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Manic-depression is a spectrum of neurobiological illnesses that involve abnormal changes in the brain's chemistry and cellular structures. The neurotransmit-ters serotonin, norepinephrine, and dopamine appear to play key roles in triggering manic-depressive episodes. Anatomical damage or changes have been documented in the lateral ventricles, frontal and temporal lobe sulci, and Sylvian fissures. How bipolar disorders specifically start is yet to be explained. Evidence from family histories, adoptions, and twins strongly indicates that the disorders are genetically transmitted. There is, however, growing evidence that some individuals may develop manic-depressive illness from an in utero neurovirus. Environmental stress does not appear to play a major role in the causation of bipolar disorder or the number of episodes experienced by a person. Brain kindling and behavioral learning theories have not been helpful in explaining the cause or course of these disorders. Once individuals are in the midst of an episode, the reduction of environmental stress does appear to help reduce or soften the symptoms. Nonetheless, medications remain the principal treatment for bipolar disorders. Psychotherapy, psychosocial education, and environmental manipulation therapies serve as important adjuncts or additive components to treatment but are never the primary or sole intervention. This is particularly true for bipolar I and II and schizoaffective disorders. Approximately 70% of patients with bipolar I disorder significantly improve after taking lithium. Psychotherapy alone seldom has a meaningful impact on severe manic-depressive episodes. The future is extremely hopeful for individuals with bipolar disorders. New medications are currently being studied clinically, and our knowledge of how the brain functions is rapidly growing. Researchers are also learning to identify early risk factors and minor symptoms that signal the onset of illness. Unfortunately, manic-depression is an illness that cannot yet be prevented and continues, for many people, to be misdiagnosed. However, as our knowledge of medications, brain functioning, and early symptoms grows, science will be better positioned to effectively prevent and treat manic and depressive episodes.

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Suggested Reading

Bearden, C. E., Hoffman, K. M., and Cannon, T. D. (2001). The neuropsychology and neuroanatomy of bipolar affective disorder: A critical review. Bipolar Disorder 3(3), 106-150.

Beckham, E. E., and Leber, W. R. (1995). Handbook of Depression, 2nd ed. Guilford Press, New York.

Goodwin, F. K., and Jamison, K. R. (1990). Manic-Depressive Illness. Oxford University Press, New York.

Torrey, E. F., Bowler, A. E., Taylor, E. H., and Gottesman, I. I. (1994). Schizophrenia and Manic-Depressive Disorder: The Biological Roots of Mental Illness as Revealed by the Landmark Study of Identical Twins. Basic Books, New York.

Soares, J. C., and Gershon, S. (Eds.) (2000). Bipolar Disorders Basic Mechanisms and Therapeutic Implications. Marcel Dekker, New York.

Young, L. T., and Joffe, R. T. (Eds.) (1997). Bipolar Disorder: Biological Models and Their Clinical Application. Marcel Dekker, New York.

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How to Stop Your Depression Now

How to Stop Your Depression Now

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