1. M OOD D ISORDERS

2. Mood disorders affect 20.9 million or 9.5% of US population ages 18 and older Disorders often co-occur with sever anxiety and/or substance abuse The average age for the onset of a mood disorder is 30 Sadly, only 50.9% of people with mood disorder receive treatment

3. B IPOLAR In an average year, 5.7 million people, or 2.6% of US population ages 18+ suffer from bipolar disorder The disorder is found in equal number of men and women, of different race and social classes Although there are equal number of men and women diagnosed, studies suggest that women tend to experience more extreme episodes Studies also suggest that a gender bias exists in the diagnosis: Women are generally misdiagnosed with depression Men are generally misdiagnosed with schizophrenia Children are more likely to develop with a family history of the disorder One parent= 15-30% more likely Both parents= 50-75% more likely Roughly 20% of adolescents develop bipolar within 5 years of the first onset of depression

4. R APID C YCLING Rapid cycling is defined as having episodes at least four times a year, which last at least two weeks 50% of diagnosed cases of bipolar disorder, report rapid cycling Reports show that rapid cycling is not affected by education level, marital status, or work status However, history of anxiety, sexual and/or physical abuse, drug abuse, and/or parental drug abuse did however, show an increased number of cases

5. D EPRESSION In an average year, 14.8 million or 6.7% of US population ages 18+ experiences major depression Depression is found more commonly in women than men Males= 8-12% Females= 20-26% 1 in 33 children experience depression, and 1 in 8 adolescents 6 million people experience late life depression, and sadly only about 10% receive treatment 15-20% families report to care for an older relative 58% of caregivers show signs of depression

6. D EPRESSION AND I LLNESS Often, depression is followed by the onset of health problems 25% of cancer patients experience depression Stroke survivors roughly 10-27% 1 in 3 heart attach survivors 1 in 3 HIV patients Parkinson is the highest with 50% experiencing depression People with eating disorders 50-75% People who abuse substances including alcohol, 27% Those suffering from diabetes, 8.5-27% Studies also indicate that depression can lead to physical illness. Those with depression are 4 times more likely to suffer a heart attack than someone without history of depression.

7. E CONOMIC I MPACT Major depression is the leading cause of disability for US population ages 5 and older Depression is in the top 3 of workplace issues Annually, $70 million is lost in medical bills, loss of productivity, and other expenditures Also annually, $12 billion is lost in workdays

8. C AUSAL F ACTOR OF D EPRESSION AND B IPOLAR D ISORDER *Have the same or similar causes.

9. Depression Genetic In a research study show that there are 10 % in the U.S. who will experience depression later in their life. Having a parent or sibling with depression, is 2 to 3 times the risk of one developing Depression than the average person. Those who are diagnosed with Depression do not have relatives with Bipolar. However, if the relatives of people with Bipolar their chances rise to both depression and Bipolar Disorder. Biological* Neurotransmitter such as Serotonin and Norepinephrine need to be balanced in order for the body to Serotonin- deals with sleep problems, moodiness and concerns Norepinephrine- adjusts attentive and stimulation Environmental* Change in life and stress can set off an episode such events: loss or death of a loved one, financial, trauma or relationship problems. http://www.blackdoginstitute.org.au/surveys/Temperament/

10. Bipolar Disorder (Manic Depression) Genetic Bipolar Disorder runs in the family. If someone has one parent with Bipolar Disorder they a 15 to 25% chance of getting the disorder. An individual who has a non-identical twin with the disorder have a 25% chance of if both parent have been diagnosed. If one who is an identical twin same genetic structure; has an even greater risk of getting the disorder. Biological* Serotonin, Norepinephrine and Dopamine are in charge of handling functions within the brain. Norepinephrine involves moods and arousal Serotonin helps regulates sleep, eating and behavior Dopamine regulates behavior, pleasure and emotional arousal Environmental * A loss or death in the family can set off mood episodes for someone who has Bipolar. Alteration of health, hormonal problems and intake of alcohol and/or drug use.

11. E FFICACY Q UESTIONS AND S ERIOUS A DVERSE E FFECTS OF A NTIDEPRESSANTS

12. E FFICACY OF A NTIDEPRESSANTS Placebo : A substance that has no therapeutic effect, used as a control in testing new drugs Some psychologists estimate that up to 75% of effects shown by antidepressant medication are due to the placebo effect Research shows that a large percentage of individuals with anxiety, depression, and other emotional problems experience significant improvement after a placebo treatment Introducing Psychology pg. 420

13. S EROTONIN OR N EUROGENESIS Neurogenesis: Birth of new neurons Scientists led by Rene Hen of Columbia University and Ronald Duman of Yale blocked neurogenesis in mice, SSRIs had no effect SSRIs “rarely make a dent in depression before three weeks, and sometimes take eight weeks to kick in. But they affect serotonin levels right away. If depression doesn't lift despite that serotonin hit, the drugs must be doing something else” SSRIs first activate the serotonin system, which is somehow necessary for neurogenesis. That is what takes weeks Wall Street Journal Nov 18 2005 Sharon Begley http://online.wsj.com/public/article/SB113226807554400588 - piwLFSMdqttzAzHEXT3ehaYKXog_20061117.html?mod=r ss_free

14. S TUDY IN A RCHIVES OF G ENERAL P SYCHIATRY 10% of Americans using antidepressants doubled from 1996- 2005 Users of antidepressants receiving therapy fell from 31% to less than 20% (half of children on antidepressants aren't in therapy) spending on direct-to-consumer antidepressant ads increased from $32 million to $122 million (1996-2005) Mark Olfson Columbia University and NY State Psychiatric institute http://www.usatoday.com/news/health/2009-08-03- antidepressants_N.htm#

15. FDA WARNING ABOUT INCREASED RISK OF SUICIDAL THOUGHTS IN YOUTH (2004) Anafranil (clomipramine), Asendin (amoxapine), Aventyl (nortriptyline), Celexa (citalopram hydrobromide), Cymbalta (duloxetine), Desyrel (trazodone HCl), Elavil (amitriptyline), Effexor (venlafaxine HCl), Emsam (selegiline), Etrafon (perphenazine/amitriptyline), fluvoxamine maleate, Lexapro (escitalopram hydrobromide), Limbitrol (chlordiazepoxide/amitriptyline), Ludiomil (maprotiline), Marplan (isocarboxazid), Nardil (phenelzine sulfate), nefazodone HCl, Norpramin (desipramine HCl), Pamelor (nortriptyline), Parnate (tranylcypromine sulfate), Paxil (paroxetine HCl), Pexeva (paroxetine mesylate), Prozac (fluoxetine HCl), Remeron (mirtazapine), Sarafem (fluoxetine HCl), Seroquel (quetiapine), Sinequan (doxepin), Surmontil (trimipramine), Symbyax (olanzapine/fluoxetine), Tofranil (imipramine), Tofranil-PM (imipramine pamoate), Triavil (perphenazine/amitriptyline), Vivactil (protriptyline), Wellbutrin (bupropion HCl), Zoloft (sertraline HCl), and Zyban (bupropion HCl).

16. I NCREASED RISK OF SUICIDALITY IN YOUNGER ADULTS USING ANTIDEPRESSANTS (2006) A boxed warning is the most serious type of warning used on prescription drug labeling FDA is announcing a request to manufacturers of all antidepressant medications to update the existing “black box” on their product labeling to include warnings about increased risks of suicidal thinking and behavior (suicidality) in young adults ages 18 to 24 during initial treatment In December 2006, the FDA’s Psychopharmacologic Drugs Advisory Committee agreed that labeling changes were needed to inform health care professionals about the increased risk of suicidality in younger adults using antidepressants http://www.fda.gov/Drugs/DrugSafety/Informationby DrugClass/ucm096321.htm

17. R ISK VERSUS P ROFIT Psychotropic drug lawsuits “ successfully prosecuted resulting in judgments against and/or known payments by pharmaceutical companies totaling $4.96 billion in criminal and civil fines and settlements” In 2011, spending on psychiatric medications to top $40 billion Citizens Commission on Human Rights www.cchr.org

18. S UICIDE Overall 11 th leading cause of death in United States 3 rd most common form of death among high school and college students Women attempt about 3 to 4 times more often than men However men use more lethal methods (gun verses pills) so are 3 to 4 times more likely to actually kill themselves than women Approx.. 50% kill themselves during the recovery phase of a depressive episode About 90% of people who are suicidal discuss their intentions Substance abuse is associated with around 25% - 50% of adolescent suicides Introducing Psychology pg. 382

19. P HARMACEUTICAL A PPROACHES

20. NEUROTRANSMMITTERS NOREPINEPHRINE (NE): Influences mood and arousal…states of vigilance…impacts heart contractions SEROTONIN: Influences sleep and wakefulness… eating and aggressive behavior…mood and arousal…feelings of well-being and happiness DOPAMINE: Impacts motor behavior… motivation… pleasure and emotional arousal GLUTAMATE: Important excitatory neurotransmitter involved in information communication throughout the brain GAMA AMINO BUTYRIC ACID (GABA): Major inhibitory neurotransmitter…inhibitory or modulation impact on brain circuits (works opposite of Glutamate)

21. S YNAPTIC T RANSMISSION

22. D EPRESSIVE D ISORDER M EDICATION

23. S ELECTIVE S EROTONIN R EUPTAKE I NHIBITORS (SSRI S ) Block the reuptake of serotonin. Side effects include gastrointestinal problems (nausea, diarrhea and vomiting), nervous intensity or feeling “wired”, and loss of libido or sexual functioning. The former two problems generally stop after a short period of time; and the latter problem may be addressed by not using the medication on weekends or with other approaches

24. M ONOAMINE O XIDASE I NHIBITORS (MAOI S ) acts to incapacitate an enzyme (monoamine oxidase) that functions in the nervous system to remove neurotransmitters including norepinephrine and serotonin. Thus by masking or inhibiting the effect of these enzymes, the levels of norepinephrine and serotonin are increased. MAO enzymes are found both in the nervous system and in the lining of the intestines. Because some natural occurring chemicals in food closely resemble norepinephrine, failure of the body to eliminate these substances can have negative impact on blood pressure and heart rate. Thus people using MAOIs must read labels and must be careful not to eat foods that contain norepinephrine like substances

25. S EROTONIN AND N OREPINEPHRINE R EUPTAKE I NHIBITORS (SNRI S ) act to prevent the reuptake of both neurotransmitters. Another medication often placed in this category is bupropion which blocks the reuptake the neurotransmitter dopamine. The side effects of these medications vary widely. Some have side effects like a tricyclic. Others have side effects similar to SSRIs

26. B IPOLAR D ISORDER M EDICATION

27. M OOD S TABILIZERS Because mood stabilizers have both antimanic and antidepressant results, and because they are effective in minimizing the frequency, length and the severity of episodes; most bipolar patients receive one or more mood stabilizers in their treatment. It is generally accepted that mood stabilizers do not impact neurotransmitters in the synapse. More detailed theories concerning their influence on brain chemistry are still being developed. Some studies are focusing on molecules inside the cell that are activated by “G” proteins. These molecules activate cellular switches in the cell membranes and perform other functions, and are often referred to as a secondary messaging system

28. L ITHIUM has been accepted longer than other mood stabilizers as an effective treatment of bipolar disorder. Because Lithium can be toxic at higher levels, blood levels need to be checked regularly to properly manage the medication. Other major side effects include nausea, diarrhea, weight gain, thirst and frequent urination, tremors, dermatological disorders and hypothyroidism. Lithium has been linked to birth defects. Women of child bearing age should use birth control methods if taking Lithium. Also, it can cause kidney damage

29. V ALPROATE is a mood stabilizer which is also anticonvulsant. Valproate is a carbon compound similar to many others which are found in animal fats. It was developed first as a solvent. The way that it interacts with the brain is unknown except that it seems to improve neuron functioning in the same areas that GABA is working. It is very effective in the treatment of acute mania and in preventing reoccurrence of bipolar episodes. It is less effective with acute depressive episodes. Side effects (upset stomach, sleepiness and tremors) are less severe than lithium and it is less toxic. May impact liver so liver inflammation needs to be monitored. Also, may cause temporary hair loss and has been linked to birth defects.

30. C ARBAMAZEPINE is a mood stabilizer which is also an anticonvulsant. It does not seem to have any particular advantage over other medication except that it will work well when other medications have failed. Side effects include sleepiness, light headedness and nausea (all of which stop after initial usage). This medication may impact liver and blood counts so liver inflammation and blood count levels need to be monitored. Birth control is probably mandatory in woman of child bearing age

31. O XCARBAZEPINE is a mood stabilizer which is also an anticonvulsant. It is very similar to Carbazaeprine without the liver and blood count problems

32. L AMOTRIGINE is a mood stabilizer which is also ananticonvulsant. It seems to limit glutamate and has been proven to be as effective as Lithium. It is very effective in the depression cycle of bipolar disorder. Minor side effects are sleepiness, light headedness, nausea, and concentration problems. More major side effects are dermatological disorders

33. A NTIPSYCHOTIC M EDICATIONS are used in the initial treatment of highly manic or highly depressed patients because the impact can be seen immediately, particularly with calming patients in an agitated manic stage. Their impact on the brain is in the blockage of dopamine. They have a tranquilizer effect on the body in which the side effects impact muscle tone and movement. A second group is known as atypical antipsychotic medication also activates serotonin receptors. These medications have less impact on involuntary muscle movement. In general, all antipsychotic medications are very potent and should be used for the shortest period of time to lessen more severe symptoms in the beginning stages of treatment

34. A NTIDEPRESSANTS to treat bipolar disorders are generally not encouraged because it can cause accelerated return to manic symptoms. However, they are available but should be used with caution

35. O THER M EDICATIONS, H ORMONES, AND S UPPLEMENTS Benzodiazepine can be helpful in treating anxiety and insomnia. However, people can easily become psychologically dependent on these substances. Calcium Channel Blocking Medications used as treatment for heart problems can have a calming effect on electrical cells similar to antipsychotic medications. These medications block the flow of calcium ions into the cell Thyroid Hormones is prescribed to treat Hypothyroidism has been shown to be common in rapid-cycle bipolar disorders. Psychostimulants (amphetamines) may be prescribed to treat treatment for resistant depression. Omega-3 Fatty Acid and Fish Oil has been correlated to lower relapse rates in treating bipolar disorders

36. P ROGNOSIS For depression and bipolar disorders

37. P ROGNOSIS D EFINITION The likelihood of recovery from a disease Basically, what a doctor would tell you about the outlook of your condition.

38. O UTLOOK FOR D EPRESSION Outlook is generally positive for depression. Up to 80% of people who seek help find relief. About 60% of people will experience a second episode. Among people with severe depression, 76% of people with medication will recover compared to 18% without. Biggest cause of relapses are non-treated individuals and improper medication use.

39. O UTLOOK FOR B IPOLAR D ISORDER Although there is no technical “cure”, treatments for Bipolar can be very effective. With lithium treatment, success rates for treatment are as high as 70 – 85%. Best to manage with medications with some form of therapy treatment. Relapses reduce up to 50%.

40. G ET H ELP ! The best way to treat any form of depression or bipolar condition is to get help. Proper education on the disorders and obeying doctor guidelines will greatly improve chances of success.