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treatment for depression

Bipolar II – Really?

Is it Bipolar II – or just plain Bipolar Disorder not yet recognized?

Google “Bipolar” on the “news” tab and see what you find.  It is astounding how many semi-celebrities have come out and said “I have Bipolar Disorder”.  Unfortunately, the story is often about Bipolar II, which somehow makes it “better”.

Bipolar Disorder is still a serious stigma – prevents people from getting jobs and such.  Technically, as Bipolar Disorder is considered a disability, an employer who did not hire or fired an admitted bipolar patient based only on that fact would be in violation of the American Disabilities Act, but few people are willing to go to the carpet on that.  Plus there is the little issue of being “able” to perform one’s job.  I can perform a job if I am taking meds.  If I am off of meds, I become highly unreliable with a lot of other liabilities – risky behavior that I have decided not to discuss.

Only a couple of years ago, I was warned by a well-meaning family member against posting too much on social media about Bipolar Disorder – and this in his mind included “liking” too many Bipolar pages.  He was concerned about my ability to obtain a decent job.  I don’t know if I have a “decent “job today – I have made my own way which works out better for me – no boss to annoy, no dress code, nobody else’s time clock.  For the most part, I don’t worry about social media – I don’t think I will ever have a “real” job again – no more frequent flyer miles for me.

Bipolar 2I was once diagnosed as Bipolar II – but really, both the doctor and the therapist thought differently – they both knew that I had regular Bipolar Disorder but wasn’t ready to accept it.  Actually, I am pretty sure my doctor tricked me into taking Lithium for the first time by telling me that it would help boost my antidepressant activity.

In retrospect, I am astounded that I believed him since I know so much about medication – but I took the medication.  How many of these people really have Bipolar I Disorder and just don’t say so.

It is much easier for people to say and accept that they have Bipolar II.  In my opinion (which is obviously vast and knowledgeable – just kidding, no really), Bipolar II is a way of sliding by the real diagnosis.  As in “I have Bipolar Disorder but not really”.  “I have Bipolar Disorder but I am not crazy”.  “I have Bipolar Disorder but I am not dangerous”.  “I have Bipolar Disorder but I won’t embarrass you”.
When it gets down to it…wasn’t that true for all of us at one time?  Or at least didn’t we believe it at one time?  I still fit some of the criteria – I am “functional”, “productive”, “hypomanic” – except when I am not.

I often confuse my doctor when he asks how it is going by saying “good enough”.  What I mean is that I am not manic exactly, I am not depressed.  Actually it works better for me if I am teetering on the edge of mania.  If I am just crazy enough that I know that I am crazy – then I will keep taking my meds.  Because I forget.

I originally sought treatment for severe depressiondepression bad enough that I had to decide whether to kill myself or study (I had a big exam the next day).  In retrospect, I was actually in a mixed episode with plenty of energy but in a really bad mood.  Oh, and then there was the slight issue of the hypnogogic hallucinations which I denied at the time.  See, even if I know that I have Bipolar DisorderManic Depression – I still forget.

It would be easier for me to say that I have Bipolar Disorder but it is “just” Bipolar II.  I thought that too.

Melissa

Suicide in Depression

Why does treatment for depression increase the risk of suicide?

Whether you are bipolar or suffer from major depressive disorder – when you start taking medication for depression, your risk of suicide actually goes up for a short period of time.

The risk of suicide in depression

Every time an advertisement for a medication for depressive disorder or bipolar depression comes on the television, one thing that seems to stick out is the warning that states “May increase the risk of suicide“.  This is often an arguing point for people who are opposed to psychiatric medications.  If it is supposed to improve your mood, why does the risk of suicide go up?  Shouldn’t the opposite be true?

How do antidepressants work?

Antidepressant medications work by increasing the activity of neurotransmitters in the mood centers of the brain.  Nerve cell signals are transmitted by the release of chemicals known as neurotransmitters.  These include naturally occurring chemicals such as serotonin, norepinephrine and dopamine.  The neurotransmitter is released from one cell which signals the next cell to react.  The same cell then “gathers up” the neurotransmitter to be used again later.

Most antidepressants specifically work by blocking the “reuptake” of neurotransmitters so that they are in the synapses or spaces between the nerve cells for a longer period of time.  This increases the likelihood that the neurotransmitter will send a “happy” signal to the next cell – sooner.

Why do antidepressants increase the risk of suicide?

Suicide and DepressionThe problem with depression and how long it takes to recover is twofold, because depression involves both mood and energy levels.  In a person with depression, the mood state is lowered because there are often not enough neurotransmitters available.  This leads to the mental effects of depression causing sadness and an inability to enjoy normal activities.  There is also a corresponding drop in energy levels making the victim lethargic and sleepy.

When antidepressants are prescribed, most healthcare practitioners make it pretty clear that the mood state will not really begin to get noticeably better for at least 2 to 3 weeks. What is not always made clear is that energy levels actually begin to improve before the mood level is increased.

Once this person with low mood level and low energy level begins to take antidepressant medication, their energy levels go up fairly quickly.  The mood level, however, stays depressed – sad and unable to see the light at the end of the tunnel.

If patients had been thinking of suicide as part of their depression, they may not have had the energy to make actual plans or to carry them out.  Once their energy levels are boosted – they may find themselves still having the same thoughts, but this time – able to act.

Are the newer medications worse?

This increased risk of suicide is not new, despite what the media has portrayed.  It is not specific to a certain medication or even a certain kind of medication.  It is a fact, a well-known risk that has existed since the beginnings of treatment of depression.

Suicide and MedicationOur medications, today, are really much less dangerous than medications of old.  Thirty years ago, your choices for the treatment of depression included only tricyclics such as Elavil and Tofranil or MAO inhibitors such as Parnate.  Both of these medication types carried a lot of very debilitating side effects (dry mouth, constipation, excessive sweating, dizziness, and food intolerances) as well as the increased risk of suicide.  While they were effective, they were also quite dangerous in the event of an overdose – possibly resulting in death.

We now have more advanced medications – the SSRIs or Serotonin specific reuptake inhibitors, Norepinephrine reuptake inhibitors (NRIs) and newer MAO inhibitors that have much fewer side effects and are less likely to result in a serious overdose – but they have not been able to eliminate the actual risk of suicide.  This is inherent in the treatment of depression because the energy improves before the mood.

With older medications, the psychiatrist would often only prescribe a few days’ worth of medication at a time because the old medications could be dangerous if too many were taken and lead to overdose by someone trying to commit suicide.  This often meant that the patient was seen once a week or more often during the first month.

Now that overdose is not such a risk, physicians often prescribe an entire months’ worth of meds at once, and no one keeps track of the patient during this dangerous period  – giving them plenty of time to plan and act.  Generally the newer medications cannot be used as a suicide tool but it does not stop patients from finding other tools.

What can help decrease the risk?

The solution is to know your patient – know your friends, know your family.  If you have a friend or relative who has been depressed and is placed on medication, be aware.Check on them frequently. Drag them around to social activities, out to eat, to outdoor events. Note any changes or patterns that indicate they may be considering suicide.  Help them through the funk.  You may get on their nerves, but you may also save their life.

A little effort and toleration of irritating friends is way better than going to a funeral and wishing you had done something.

 

Newer medications used for prevention of suicide in depression are much less dangerous than medications of old.

Complications Associated with Depression Treatment

These days, the medications used to treat depression are actually remarkably good.

Not only are they effective, but they have proven to be safe, and are even no addictive. Most people have little or no side effects from the medication at all, and if they do experience mild side effects, those effects usually pass rather quickly.

The complications associated with depression treatment don’t actually pertain to the medication used at all — but there are some complications indeed. You see, usually when people experience major depression there is an exceedingly legitimate chance that depression will reoccur later.

Depression Treatment - ComplicationsIn fact, research shows that of everyone who seeks treatment for depression and are able to get past the depression and discontinue the medication — with the approval of their doctor — one-third of those people will experience depression again, often within a year. Furthermore, of those people, approximately half will experience depression again within their lifetime.

Depression also has other effects. There is, of course, a 15% chance of suicide. People who suffer from depression, typically are not as healthy as those who do not, from a physical standpoint. Furthermore, those who suffer from depression are less likely to live through a heart attack or stroke.

This does not mean that you are doomed if you suffer from depression. It is crucial to seek treatment and work closely with your doctor. Counseling should be sought, and should continue even after the depressive episode has passed. Your doctor will work with you, to adjust medication appropriately — and to discontinue the medication when it is not needed. He or she will also help you to be more aware of depression as it starts creeping in.

Studies have shown that the earlier the depression is treated, the sooner it is likely to pass. Therefore, it is vital that you and your doctor stay up to date with your mental and physical state.

Also read; What is the Symptoms of Depression

Causes of Depression

Anxiety can also bring on depression.

For some people, the depression can become quite serious while it for others has a reasonable cause and passes without seeking treatment. But because we are all unique, the causes of depression are widely varied. What depresses some may not adversely affect someone else.

Melanchony and DepressionWhile each person is unique, we all suffer from depression from time to time.
There are numerous treatments available for depression, and these treatments will most likely help you. However, the surest treatment for depression is finding the cause and dealing with that underlying problem. Finding the problem, however, may not be easy for some.

Many things in life that will naturally cause depression. For example, grief is a form of depression, and it is perfectly normal. However, if the symptoms of depression — even in times of grief — start interfering with your life, a problem may exist. Typically with grief, the feeling of loss and sadness may continue for an extended period of time. However, those feelings should not interfere with your day-to-day life.

Financial problems may also cause depression, as well as marital problems. However, not all depression is caused by life events. Sometimes depression has a physical underlying problem. This may be an illness or another health problem, but it could also be a chemical imbalance that can easily be corrected with medication.

Also note the risk factors associated with depression. These include a family history of depression, a serious life event, stress, abuse, or death or illness of a loved one.

Again, the causes of depression are numerous and varied, but seeking treatment and finding the cause is half the battle. Sometimes, it is the entire war because once the problem is identified; it can be more easily dealt with.

– Kurt Pedersen

Helpful resource: The Easy Calm Video Coaching Series

(The Leading Anxiety and Panic Attack Coaching Series in Downloadable Video Format)