Chapter 6 PUTTING IT…together

Making Sense of All That Is Known

During the past 40 years, researchers and clinicians have made tremendous gains in the understanding and treatment of depressive and bipolar disorders. These are now among the most treatable of all psychological disorders. The choice of treatment for bipolar disorders is narrow and simple: drug therapy, ideally accompanied by psychotherapy, is the single most successful approach. The picture for unipolar depression is more varied and complex, although no less promising. Cognitive, cognitive-behavioral, interpersonal, and antidepressant drug therapy are all helpful in cases of any severity; couple therapy is helpful in select cases; pure behavioral therapy helps in mild to moderate cases; and ECT is useful and effective in severe cases.

CLINICAL CHOICES

Now that you’ve read about disorders of mood, try the interactive case study for this chapter. See if you are able to identify John’s symptoms and suggest a diagnosis based on his symptoms. What kind of treatment would be most effective for John? Go to LaunchPad to access Clinical Choices.

Several factors have been tied closely to unipolar depression, including biological abnormalities, a reduction in positive reinforcements, negative ways of thinking, a perception of helplessness, and life stress and other sociocultural influences. Precisely how all of these factors relate to unipolar depression, however, is unclear. Several relationships are possible:

  1. One of the factors may be the key cause of unipolar depression.

  2. Different factors may be capable of initiating unipolar depression in different people. Some people may, for example, begin with low serotonin activity, which predisposes them to react helplessly in stressful situations, interpret events negatively, and enjoy fewer pleasures in life. Others may first suffer a severe loss, which triggers helplessness reactions, low serotonin activity, and reductions in positive rewards.

  3. An interaction between two or more specific factors may be necessary to produce unipolar depression. Perhaps people will become depressed only if they have low levels of serotonin activity, feel helpless, and repeatedly blame themselves for negative events.

  4. The various factors may play different roles in unipolar depression. Some may cause the disorder, some may result from it, and some may keep it going.

As with unipolar depression, clinicians and researchers have learned much about bipolar disorders during the past 40 years. But bipolar disorders appear to be best explained by a focus on one kind of variable—biological factors. The evidence suggests that biological abnormalities, perhaps inherited and perhaps triggered by life stress, cause bipolar disorders. Whatever roles other factors may play, the primary one appears to lie in this realm.

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There is no question that investigations into depressive and bipolar disorders have been fruitful and enlightening. And it is more than reasonable to expect that important research findings and insights will continue to unfold in the years ahead. Now that clinical researchers have gathered so many important pieces of the puzzle, they must put the pieces together into a still more meaningful picture that will suggest even better ways to predict, prevent, and treat these disorders.