Saturday, August 26, 2017

More than the blues: depression


Depression​ ​and​ ​mania—the​ ​companion​ ​moods​ ​of​ ​bipolar​ ​disorder—are​ ​“ancient illnesses”​ ​and​ ​common​ ​among​ ​the​ ​general​ ​population,​ ​and​ ​successfully​ ​treating​ ​them is​ ​perhaps​ ​the​ ​best​ ​way​ ​to​ ​eliminate​ ​the​ ​stigma​ ​surrounding​ ​mental​ ​illness,​ ​says​ ​Kay Redfield​ ​Jamison,​ ​a​ ​foremost​ ​academic​ ​authority​ ​on​ ​manic-depressive​ ​illness​ ​whose best-selling​ ​memoir​ ​​An ​ ​ Unquiet ​ ​ Mind ​ ​​ chronicled​ ​her​ ​early​ ​experience​ ​with​ ​bipolar disorder. 

All ​the ​major ​psychiatric ​illnesses disproportionately hit ​the ​young, ​and particularly ​college ​ ​
age. “The​ ​average​ ​age​ ​of​ ​onset​ ​of​ ​bipolar​ ​illness​ ​is​ ​17,​ ​18,​ ​19.​ ​All​ ​of​ ​the​ ​major​ ​psychiatric illnesses​ ​are​ ​illnesses​ ​of​ ​youth,”​ ​Jamison​ ​said.​ ​“It’s​ ​not​ ​like​ ​cardiac​ ​disease,​ ​it’s​ ​not​ ​like dementia,​ ​it’s​ ​not​ ​like​ ​cancer,​ ​which​ ​disproportionately​ ​hit​ ​older​ ​people.​ ​All​ ​the​ ​major psychiatric​ ​illnesses​ ​disproportionately​ ​hit​ ​the​ ​young,​ ​and​ ​particularly​ ​college​ ​age.”

Jamison​ ​said​ ​it’s​ ​also​ ​important​ ​to​ ​note​ ​that​ ​depression​ ​and​ ​mania​ ​are​ ​not​ ​modern ailments.​ ​Hippocrates​ ​described​ ​mania​ ​and​ ​melancholia​ ​extremely​ ​well​ ​in​ ​about​ ​500 B.C.,​ ​she​ ​said,​ ​as​ ​did​ ​the​ ​authors​ ​of​ ​ancient​ ​Persian​ ​and​ ​Chinese​ ​texts.  “Depression​ ​and​ ​mania​ ​are​ ​complex​ ​and​ ​multifaceted​ ​disorders,”​ ​said​ ​Dr.​ ​Jamison​ ​in​ ​a talk​ ​at​ ​Vanderbilt​ ​University​ ​in​ ​2017.​ ​(www.Vanderbilt.edu) 


“When​ ​we​ ​talk​ ​about​ ​these​ ​illnesses,​ ​we’re​ ​not​ ​just​ ​talking​ ​about​ ​illnesses​ ​of​ ​mood,” she​ ​said.​ ​“We’re​ ​talking​ ​about​ ​illnesses​ ​of​ ​energy​ ​and​ ​sleep​ ​and​ ​cognition—the​ ​ability to​ ​think​ ​clearly,​ ​the​ ​ability​ ​to​ ​reason.”  This​ ​is​ ​particularly​ ​problematic​ ​on​ ​college​ ​campuses,​ ​she​ ​said,​ ​where​ ​the​ ​essence​ ​of what​ ​young​ ​people​ ​are​ ​doing​ ​is​ ​learning.​ ​“When​ ​you​ ​have​ ​illnesses​ ​that​ ​disrupt​ ​that capacity​ ​to​ ​learn,​ ​it​ ​can​ ​be​ ​very,​ ​very​ ​frightening,”​ ​she​ ​said.​ ​“Suicidal​ ​thinking​ ​is​ ​not uncommon,​ ​and​ ​unfortunately,​ ​suicide​ ​is​ ​not​ ​uncommon.” 

Moods​ ​during​ ​depression​ ​includes​ ​hopelessness,​ ​irritability​ ​and​ ​apathy,​ ​she​ ​said. Mania,​ ​on​ ​the​ ​other​ ​hand,​ ​is​ ​the​ ​opposite​ ​in​ ​most​ ​ways.  “When​ ​people​ ​are​ ​manic,​ ​they​ ​have​ ​an​ ​incredible​ ​amount​ ​of​ ​energy,”​ ​Jamison​ ​said. “They​ ​speak​ ​and​ ​think​ ​quickly,​ ​they​ ​need​ ​far​ ​less​ ​sleep​ ​than​ ​usual,​ ​they’re​ ​restless, irritable,​ ​and​ ​they​ ​show​ ​astonishingly​ ​bad​ ​judgment.​ ​They​ ​spend​ ​money​ ​they​ ​don’t have,​ ​and​ ​they​ ​impose​ ​their​ ​enthusiasms​ ​and​ ​convictions​ ​on​ ​others.​ ​They’re​ ​impulsive, reckless,​ ​and​ ​they​ ​impetuously​ ​start​ ​new​ ​projects​ ​and​ ​new​ ​relationships.  “Mania,​ ​in​ ​short,​ ​is​ ​a​ ​high-voltage​ ​state,”​ ​she​ ​said.  Bipolar​ ​disorder​ ​is​ ​very​ ​common,​ ​Jamison​ ​said.​ ​

Approximately​ ​one​ ​person​ ​out​ ​of​ ​100 will​ ​develop​ ​a​ ​severe,​ ​classic​ ​form​ ​of​ ​the​ ​illness,​ ​and​ ​another​ ​2-3​ ​per​ ​cent​ ​of​ ​the population​ ​will​ ​experience​ ​a​ ​milder​ ​form.​ ​Some​ ​15-20​ ​per​ ​cent​ ​of​ ​people​ ​will​ ​have​ ​at least​ ​one​ ​episode​ ​of​ ​major​ ​depression​ ​in​ ​their​ ​lifetime.  “These​ ​are​ ​not​ ​weird,​ ​bizarre​ ​diseases—these​ ​are​ ​common.​ ​Depression​ ​is​ ​known​ ​as​ ​‘the common​ ​cold​ ​of​ ​psychiatry’​ ​for​ ​good​ ​cause,”​ ​she​ ​said.  Both​ ​depression​ ​and​ ​bipolar​ ​illness​ ​are​ ​genetic,​ ​she​ ​noted.​ ​Men​ ​and​ ​women​ ​are​ ​equally liable​ ​to​ ​bipolar​ ​illness,​ ​and​ ​women​ ​are​ ​about​ ​twice​ ​as​ ​likely​ ​to​ ​get​ ​depression.​ ​In addition,​ ​alcohol​ ​and​ ​drug​ ​abuse​ ​are​ ​very​ ​common​ ​among​ ​those​ ​who​ ​experience​ ​these disorders.​ ​The​ ​highest​ ​comorbidity​ ​in​ ​psychiatry​ ​is​ ​with​ ​bipolar​ ​illness​ ​and​ ​alcohol​ ​or drug​ ​abuse,​ ​she​ ​said. 

Jamison​ ​spoke​ ​of​ ​her​ ​own​ ​struggle​ ​to​ ​come​ ​to​ ​terms​ ​with​ ​her​ ​bipolar​ ​illness​ ​and​ ​to accept​ ​the​ ​necessity​ ​of​ ​taking​ ​lithium​ ​to​ ​treat​ ​it. 


Healing ​the ​Brain: ​Depression ​and ​Mental ​Illness ​ gives​ ​readers​ ​a​ ​view​ ​of​ ​the remarkable​ ​human​ ​brain,​ ​its​ ​capabilities,​ ​and​ ​its​ ​vulnerabilities.​ ​A​ ​brain​ ​compromised by​ ​depression​ ​and​ ​other​ ​mental​ ​illnesses​ ​is​ ​tragic​ ​and​ ​in​ ​many​ ​cases​ ​increasingly treatable.​ ​

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