In Another Land

Medical terminology can be confusing - even when practitioners try not to be! So, here's my summary in general English:

It helps to think of the blues, depression, bipolar disorder, and other mental disorders, as points on a continuum that stretches from minor and transitory to serious and long-term/permanent.

Follow up:

The "blues", feeling down, in the version every human being experience in reaction to less-than-satisfactory circumstances, is the starting point: you don't want to feel that way, but it happens, and it normally goes over relatively quickly. But sometimes it doesn't "go over". As you progress along the line, the dark feelings get more intense, more regular, more troubling, until you reach a point where you need help. That's depression.

Depression can be in reaction to outward events and circumstances, or it can be because the chemicals in your brain do not function properly.

Things that happen around or to you (severe psychological stress, physical illness or condition, etc.) can trigger depression. Sometimes you can deal with it yourself, sometimes you need help, but the key point is that the main cause lies outside you - it influences you, can have a devastating impact on your brain (see below) and life in general, but it will usually pass.

But it won't pass if the cause is internal: a growing amount of evidence indicates that people with clinical depression (depression that needs medical help, and is not due to external factors) have an imbalance of the brain's neurotransmitters, the chemicals that allow nerve cells in the brain to communicate with each other. Serotonin, one of these neurotransmitters, has received a lot of attention, but other neurotransmitters are also involved (noradrenaline, dopamine, acetylcholine, GABA). In addition, there seems to be strong evidence for a genetic component to clinical depression.

Going beyond depression you get to bipolar disorder (formerly called manic-depressive disorder), characterised by extreme mood-swings between abnormally high (manic) and abnormally low (depression). What is normally called depression is just one-half of bipolar - some even label it unipolar disorder. You could also be just manic. The mood swings could occur far apart, with "normal" periods in-between, or it can occur close together, in which case it is termed rapid-cycling. Paradoxically the two opposing moods can even co-exist at the same time in some individuals: imagine living in heaven and hell at the same time, that's about how it feels! No wonder that this form of bipolar disorder usually exhibit symptoms of even more serious mental disorders such as psychosis.

Current research seems to indicate that clinical depression and bipolar disorder are not caused by a single chemical or gene, but by a combination of different factors.

Treatment for depression and bipolar disorder also covers a whole continuum, from psychotherapy (talk sessions) and sociotherapy to very powerful drugs, usually in a combination tailored to your specific situation.

In conclusion: depression and bipolar disorder, like other mental illnesses, need to be treated by a medical professional. If you have any reason to think that you suffer from depression, go to your doctor. If necessary, he or she will refer you to specialists. But don't ignore it!

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