Posts Tagged Bipolar Disorder
Everything you need to know about chemical imbalances in the brain
A chemical imbalance in the brain occurs when a person has either too little or too much of certain neurotransmitters.
Neurotransmitters are the chemical messengers that pass information between nerve cells. Examples of neurotransmitters include serotonin, dopamine, and norepinephrine.
People sometimes call serotonin and dopamine the “happy hormones” because of the roles that they play in regulating mood and emotions.
While this theory may hold some truth, it runs the risk of oversimplifying mental illnesses. In reality, mood disorders and mental health illnesses are highly complex conditions that affect 46.6 million adults living in the United States alone.
In this article, we discuss conditions with links to chemical imbalances in the brain, myths surrounding this theory, possible treatment options, and when to see a doctor.
Although chemical imbalances in the brain seem to have an association with mood disorders and mental health conditions, researchers have not proven that chemical imbalances are the initial cause of these conditions.
Other factors that contribute to mental health conditions include:
- genetics and family history
- life experiences, such as a history of physical, psychological, or emotional abuse
- having a history of alcohol or illicit drug use
- taking certain medications
- psychosocial factors, such as external circumstances that lead to feelings of isolation and loneliness
While some studies have identified links between distinct chemical imbalances and specific mental health conditions, researchers do not know how people develop chemical imbalances in the first place.
Current biological testing also cannot reliably verify a mental health condition. Doctors do not, therefore, diagnose mental health conditions by testing for chemical imbalances in the brain. Instead, they make a diagnosis based on a person’s symptoms and the findings of a physical examination.
What conditions are linked to chemical imbalances?
Research has linked chemical imbalances to some mental health conditions, including:
Depression, also called clinical depression, is a mood disorder that affects many aspects of a person’s life, from their thoughts and feelings to their sleeping and eating habits.
Although some research links chemical imbalances in the brain to depression symptoms, scientists argue that this is not the whole picture.
For example, researchers point out that if depression were solely due to chemical imbalances, treatments that target neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), should work faster.
The symptoms of depression vary widely among individuals, but they can include:
- persistent feelings of sadness, hopelessness, anxiety, or apathy
- persistent feelings of guilt, worthlessness, or pessimism
- loss of interest in formerly enjoyable activities or hobbies
- difficulty concentrating, making decisions, or remembering things
- restlessness or hyperactivity
- insomnia or sleeping too much
- changes in appetite and weight
- physical aches, cramps, or digestive problems
- thoughts of suicide
Many different types of depression exist. These include:
- major depressive disorder (MDD)
- persistent depressive disorder
- psychotic depression
- postpartum depression
- seasonal affective disorder (SAD)
The dramatic hormonal changes that take place after giving birth are among the factors that can increase a woman’s risk of developing postpartum depression. According to the National Institute of Mental Health, 10–15% of women experience postpartum depression.
Bipolar disorder is a mood disorder that causes alternating periods of mania and depression. These periods can last anywhere from a few days to a few years.
Mania refers to a state of having abnormally high energy. A person experiencing a manic episode may exhibit the following characteristics:
- feeling elated or euphoric
- having unusually high levels of energy
- participating in several activities at once
- leaving tasks unfinished
- talking extremely fast
- being agitated or irritable
- frequently coming into conflict with others
- engaging in risky behavior, such as gambling or drinking excessive quantities of alcohol
- a tendency to experience physical injuries
Severe episodes of mania or depression can cause psychotic symptoms, such as delusions and hallucinations.
People who have bipolar disorder can experience distinct changes in their mood and energy levels. They may have an increased risk of substance abuse and a higher incidence of certain medical conditions, such as:
The exact cause of bipolar disorder remains unknown. Researchers believe that changes in the dopamine receptors — resulting in altered dopamine levels in the brain — may contribute to the symptoms of bipolar disorder.
However, people who have an anxiety disorder often experience persistent anxiety or excessive worry that worsens in response to stressful situations.
The GABA neurotransmitter reduces neuronal activity in the amygdala, which is the part of the brain that stores and processes emotional information.
GABA is not the only neurotransmitter that anxiety disorders involve. Other neurotransmitters that may contribute to these disorders include:
- corticotropin-releasing hormone
- opioid peptides
- neuropeptide Y
Doctors can prescribe a class of medications called psychotropics to rebalance the concentration of particular neurochemicals in the brain.
Doctors use these medications to treat a range of mental health conditions, including depression, anxiety, and bipolar disorder.
Examples of psychotropics include:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
- Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Pamelor).
- Benzodiazepines, including clonazepam (Klonopin) and lorazepam (Ativan).
While some people experience reduced symptoms within a few weeks, it can sometimes take months for others to feel the effects.
Different psychotropics have varying side effects. People can discuss the benefits and risks of these medications with their doctor.
The side effects of psychotropic medications can include:
- If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Call 911 or the local emergency number.
- Stay with the person until professional help arrives.
- Remove any weapons, medications, or other potentially harmful objects.
- Listen to the person without judgment.
- If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.
When to see a doctor
These symptoms should not cause alarm if they are mild and resolve within a few days.
However, people may wish to consider speaking with a doctor or trained mental health professional if they experience emotional, cognitive, or physical symptoms every day for more than 2 weeks.
Mental health is complex and multifaceted, and numerous factors can affect a person’s mental well-being.
Although chemical imbalances in the brain may not directly cause mental health disorders, medications that influence the concentration of neurotransmitters can sometimes provide symptom relief.
People who experience signs and symptoms of a mental health problem for more than 2 weeks may wish to speak to a doctor.
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
- Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
- Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
- Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
Signs and Symptoms
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.
Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.
Risk factors include:
- Personal or family history of depression
- Major life changes, trauma, or stress
- Certain physical illnesses and medications
Treatment and Therapies
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.
Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.
Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.
To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.
You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH websiteand in the NIMH publication Depression: What You Need to Know.
Brain Stimulation Therapies
If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
- ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
- Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
- Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
- ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
- ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.
Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.
If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.
Beyond Treatment: Things You Can Do
Here are other tips that may help you or a loved one during treatment for depression:
- Try to be active and exercise.
- Set realistic goals for yourself.
- Try to spend time with other people and confide in a trusted friend or relative.
- Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately.
- Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Continue to educate yourself about depression.
Join a Study
What are Clinical Trials?
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
How do I find a Clinical Trials at NIMH on Depression?
Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.
How Do I Find a Clinical Trial Near Me?
To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.
Free Booklets and Brochures
- Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.
- Depression and College Students: This brochure describes depression, treatment options, and how it affects college students.
- Depression and Older Adults: Depression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.
- Depression: What You Need to Know: This booklet contains information on depression including signs and symptoms, treatment and support options, and a listing of additional resources.
- Postpartum Depression Facts: A brochure on postpartum depression that explains its causes, symptoms, treatments, and how to get help.
- Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.
- Join a Study: Depression – Adults
- Join a Study: Depression – Children
- Join a Study: Perimenopause-Related Mood Disorders
- Join a Study: Postpartum Depression (PPD)
- Depression and Older Adults (NIHSeniorHealth.gov)
- Depression: MedlinePlus
- Moms’ Mental Health Matter: Depression and Anxiety Around Pregnancy (National Institute of Child Health and Human Development)
Research and Statistics
- Journal Articles: This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
- Statistics: Major Depression: This webpage provides information on the statistics currently available on the prevalence and treatment of depression among people in the U.S.
- Watch: “Baby Blues” – or Postpartum Depression?: This video provides patient testimony and information on the signs and symptoms of postpartum depression and reinforces the importance of seeking help and treatment from a health professional.
- Watch: One Woman’s Experience With Depression: This video by the National Institute on Aging tells the story of an older woman who struggled for years with depression, but who is now in recovery. For more on older adults and depression, visit the “Depression” topic on NIHSeniorHealth at www.nihseniorhealth.gov.
Last Revised: February 2018
The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a new study from the University of Eastern Finland and the German Center for Neurodegenerative Diseases, DZNE. Continuous use of antiepileptic drugs for a period exceeding one year was associated with a 15 percent increased risk of Alzheimer’s disease in the Finnish dataset, and with a 30 percent increased risk of dementia in the German dataset.
Some antiepileptic drugs are known to impair cognitive function, which refers to all different aspects of information processing. When the researchers compared different antiepileptic drugs, they found that the risk of Alzheimer’s disease and dementia was specifically associated with drugs that impair cognitive function. These drugs were associated with a 20 percent increased risk of Alzheimer’s disease and with a 60 percent increased risk of dementia.
The researchers also found that the higher the dose of a drug that impairs cognitive function, the higher the risk of dementia. However, other antiepileptic drugs, i.e. those which do not impair cognitive processing, were not associated with the risk.
“More research should be conducted into the long-term cognitive effects of these drugs, especially among older people,” Senior Researcher Heidi Taipale from the University of Eastern Finland says.
Besides for epilepsy, antiepileptic drugs are used in the treatment of neuropathic pain, bipolar disorder and generalized anxiety disorder. This new study is the largest research on the topic so far, and the first to investigate the association in terms of regularity of use, dose and comparing the risk between antiepileptic drugs with and without cognitive-impairing effects. The results were published in the Journal of the American Geriatrics Society.
The association of antiepileptic drug use with Alzheimer’s disease was assessed in Finnish persons diagnosed with Alzheimer’s disease and their controls without the disease. This study is part of the nationwide register-based MEDALZ study, which includes all 70,718 persons diagnosed with Alzheimer’s disease in Finland during 2005-2011 and their 282,862 controls. The association of antiepileptic drug use with dementia was investigated in a sample from a large German statutory health insurance provider, Allgemeine Ortskrankenkasse (AOK). The dataset includes 20,325 persons diagnosed with dementia in 2004-2011, and their 81,300 controls.
[BLOG POST] Anti-epilepsy medicine use during pregnancy does not harm overall health of children, study finds
Children whose mothers have taken anti-epilepsy medicine during pregnancy, do not visit the doctor more often than children who have not been exposed to this medicine in utero. This is the result of a new study from Aarhus.
Previous studies have shown that anti-epilepsy medicine may lead to congenital malformations in the foetus and that the use of anti-epilepsy medicine during pregnancy affects the development of the brain among the children. There is still a lack of knowledge in the area about the general health of children who are exposed to anti-epilepsy medicine in foetallife. But this new study is generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy.
Being born to a mother who has taken anti-epilepsy medicine during pregnancy appears not to harm the child’s health. These are the findings of the first Danish study of the correlation between anti-epilepsy medicine and the general health of the child which has been carried out by the Research Unit for General Practice, Aarhus University and Aarhus University Hospital.
The results have just been published in the international scientific journal BMJ Open.
The researchers have looked into whether children who have been exposed to the mother’s anti-epilepsy medicine have contact with their general practitioner (GP) more often than other children – and there are no significant differences.
No reason til worry
“Our results are generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy, including women with epilepsy,” says Anne Mette Lund Würtz, who is one of the researchers behind the project.
The difference in the number of contacts to the general practitioner between exposed and non-exposed children is only three per cent.
“The small difference we found in the number of contacts is primarily due to a difference in the number of telephone contacts and not to actual visits to the GP. At the same time, we cannot rule out that the difference in the number of contacts is caused by a small group of children who have more frequent contact with their GP because of illness,” explains Anne Mette Lund Würtz.
Of the 963,010 children born between 1997 and 2012, who were included in the survey, anti-epilepsy medicine was used in 4,478 of the pregnancies that were studied.
Anti-epilepsy medicine is also used for the treatment of other diseases such as migraine and bipolar disorder. The study shows that there were no differences relating to whether the women who used anti-epilepsy medicine during pregnancy were diagnosed with epilepsy or not.
Background for the results
Type of study: The population study was carried out using the Danish registers for the period 1997-2013.
The analyses takes into account differences in the child’s gender and date of birth, as well as the mother’s age, family situation, income, level of education, as well as any mental illness, use of psychiatric medicine and insulin, and substance abuse.
…It seems out of place bringing up such a serious topic on depression and bipolar disorder when the festivities are just around the corner. But it is one of those attacks that’s out there and doesn’t appreciate seasons. In fact, the socially busy holiday season can act as a catalyst.
Though there are many different types of depressions, what is common is that they usually occur in all ages. Of all the types, major depression and bipolar disorder are the ones that are highlighted more. NIMH says that 5.7 million people are afflicted in the U.S alone. Wikipedia cites a research study that says bipolar disorder is possibly the most costly category of mental disorders in the United States.
The good news is that these classes of depression are treatable. The doctors form the first line of defense always. And if you are looking for extra information and education, the web forms the second. Always consult a medical practitioner, but look up these five websites for any information on depression and bipolar disorder…
Welcome to the Family Center
Family support is crucial for those affected by depression or bipolar disorder. If you or someone in your family lives with a mood disorder, the Rebecca’s Dream Family Center is a place of compassion, hope and understanding. It is a central place for a wide variety of family-focused resources and information…