Clinical depression, also known as major or unipolar depression, affects 9.9 million American adults, about 5 percent of the adult population, each year, according to the National Alliance of Mental Illness. Bipolar – manic-depressive disorder – affects 2.3 million adult Americans, about 1.2 percent of the U.S. population.Clinical DepressionBrian Butler, the lead clinician for Pike Peak Behavioral Health Group’s intensive outpatient program, said clinical depression lasts for long periods. It’s different from experiencing occasional sadness or a moody day. “Everybody experiences sadness,” Butler said. “Everybody is sad once in a while. That is not what we look at when we talk about what we call clinical depression.”Clinical depression renders a person’s life dysfunctional. “It affects the family life, their job, their ability to eat and sleep,” he said. Because clinical depression lasts longer than someone who may be “blue” for a couple of days, Butler said it is more difficult to overcome. “It is actually a change in their brain chemistry,” he said. “It is a brain disorder.”James Ungvarsky of the Colorado School of Professional Psychology agreed. “Depression in many clinical instances may be related to an imbalance in certain neurotransmitters in particular areas of the brain,” he said. “When this happens, it may be impossible for someone who is depressed to simply “snap out of it” until the balance is once more restored.”Ungvarsky added that diagnosing depression is not simple; it takes in-depth one-on-one counseling to distinguish it from other diagnoses.Bipolar disordersAlthough bipolar disorder is a form of depression and in some ways mirrors major depression, there are significant differences.There are two types of bipolar disorders – bipolar I and II, Butler said. Bipolar I disorder is what Butler described as “classical bipolar.”Classical refers to periods of mania in between periods of normal behavior. “They will usually experience a short period of normal mood and then they will go into a depression or clinically depressed state,” Butler said. It’s a cycle that is continually repeated if the person does not seek help.Examples of bipolar 1 manic episodes include increased sexual activity, unrealistic beliefs of one’s abilities or strengths and spending sprees, Butler said. “People with bipolar mania may mortgage their house for cash to send to a Guatemalan orphanage,” he said. “They may decide to get in their car and drive to California.”Bipolar II disorder symptoms may be less intense.Bipolar II disorder involves “at least one or more major depressive episodes with at least one hypo-manic episodes interspersed,” Butler said. There are two primary differences between bipolar 1 and 11.One is the degree of the hypo-manic episodes. “[There] is manic behavior (in the bipolar 11 person), but behaviors are not at the extreme degree that would be considered a full manic state,” he said. “Everything is more than usual, but it isn’t quite a full blown manic state.”The other notable difference in a bipolar II person is the more frequent occurrence of depressive episodes.Butler stressed again that the clinically depressed person suffers for long periods, with no normal or manic episodes interspersed. And bipolar disorder is a mixed bag of emotional highs and lows, with normalcy peeking through at various times.The most common signs of clinical depression include loss of appetite, energy, and interest in activities; and variations in sleep patterns. “Some of those symptoms, not all of them, would include significant changes in sleep patterns,” he said. “A person who defines themselves as sleeping either 14 [or] 18 hours a day and just doesn’t have the energy to get out of bed may find now that they can’t sleep. They lay down at maybe two or three in the morning and they wake up at five. They are going on very little sleep.”CausesTherapists look at and assess a number of factors in diagnosing both clinical depression and bipolar disorders, such as medical, environmental and biological histories, Butler said. A medical assessment is vital since clinical depression may result from illnesses like a stroke or heart attack.”The cause of depression and bipolar illness most likely has some biological basis that predisposes individuals to experience such swings in moods,” Ungvarsky said. “But there likely is needed some environmental influences to prompt the swings as well.”What causes depressive disorders is different for each individual. But what is certain, Butler said, is that these disorders are legitimate. He said depression is truly a brain disorder. “People aren’t making it up … they’re not just depressed because they want to be,” he said. “It’s just a matter of getting the right treatment.”TreatmentClinical depression has become one of America’s most costly illnesses, according to the El Paso County Mental Health Association. Left untreated, depression is as costly as heart disease or AIDS to the U.S economy. More than $43.7 billion is spent each year on absenteeism from work (over 200 million days lost from work each year), lost productivity and direct treatment costs.Butler said there are primarily three forms of treatment for clinical and bipolar depression: psychotherapy, medication, electroconvulsive therapy (ECT), or a combination of all.People are often hesitant to seek therapy because they are afraid of what people might think of them, Butler said. “A lot of people are still fairly uncomfortable about coming in for mental health evaluations or help because the stigma is still there,” he said. “If I had cancer and went in for help, people would say, “Hey, absolutely. Do what you gotta do.”Managing medication and depression can be tricky because everyone responds differently to medications. One form of treatment that may work well for some, may not for others, Butler said.Medication for the bipolar person is necessary the majority of the time, he said. “Bipolar is not something you are cured of,” Butler said. “It’s life-long. It’s like diabetes.” Diabetics take insulin, he said. “It’s the same thing with bipolar. As long as they follow their medication and follow the treatment guidelines, they are very successful, very happy. Life is good.”Dr. Elizabeth Hogan, a Colorado Springs psychiatrist, said prescribing the wrong medication could be dangerous.For example, a medication designed for clinical depression is not appropriate for those with bipolar disorder. A drug for clinical depression might not cause manic episodes, but it could “draw them out,” Hogan said.Butler said ECT, referred to in the past as electric shock therapy, is affective for many people. It’s come a long way, he said. “They use a general anesthetic and the person just goes to sleep,” Butler said. “They wake up and feel much better.” ECT is the gold standard for people with depression, he said.Ungvarsky added that some people turn to herbal or natural treatments, spiritual counseling or a lifestyle change. “Other actions, such as dietary changes, increased exercise, light therapy and social activities, have also been known to alleviate some depression,” he said.Whether it’s bipolar or clinical, depression is real, and relief is a phone call away.Editor’s note: This article is simply an overview of bipolar disorder and clinical depression. There are numerous symptoms, including rage and abusive behaviors, beyond what we’ve mentioned that are associated with both clinical depression and bipolar disorder. It is imperative that you seek help from a mental health professional before self-diagnosing or trying to diagnose a loved one or friend.For more information, visit the following Web sites:The National Alliance on Mental Illness – www.nami.org; National Institute on Mental Health – www.nimh.nih.gov; Mental Health Association – www.mentalhealthanswers.org.Or call the Pikes Peak Mental Health Center at 572-6100 or 1-800-285-1204.
