Depressive and Bipolar Disorders: Crash Course Psychology #30


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American psychologist, and professor of psychiatry, Kay Redfield Jamison, is one of the world’s
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foremost authorities on bipolar disorder. She’s spent her career researching, lecturing,
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and writing seminal books on the condition.
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A condition that she also happens to have had her entire adult life.
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In her memoir, “An Unquiet Mind,” Jamison details what it really means to be bipolar.
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She writes of not sleeping for days on end, of feeling long periods of euphoria, and filling
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whole notebooks with her racing thoughts and grandiose ideas.
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While in these manic states, she experienced a tremendously inflated sense of self-esteem
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and did impulsive things that felt good at the time but had painful consequences, like
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going on lavish shopping sprees, engaging in promiscuous behavior, racking up credit
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card debt, and emptying her bank accounts.
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But these episodes were followed by emotional crashes: Crippling bouts of depression that
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sent her into a suicidal spiral. At the age of 28, Jamison tried to kill herself by taking
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an overdose of Lithium, lapsed into a coma, but thankfully emerged from it determined
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to find help through medication and therapy.
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Through her research and writing, Dr. Jamison has pioneered our understanding of bipolar
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disorder, depression, and the nexus of mental struggles that we now think of as mood disorders.
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And she’s probably one of the best ambassadors we have for all those people who live successful,
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productive lives with mental illness.
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Just like the anxiety disorders we talked about last time, mood disorders are misunderstood.
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They’re diluted by depictions of depression as something that can be treated with one
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day at a spa or descriptions of people as manic depressive just because they were sad
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yesterday and aren’t today.
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As students of psychology, our job is to understand what mood disorders really are, how they manifest
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themselves, and what might cause them. And as you probably guessed, this can be pretty
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tough terrain to explore. These disorders can take people from terrifying highs to pits
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of despair that seem all but bottomless.
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But! In between there’s what Jamison has called, “A rich, imaginative life”
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— all made possible by your moods.
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We’ve been talking a lot about terms and concepts that mean something different than what you
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think they mean, but this time, the term “Mood” is not one of those.
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In a psychological context, moods are pretty much exactly what you think they are: Emotional
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states that are even more subjective and harder to define than the emotions themselves.
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And while psychologists have defined about 10 basic emotions, moods tend to fall
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into two broadly and infinitely variable categories. You got the good moods and the bad moods.
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Probably the most important distinction between emotion and mood is that moods are long-term
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emotional states rather than discreet, fleeting feelings.
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And “mood-disorders,” which are characterized by emotional extremes and challenges in regulating
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mood tend to be longer-term disturbances.
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These include depressive disorders, typified by prolonged hopelessness and lethargy, and
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bipolar disorders, the most prominent of which involve alternating between depression and mania.
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Depression has been called the common cold of psychological disorders. Which is not to
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say that it isn’t serious, but it’s common and it’s pervasive and it’s the top reason
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people seek out mental health help.
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We’ve all felt down before, obviously, often in response to a specific loss: a breakup
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or a lost job or the death of a loved one.
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And the fact is, you probably should feel bad at times like those. It can actually be
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good for a mind and body to slow down, to help digest losses that you experience, but
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in general, sadness is temporary. It’s when sadness and grief extend beyond the generally
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accepted social norms, or plunge into a depth that causes serious dysfunction that you find
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yourself in the territory of depressive disorders.
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The DSM-5, our handy (if super flawed) user’s guide to psychological disorders officially
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diagnoses a major depressive disorder when a patient has experienced at least five signs
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of depression for more than two weeks.
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These symptoms include not just depressed mood, but also significant weight or appetite
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loss or gain, too much or too little sleep, decreased interest in activities, feeling
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worthless, fatigued, or lethargic, difficulty concentrating or making decisions, and recurrent
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thoughts of death or suicide.
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So while everyone experiences sadness, depression is a physiological as well as psychological
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illness. It messes with your sleep, and appetite, and energy, and neurotransmitter levels, all
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interfering with the way your body runs itself.
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Plus in keeping with our definition of psychological disorders, to be considered a true disorder
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this behavior needs to cause the person or others around them prolonged distress – the
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feeling that something is really wrong.
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Just as a person with a severe, generalized anxiety disorder may never want to leave the
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house, a clinically depressed person often feels so hopeless and overwhelmed that they
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have trouble living a normal life. And unlike the bipolar disorders, the depressive disorders
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tend to be all lows.
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You’ve probably heard of manic depression. It’s the outdated term for bipolar disorders.
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These include those classic dark lows of depression, but also bouts of the opposite – of extreme
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mania in more severe cases. Someone suffering from a bipolar disorder may flip back and
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forth between normal and depressive and manic phases within a single day or week or month.
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And a true manic episode doesn’t just mean being energetic or happy, it’s a period of
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intense, restless, but often optimistic hyperactivity in which your estimation of yourself and your
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abilities and your ideas can often get skewed. Like, really, REALLY skewed.
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Some patients experience mania only rarely, but when they do, it can be destructive. Kay
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Jamison has testified to that.
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Once during a manic episode, she bought up a drug store’s entire supply of snake-bite
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kits, convinced of an imminent attack of rattlesnakes that only she knew was coming.
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In another, she purchased 20 books by the Penguin Publishing House because she said,
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“It could be nice if the penguins could form a colony.”
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In other words, bad judgment is common. And it can get worse.
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Full blown manic episodes often end up in psychiatric hospitalization, since the risk
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to self or others can become severe. When the highs eventually end, they’re often followed
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by dark periods of depression. When left untreated, suicide or suicide attempts are common, another
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element of the disorder that Jamison herself can attest to.
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Like so many things in psychology, the cause of mood disorders is often a combination of
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biological, genetic, psychological, and environmental factors. We know, for example, that mood disorders
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run in families – genes matter. And you’re more likely to experience a bipolar or depressive
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disorder if you have parents or siblings who suffer from them.
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Studies have of identical twins show that if one twin has a bipolar disorder, that the
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other has a seven in ten chance of also being diagnosed, regardless of whether they were
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raised together or apart.
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And while a stressful life can’t give you bipolar disorder, it could trigger a manic
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or depressive episode in someone with a pre-existing condition. Or start a descent into a major
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depressive episode in someone who never before had experienced depression. In other words,
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a person who loses a loved one could go from sad to depressed or slide into a bipolar episode,
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but it couldn’t cause them to have the disorder to begin with.
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In the case of depressive disorders, for most people, after weeks, months, or even years,
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their depression can end, hopefully with the return to baseline healthy functioning.
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World-wide, women tend to be diagnosed with major depression more often than men, but
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many psychologists think this is simply because women tend to seek treatment more. It’s also
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possible that depression in men tends to manifest itself more in terms of anger and aggression,
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than as sadness and hopelessness.
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This is just an example of how depression is much more than just being sad and that
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the characteristic lack of purpose and helplessness can manifest itself in a lot of different ways.
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Looking at mood disorders from a neurological perspective, we see that depressed, manic,
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and average brains show very different brain activity in neural imaging scans. As you might
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expect, a brain in a depressed state slows down. While a brain in a manic state shows
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a lot of increased activity, making it hard for that person to calm down or focus or sleep.
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Our brain’s neurotransmitter chemistry also changes with these different states. For example,
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norepinephrine, which usually increases arousal and focus, is severely lacking in depressed
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brains, but kind of off the charts during manic episodes. In fact, drugs that seek to
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reduce mania in part do it by reducing norepinephrine levels. You may have also heard about how
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low serotonin levels correlate with depressive states. Exercise, like jogging or break dancing
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or whatever, increases serotonin levels, which is one reason exercise is often recommended
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to combat depression. And most medications designed to treat depression seem to work
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by raising serotonin or norepinephrine levels.
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And of course there’s yet another way to look at things. The social-cognitive perspective
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examines how our thinking and behavior influence depression.
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People with depression often view bad events through an internal lens or mind set that
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influences how they’re interpreted. And how you explain events to yourself, in a negative
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or positive way, can really effect how you recover from them – or don’t.
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Say you were humiliated in the lunch room when someone tripped you and chicken soup
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flew all over the place, and you sat down on a brownie, and it was just a bad day. A
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depressive mind might immediately start thinking that the humiliation will last forever, that
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no one will ever let you live it down, that it’s somehow your own fault, and you can’t
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ever do anything right.
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That negative thinking, learned helplessness, self-blame, and over-thinking can feed off
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itself and basically smother the joy out of the brain, eventually creating a vicious self-fulfilling
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cycle of negative thinking.
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The good news is that the cycle can be broken by getting help from a professional, turning
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your attention outward, doing more fun things, and maybe even moving to a different environment.
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But again, that social-cognitive prospective is just part of a much bigger puzzle. Positive
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thinking is important, but it’s often inadequate on its own own when up against genetic or neurological factors.
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So mood disorders are complicated conditions and rarely are they eliminated with a single
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cure. Instead, they’re often things you just live with. And as Dr. Jamison has shown us,
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you can live well.
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Today we talked about what mood disorders are, as well as what they aren’t. You learned
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about the symptoms of depressive and bipolar disorders, and the possible biological, genetic,
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environmental, and social-cognitive causes of mood disorders.
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Thank you for watching this episode, which was brought to you by Marshall Scott and
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crediblefind.com. Thank you so much to all of you that have supported us! To find out
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how you can become a sponsor or supporter, just go to suppable.com/crashcourse.
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This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant
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is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins. The script supervisor
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is Michael Aranda who is also our sound designer. And the graphics team is Thought Cafe.


This post was previously published on YouTube.

Photo credit: Screenshot from video.