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 Depression and
Bipolar Disorder:
Your Guide to Recovery

William R. Marchand, MD

Bull Publishing Company

Boulder, Colorado
Copyright © 2012 by Bull Publishing Company
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted
in any form or by any means, including photocopying, recording, or other electronic or
mechanical methods, without the prior written permission of the publisher, except in the
case of brief quotations embodied in critical reviews and certain other noncommercial uses
permitted by copyright law.

Published by Bull Publishing Company

P.O. Box 1377
Boulder, CO, USA 80306
www.bullpub.com

Library of Congress Cataloging-in-Publication Data

Marchand, William R.
Depression and bipolar disorder : your guide to recovery / William R. Marchand. -- 1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-933503-99-8 (pbk.)
1. Manic-depressive illness--Popular works. 2. Depression, Mental--Popular works.
3. Self-care, Health. I. Title.
RC516.M374 2012
616.85’27--dc23
2012012064

First Edition
17 16 15 14 13 12 10 9 8 7 6 5 4 3 2 1

Interior design and project management: Dovetail Publishing Services

Cover design: Shannon Bodie, Lightbourne, Inc.
This book is lovingly
dedicated to my readers.
This page intentionally left blank
 Contents

Introduction 1
Why you need this book   2
Not receiving treatment   3
Misdiagnosis and inadequate treatment   5
Who will find this book useful   6
How to use this book   7
About the author   10
What this book can’t do   12
Evidence-based information and the bibliography   12
A message of hope   14

Chapter 1 Managing Emotional Distress

and Thoughts of Self-Harm 15
Options for receiving help immediately   16
Suicide risk factors   16
Developing a stress and crisis management plan   18

Chapter 2 Mood Disorders and the

Diagnostic Process 23
How psychiatric disorders are diagnosed   27
The disorders  32
Mood episodes  32

v
vi Depression and Bipolar Disorder

Depressive spectrum disorders   34

Bipolar spectrum disorders   34

Chapter 3 Do You Have a Mood Disorder? 43

Mood episodes  45
Depressive episodes  45
Cardinal symptoms: Depression and anhedonia   46
Other depressive symptoms   47
Distress/impairment and medical causes   48
Dysthymic disorders  49
Manic, hypomanic, and mixed episodes   50
Mood elevation  50
Other mood elevation symptoms   50
Impairment and medical causes   52
Mixed episodes  53
Episode duration  53
Mood episode summary   54
Interpreting your results   56
Mood episodes you have experienced   56
Your likely mood disorder diagnosis   58
Differential diagnosis  62
Coexisting conditions  63
Do you have a coexisting (comorbid) psychiatric condition?   64
Substance use disorders   65
Psychotic disorders  66
Obsessive-compulsive disorder  67
Generalized anxiety disorder   68
Panic disorder  69
Specific phobias  70
 Contents vii

Social phobia  71
Posttraumatic stress disorder (PTSD)   71
Attention-deficit/hyperactivity disorder (ADHD)   73
Eating disorders  74
Summary of possible comorbid conditions   75
Should you seek further evaluation from a mental health
or medical professional?   76

Chapter 4 Mood Disorders: Facts

and Causes 79
How common are mood disorders?   79
Course of illness for mood disorders   80
Additional features of mood disorders   83
Psychotic symptoms  83
Rapid cycling bipolar illness   83
Seasonal symptoms  84
Mood episodes caused or worsened by other disorders,
medications, or substances   84
The biology and psychology of mood disorders   88
The neurobiology of emotion   89
The biology of mood disorders   92
Brain structure  93
Genetic factors  94
Neurotransmitters  96
Inflammation  102
Neurocircuitry  103
Summary of the neurobiology of mood disorders   107
The psychology of mood disorders   107
Freudian theory  110
Cognitive theory  111
viii Depression and Bipolar Disorder

Interpersonal theory  113
Mindfulness theory  113
Summary of the biology and psychology of mood disorders   116

Chapter 5 How and Where to Find Help 117

Prescribers who treat mood disorders   118
Physicians other than psychiatrists   118
Psychiatrists  121
Other prescribers  124
Therapists who treat mood disorders   125
Finding help  126
Getting help if you are in crisis   126
National resources for finding treatment   127
Local resources for finding treatment   129
Support organizations  129
Costs of treatment   130

Chapter 6 Collaborating with Your Team 133

Who’s on your team?   134
Roles and responsibilities   135
Medical and mental health professionals   135
Friends and family   136
The team captain   138
Communication strategies  140
Learning the language   140
Managing time  141
Avoiding intimidation  141
What to do if things aren’t working out
with your provider   142
 Contents ix

Chapter 7 The Diagnostic Evaluation 145

What to expect   145
Components of a diagnostic assessment   146
Current psychiatric history   147
Past psychiatric history   148
Psychiatric disorder and substance use screening   148
Medical and surgical history   149
Current medications  149
Medication allergies  149
Family history  150
Social history  150
Mental status examination   150
Physical examination  151
Laboratory or diagnostic procedure results   152
Psychological testing  152
Diagnostic and symptom severity testing   152
Getting ready for the appointment   153
Preparing your evaluation form   153

Chapter 8 Medication and Other Biological

Treatments 169
General principles of biological interventions   170
Effectiveness studies  170
We can’t know everything about any given treatment   171
All biological treatments have risks   173
Medications used to treat mood disorders   173
Antidepressants  174
Selective serotonin reuptake inhibitors (SSRIs)   174
x Depression and Bipolar Disorder

Selective serotonin reuptake inhibitors and 5-HT1A

receptor partial agonists   174
Serotonin-norepinephrine reuptake inhibitors (SNRIs)   175
Dopamine-norepinephrine reuptake inhibitors   175
Serotonin modulators and norepinephrine-serotonin
modulators  175
Tricyclic and tetracyclic antidepressants (TCAs)   176
Monoamine oxidase inhibitors (MAOIs)   177
How well do antidepressants work?   180
Antidepressant side effects   181
Discontinuation syndrome  183
Mania and rapid cycling in bipolar disorder   183
Serotonin syndrome  184
Sexual side effects   184
Suicide  184
Mood stabilizers  186
Anticonvulsants  187
Antipsychotics  190
Lithium  193
Additional biological treatments   194
Transcranial magnetic stimulation (TMS)   194
Electroconvulsive therapy (ECT)   195
Vagus nerve stimulation (VNS)   196
Light therapy  197
Summary of biological treatments   197

Chapter 9 Psychotherapy 199

Why psychotherapy?  199
What is psychotherapy?   200
 Contents xi

Developing self-awareness  201
Cognitive and mindfulness-based therapies   203
Cognitive therapy (CT)   204
Mindfulness-based psychotherapies  206
Mindfulness-based stress reduction (MBSR)   209
Mindfulness-based cognitive therapy (MBCT)   210
Summary of mindfulness therapies   211
Other psychotherapy methods   211
Family-focused therapy (FFT)   212
Group therapy  212
Interpersonal therapy (IPT)   213
Interpersonal and social rhythm therapy (IPSRT)   213
Marital and family therapy (MFT)   213
Problem-solving therapy (PST)   214
Psychodynamic psychotherapy  214
Psychoeducation  214
Summary of psychological approaches   215

Chapter 10 Complementary Approaches

to Recovery 217
Acupuncture  218
Aerobic exercise  218
Dietary supplements  219
Folate  220
Omega-3 fatty acids   220
SAM-e  222
St. John’s wort   222
Mindfulness meditation  223
Religion and spirituality   224
xii Depression and Bipolar Disorder

Social support  225
Evaluation of your level of social support   226
Companion animals  228
Self-help books and websites   229
Summary of alternative and adjunctive recovery strategies   233

Chapter 11 Starting Treatment 235

Which initial treatment approach?   236
Potential risks versus benefits   236
Three general treatment strategies   237
Starting treatment for a depressive disorder   238
Major depressive disorder   241
Uncomplicated major depression   241
Major depression with psychotic symptoms   241
Major depression with catatonic symptoms   244
Major depression with a seasonal pattern   244
Major depression with a comorbid anxiety disorder   244
Major depression with a comorbid substance use
disorder  245
Major depression with a comorbid eating disorder   245
Major depression with comorbid dementia   246
Dysthymic disorder  246
Adjustment disorder with depressed mood   246
Starting treatment for bipolar disorder   247
Bipolar depression  247
Biological treatments for bipolar depression   248
Psychotherapy for bipolar depression   250
 Contents xiii

Manic, hypomanic, and mixed episodes   250

Biological treatments  251
Psychotherapy  251
Treatment setting  252
Which treatment setting is right for you?   252
What about involuntary treatment?   253

Chapter 12 Special Considerations

for Women 255
Major depression  256
Diagnosis of depression during pregnancy and
after delivery  256
Depression and your child   257
Depression treatment during pregnancy and
breast-feeding  258
Antidepressant treatment during pregnancy   258
Antidepressant treatment while breast-feeding   264
Psychotherapy treatment while pregnant or
breast-feeding  265
Recommendations  265
Bipolar disorder  268
Medication treatment for bipolar disorder during
pregnancy and breast-feeding   269
Recommendations  270
Premenstrual dysphoric disorder   271

Chapter 13 Getting Well:

The Acute Phase of Treatment 273
Follow-up appointments  273
Individual variations in treatment response   276
xiv Depression and Bipolar Disorder

Are you getting better?   277

Mood symptom fluctuation   277
Mood cycles  278
The nature of treatment response   279
Mood charts  279
Maximizing treatment  284
Inputs to good decision making   284
Evidence-based decision making   288
Outputs  290
Acute treatment for depressive disorders   291
Acute treatment for bipolar disorders   292
Bipolar depression  292
Mania, hypomania, and mixed episodes   296

Chapter 14 Maintenance Treatment and

Relapse Prevention 297
Maintenance treatment  297
The aim of maintenance treatment   298
Decisions about maintenance treatment   298
Maintenance treatment for depressive disorders   300
Maintenance treatment for bipolar disorders   302
Additional strategies for relapse prevention   303
Developing a relapse prevention plan   304
Your relapse triggers   307
Preventing and managing triggers   307
Early signs of relapse   310
Responding to a potential relapse   311
Final thoughts  312
 Contents xv

Appendix A. Resources for Getting Help   313

Appendix B. Useful Websites   315

Appendix C. Recommended Reading   316

Glossary  317

Bibliography  323

Index  353
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