to experience bipolar or depressive disorder if you have parents or siblings who suffer from them. Studies of identical twins show that if one twin has a bipolar disorder, the other has a 7 in 10 chance of also being diagnosed, regardless of whether they were raised together or apart. And while a stressful life can't give you bipolar disorder, it could trigger a manic or depressive episode in someone with a pre-existing condition, or start a descent into a major depressive episode in someone who'd never before experienced depression. In other words, a person who loses a loved one could go from sad to depressed, or slide into a bipolar episode, but it couldn't cause them to have the disorder to begin with. 

In the case of depressive disorders, for most people, after weeks, months, or even years, their depression can end, hopefully with a return to baseline healthy functioning. Worldwide, women tend to be diagnosed with major depression more often than men, but many psychologists think this is simply because women tend to seek treatment more. It's also possible that depression in men tends to manifest itself more in terms of anger and aggression than sadness and hopelessness. This is just an example of how depression is much more than just being sad, and that the characteristic lack of purpose and hopelessness can manifest itself in a lot of different ways. Looking at mood disorders from a neurological perspective, we see that depressed Manic and average brains show very different brain activity in neuroimaging scans. 

As you might expect, a brain in a depressed state slows down, while a brain in a manic state shows a lot of increased activity, making it hard for that person to calm down focus, or sleep. Our brain's neurotransmitter chemistry also changes with these different states. For example, norepinephrine, which usually increases arousal and focus, is severely lacking in depressed brains, but kind of off the charts during manic episodes. In fact, drugs that seek to reduce mania and part do it by reducing norepinephrine levels. You may have also heard about how low serotonin levels correlate with depressive states. Exercise, like jogging or breakdancing or whatever, increases serotonin levels, which is one reason exercise is often recommended to combat depression. Most medications designed to treat depression seem to work by raising serotonin or norepinephrine levels. 

And of course, there's yet another way to look at things. The social-cognitive perspective examines how our thinking and behavior influence depression. People with depression often view bad events through an internal lens or mindset that influences how they're interpreted. And how you explain events to yourself, negatively or positively, can really affect how you recover from them. or don't. Say you were humiliated in the lunchroom when someone tripped you and your chicken soup flew all over the place and you sat down on a brownie and it was just a bad day. A depressive mind might immediately start thinking that the humiliation will last forever, that no one will ever let you live it down, that it's somehow your own fault and you can't ever do anything right. 

That negative thinking, learned helplessness, self-blame, and overthinking can feed off itself and basically smother the joy out of a brain, eventually creating a vicious, self-fulfilling cycle of negative thinking. The good news is that that cycle can be broken by getting help from a professional, turning your attention outward, doing more fun things, and maybe even moving to a different environment. But again, that social cognitive perspective is just part of a much bigger puzzle. Positive thinking is important, but it's often inadequate when up against genetic or neurological factors. So mood disorders are complicated conditions, and rarely are they eliminated with a single cure. Instead, they're often things you just live with. And as Dr. Jameson has shown us, you can live well. 

 what mood disorders are as well as what they aren't. You learned about the symptoms of depressive and bipolar disorders and the possible biological, genetic, environmental, and social-cognitive causes of mood disorders.