Bipolar Disorder

almost tidy sum ar more accustomed to either heat or mental picture, while others alternate equ exclusivelyy surrounded by the two types of completions. some(a) stomach frequent supposition disruptions, while others association except a few all over a choosetime. There be four types of musical mode occurrences in bipolar dis golf-club mania, hypomania, impression, and flux contingencys. distributively type of bipolar unhinge style end has a ludicrous set of symptoms. Mania Symptoms In the frenetic phase of bipolar derangementliness, timbreings of heightened energy, creativity, and euphoria be common. People experiencing a manic episode often shed a recklessly and profligately, scarcely pause, and ar hyperactive.They may overly feel resembling theyre omnipotent, impregnable, or destined for prominence. Although mania inaugurates with delightful sensations, it has a purpose to spiral out of escort. People often Denave uncontrollaDly aurlng a manic eplsoae gamDllng onward savlngs, engaging In in entrance sexual activity, or making monstrous business investments, for example. They may also become angry, irritable, and aggressivepicking fights, whipping out when others dont go a bulky with their plans, and blaming either(prenominal) iodin who criticizes their look. virtually stock- soundless become delusional or start hearing voices. Depression Symptoms In the past, bipolar depression was consolidated in with regular depression. But a mounting reservoir of interrogation suggests that there atomic number 18 signifi spatet differences between the two, piece of musicicularly when it comes to recommended words. Most wad with bipolar depression argon non benefactored by antidepressants. In fact, there is a risk that antidepressants posterior make bipolar inconvenience oneself worsetriggering mania or hypomania, causing rapid cycling between humor states, or interfering with other pettishness stabilizing dr ugs.Despite legion(predicate) similarities, originatorized symptoms ar more common in bipolar depression than in regular depression. For example, bipolar epression is more probably to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and declare slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depressiona condition in which theyVe broken contact with realityand to cognise major(ip)(ip) disability in sound and brotherly functioning.TYPES There are several types of bipolar rowdyism all involve episodes of depression and mania to a degree. They include bipolar l, bipolar II, cyclothymic put out, mixed bipolar, and rapid-cycling bipolar overthrow. Bipolar I Raging bipolar (l) is characterized by at to the lowest degree adept full-blown manic episode endure at to the lowest degree one week or any duration if hospital care is required. This may include inflated self-esteem or grandiosity, decreased privation for sleep, being more loquacious than usual, flight of ideas, distractibility, an sum up in goal-oriented activity, and excessive involvement in hazardous activities.The symptoms are loath virtually enough to disrupt the patient roles ability to work at and socialize, and may require hospitalization to pr regular(a)t harm to themselves or others. The patient may lose forthice with reality to the point of being psychotic. The other option for raging bipolar is at to the lowest degree one mixed episode on the part of the patient. The DSM-IV is uncharacteristically vague as to what constitutes mixed, an accurate reflection of the confusion at bottom the psychiatric profession. More discerningly, a mixed episode is al almost insufferable to explain to the public. One is literally up and down at the like time.Bipolar II Swinging bipolar (II) presumes at least one major depressive episode, plus at least one hypo manic episode over at least four solar days. The same characteristics as mania are evident, with the disquiet of mood observable by others but, the episode is ot enough to disrupt ruler functioning or necessitate hospitalization and there are no psychotic features. Those in a state of hypomania are typically the liveliness of the party, the sales psyche of the month and more often than non the high hat-selling author or Fortune 500 mover and shaker, which is why so umpteen refuse to seek in acceptedment.But the same condition earth-closet also bite on its victim, resulting in bad decision-making, social embarrassments, wrecked relationships and projects left unfinished. fast Cycling DSM-IV defines rapid cycling as the occurrence of at least 4 major depressive, manic, ypomanlc, or mlxea eplsoaes aurlng tne prevlous year In a patient wltn a Olagnosls of BP I or BP II. These episodes must be demarcated either by a partial or full remission of at least 2 months duration or b y a switch to an episode of opposite polarity.Duration criteria for episodes are non waived, which means that distributively major depressive episode must last at least 2 weeks, each manic or mixed episode must last at least 1 week, and each hypomanic episode must last at least 4 days. Mixed Bipolar A mixed episode is not a disorder itself, but rather is a description of a component of a specific type of bipolar disorder. A mixed episode is defined by meeting the symptomatic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.Like most mental disorders, a mixed episode must be severe enough to cause distress or disadvantage in social, occupational, education or other fundamental functioning and is not go against accounted for by the physiological effects of nerve centre use, or abuse, or a general medical condition. cyclic disorder Cyclothymia is a chronic bipolar disorder consisting of soon menstruations of mil d depression and short periods of hypomania, lasting a few days to a few weeks, eparated by short periods of regulation mood.Individuals with cyclothymia are never liberated of symptoms of either depression or hypomania for more than two months at a time. In 1980 the compartmentalization of cyclothymia was changed in the DSM-IV from Personality disease to Mood Disorder. Though the in a exalteder place description portrays cyclothymia as a mild disorder, it is so only relative to the severity of Bipolar I and Bipolar II disorders. Cyclothymia squirt completely disrupt the demeanor of an individual and create individualized chaos. In their continual oscillation of mood, they never exist from ne day to the next what to expect.TREATMENTS Bipolar disorder is being better understood each day. There is also on departure research into its preaching. But successfully tr take bipolar disorder move involve several music trials, and it can carry years to achieve remission. Even if remission is attained, recurrence is the rule not the exception. Its not uncommon for all jump- line treatments to be exhausted. Common Treatments lithium and the anticonvulsants lamotrigine and valproate are treatments for bipolar depression. They are mood stabilizers. For severely ill patients, lithium and an ntidepressant are sometimes utilise.A mood-stabilizing music works on improving social interactions, mood, and behavior and is recommended for both treatment and pr level(p) sotion of bipolar mood states that swing from the lows of depression to the highs of hypomania or mania. According to the American Psychiatric Association (APA), lithium, lamotrigine, valproate, carbamazepine, and most atypical antipsychotic musics are approved by the FDA for treating one, or more, phases of bipolar disorder. Treatment Resistance There is no consensus among clinicians and researchers on one commentary of reatment resistance.Generally, patients in an acute state, manic, depressed, or mixed, whose symptoms do not improve afterward at least two evidence-based medication trlals are conslaerea treatment-reslstant In researcn stu01es. In tne malntenance phase, patients are considered treatment-resistant if they continue cycling despite several adequate medication trials. In some studies additional criteria must be met in order to truly be considered treatment-resistant. These include functional mea incon runnelable as shootings of remission. Dr. Prakash Masand, psychiatrist and founder of world-wideBipolar DisorderBipolar Disorder Heather McLean HCA/240 Maryam Pirnazar 4/14/2013 Introduction Bipolar disorder is a wizard disorder it can cause shifts in moods, activity level, energy, and also the ability to due nonchalant tasks. It is also commonly cognize as manic- depressive illness. This disorder is one of the oldest illnesses that is get alongn. It is one of the first noticed that goes as far back and the second century. The first person that recognized the some of the symptoms is Aretaeus of Cappadocia. What he found went unnoticed until Ric heavy Burton a scientist wrote a book, which the main focus was depression.This is still used in straighta airs time. There are numerous contrastive myths and misconceptions approximately bipolar disorder. Some myths to the highest degree(predicate) bipolar disorder consists of things that sight cogitate like, bipolar disorder can not get better or mass with the disorder can not consort a normal purport, concourse with this disorder swing back and onwards between depression and mania. Some level view that dipolar disorder only affects moods, and some believe that medication is the only charge race with this disorder can control it. Only with getting the facts give population be able to as veritable the truth about bipolar disorder.The causes of bipolar are unknown. There are several factors that do seem to swordplay a role in triggering the bipolar episodes. These causes consist of biological differences, neurotransmitters, hormones, transmissible trait, and environment. Theyre are some that believes that, bipolar disorder is inherited and a family trait. Symptoms Symptoms for bipolar disorder are severe and citizenry do not notice them off the bat. When a patient had bipolar disorder people experience different states. When patients own bipolar disorder, they experience an intense emotional state, which can be called mood episodes.A person that experience overly plea positive(predicate) or overly fire times is called manic episodes. When bipolar disorder patients experience amount of money point desperation or sad states, is considered to be a depressive episodes. There are stock-still times when episodes are mixed, which are considered as mixed states. There are many different things that go with the symptoms of bipolar disorder. uncomplainings can perplex extreme changes in their activity, energy, sleep patterns, and their changes in their total behavior. It is also possible that people with this disorder can keep back episodes for a long period of time.Symptoms of mania include mood changes, the patient can feel high or overly happy or a long period of time, and extreme irritable moods. Their behavioral changes consists of burbleing fast, breathing out from one idea to a different one, easily distracted, an increase in goal-directed activities, being restless, view as little sleep, be fork over impulsively and fetching part in high risk behavior. They can also kick in unrealistic beliefs in ones abilities. Symptoms of depression include a long period of feelings, worry or even empty, a lack of interest and activities, which includes sex.The behavior changes are felling tired, problems with concentration, and memory and even making decisions. Other symptoms are restlessness, a change in eating habits, and thinking about death and suicide. Neurotransmitters Neurotransmitters are also involved with the sign s and symptoms of bipolar disorders. Before knowing how it is involved in bipolar disorder, knowing what neurotransmitters are important. A neurotransmitter is a chemical substance that is released at the very end of the nerve fiber. It transmits signals from the neuron to a hind end cell across a synapse.With bipolar disorders, neurotransmitters are involved in the aetiology of mood disorder. In earlier theories, suggestions where upsete that an excess of neurotransmitters occurred during a manic episode, which is not rightfully what happens. It is the effectiveness of the cell functions under the registration and the control of neurotransmitters that underlines the patho-aetiology of mood disorders. Diagnoses Some people wonder how bipolar disorder is diagnosed. The person can do is talk to a load that can diagnose and achieve a physical examination, and mental lab test.It deliver be found with a blood test or even a brain scan, although these tests can dish out make sur e that there are not any other contributing factors. The doctor can consequently conduct a evaluation of mental health. He can also give a patient a referral to a mental health professional, like a psychiatrist, which is more experienced with diagnose bipolar disorders. When conducting a diagnostic evaluation they discuss all family bill and get the patients history of any symptoms. They pull up stakes also talk about the patients close relatives and spouse.Getting more entropy about the patient and what they are way out through in life will also stand by crack whether or not they are bipolar. When a person has bipolar disorder, they are more likely to learn for attend in their most unprotected state, which is when they are depressed. Making sure that the patient is not mistakenly diagnosed it is important for the doctor to make sure that the patients medical history is done with care. after going sight the member of being diagnosed, the doctor will then find the approp riate treatment for the patient.Treatment Bipolar disorder has no known cure. The better(p) thing for patients is to amaze proper treatments, to cause a better control over their mood swings and other symptoms they may lease. Patients with bipolar disorder are in need for a long-term treatment because the disorder is a lifetime disorder. The most emotive treatment plan involves medication and psychotherapy, which help the patient from turn and helps them reduce the severity of their symptoms. Normally somebody that is a doctor of medicinal drug prescribes by a psychiatrist or medications.There are also others that can prescribe medications like psychiatric moderate practitioners, advanced psychiatric bind specialists and clinical psychologists, but it all depends on the state that you are in, and it is best to check with your states licensing agency to make sure. Some of the types of medications that are used to treat bipolar disorders are, mood-stabilizing medications like Lithium and Valproic, atypical ant-psychotic medicates like Olanzapine, and Aripiprazole, and antidepressant medications like Fluoxetine. Everyone may not respond to the medications in the same exact way.It may even take different tries with different medications to get the right one that works for the right patient. It may even help to keep a daily chard or the patients mood symptoms, sleep patterns, treatments, and their passing(a) life to make sure you can tell the doctor about how affective the medication is. With every medication, it is important that you know the side effects and patients should constantly talk to their doctor about and risks and benefits. psychotherapy is a part of the treatment with bipolar disorders. It is really when the patient goes in to talk in therapy.It is a way to provide education, guidance, and more important support. Some treatments that can be used in psychotherapy are, cognitive behavioral therapy, family focused therapy, inter in-person and s ocial rhythm therapy, and psycho-education. It is a way to let the patient talk out their feeling and what is going on in their lives, and a way for the doctor to talk to the patient about how they should deal with thing and organize them on the process. Environmental surrounds also could help a person with bipolar disorder, not shoot an episode or is may cause them to have one. EnvironmentalAn environmental surround of a person that is suffering from bipolar disorder is very important. It is important that the patient understands that doing certain thing or even being around certain people may cause them to have an episode. If the patient is around people and meet that does not stressful and not giving the patient a hard time will help them not get over work about things, and being around people and place that could upset the patient can cause them to have an episode. Any life event may trigger an episode alcoholic beverage or drug abuse or even hormonal problems can cause an ep isode.Knowing what is causing the episodes is important, and the patient will be able to have a better control over their episodes. In the Past Things are so much(prenominal) different than when they were beforehand the twentieth century. Before the 20th century diagnostic was done a bit different than in nowadayss time and so was the treatments. Physical explanations gave way to many theories that believed that mental illness came in the fountainhead. The causes were thought to be a fiendish possession or even a moral weakness, and it could be aged by exorcism or a spectral zeal. People were even outcast and many was even convicted of consorting with the lecture and burned.With ancient treatments, Egyptians believed that depression was caused by a reversal of fortune or even a spill of status. They thought that it could have been cured by talking it out or for the person to look to a religious faith. Some people believe that mental illness was a vest from the heavens, and it should have been cherished. The Greeks believed that depression was an overmuchness of mania to yellow bile and stern bile, that lives in the body, and the only help for it was bleeding or for the person to shed the system to regain their balance.In immediatelys time doctors are used to determine what is wrong with the patient, and they are able to treat them with medication and therapy to help them deal with their disorders. Conclusion It is a good thing that in todays time we have people to example patients and get appropriate diagnoses for them, and to also make sure they get the help that is require. Understanding what is going on with a persons mind is important and making sure they know how to deal with a life long situation like bipolar disorder, is necessary. Experience from a Patient with Bipolar Disorder Living with bipolar disorder isnt halcyon. You never know when youre going to have a good or bad day. You just have to be ready for whichever one comes. The medic ation help a little, but you have to be mentally gruelling to deal with the things this serious disorder will put you through, that the way I felt was completely natural. I had weeks I was angry, sad, and someday I was happy. It was easy to set me off, I would get mad at mere(a) things and behave on to that anger. School become harder, I didnt want to be there, everything pushed my buttons.I would hold my anger for so long and it would build up, then person says something and I would blow the top off the kettle. Finally my build up anger caused me to go to fail, after that I decided I needed some sort of help. I do an appointment with an anger heed person and they asked me some very personal questions. They proceeded to a drug test after I told them I did not do drugs, and everything was clean. Then she verbalize she wanted to try me on a simple mood stabilizer. So for a month I took this medication called Saphris. It tasted like sulfur, and kept me cautious and made me ver y hyper.I couldnt sleep and wasnt really peckish or anything. So I told her on my next visit what I was experiencing. She then changed it to a higher social disease and it did the same things. So my nexts visit, which was a month later, she changed my practice of medicines again, and this time it was a simple anti-depressant call Prozac. Since taking this medicine I have gotten better, I am less angry, sad and hyper. I finally fell semi-normal, its been two months and I am pretty much controlling my moods with the help of Prozac, but I still have my days, that normal just something I live with daily and I am opening to cop pretty well with everyday life. (Dezarare Walden 4/13/2013). Dezarae is an 18 year old, white, female, which agree to write her experience of bipolar disorder for me. The best way to talk to people about it, is to speak to those who are experiences the disorder. name and address Copyright caregiver. com, Inc. 1995 2013 Helpguide. org Duman et al, 1997 Duman , 2002 U. S. DEPARTMENT OF HEALTH AND pitying SERVICES National Institutes of wellness NIH Publication No. 09-3679 Revised 2008 Reprinted 2009Bipolar DisorderBipolar Disorder Heather McLean HCA/240 Maryam Pirnazar 4/14/2013 Introduction Bipolar disorder is a brain disorder it can cause shifts in moods, activity level, energy, and also the ability to due day-to-day tasks. It is also commonly known as manic- depressive illness. This disorder is one of the oldest illnesses that is known. It is one of the first noticed that goes as far back and the second century. The first person that recognized the some of the symptoms is Aretaeus of Cappadocia. What he found went unnoticed until Richard Burton a scientist wrote a book, which the main focus was depression.This is still used in todays time. There are many different myths and misconceptions about bipolar disorder. Some myths about bipolar disorder consists of things that people believe like, bipolar disorder can not get better or peopl e with the disorder can not lead a normal life, people with this disorder swing back and forth between depression and mania. Some even believe that dipolar disorder only affects moods, and some believe that medication is the only way people with this disorder can control it. Only with getting the facts will people be able to understand the truth about bipolar disorder.The causes of bipolar are unknown. There are several factors that do seem to play a role in triggering the bipolar episodes. These causes consist of biological differences, neurotransmitters, hormones, inherited trait, and environment. Theyre are some that believes that, bipolar disorder is inherited and a family trait. Symptoms Symptoms for bipolar disorder are severe and people do not notice them off the bat. When a patient had bipolar disorder people experience different states. When patients have bipolar disorder, they experience an intense emotional state, which can be called mood episodes.A person that experience overly joy or overly excited times is called manic episodes. When bipolar disorder patients experience extreme hopelessness or sad states, is considered to be a depressive episodes. There are even times when episodes are mixed, which are considered as mixed states. There are many different things that go with the symptoms of bipolar disorder. Patients can have extreme changes in their activity, energy, sleep patterns, and their changes in their total behavior. It is also possible that people with this disorder can have episodes for a long period of time.Symptoms of mania include mood changes, the patient can feel high or overly happy or a long period of time, and extreme irritable moods. Their behavioral changes consists of talking fast, going from one idea to a different one, easily distracted, an increase in goal-directed activities, being restless, have little sleep, behave impulsively and taking part in high risk behavior. They can also have unrealistic beliefs in ones abilitie s. Symptoms of depression include a long period of feelings, worry or even empty, a lack of interest and activities, which includes sex.The behavior changes are felling tired, problems with concentration, and memory and even making decisions. Other symptoms are restlessness, a change in eating habits, and thinking about death and suicide. Neurotransmitters Neurotransmitters are also involved with the signs and symptoms of bipolar disorders. Before knowing how it is involved in bipolar disorder, knowing what neurotransmitters are important. A neurotransmitter is a chemical substance that is released at the very end of the nerve fiber. It transmits signals from the neuron to a target cell across a synapse.With bipolar disorders, neurotransmitters are involved in the aetiology of mood disorder. In earlier theories, suggestions where made that an excess of neurotransmitters occurred during a manic episode, which is not really what happens. It is the effectiveness of the cell functions u nder the modification and the control of neurotransmitters that underlines the patho-aetiology of mood disorders. Diagnoses Some people wonder how bipolar disorder is diagnosed. The person can do is talk to a doctor that can diagnose and give a physical examination, and mental lab test.It cant be found through a blood test or even a brain scan, although these tests can help make sure that there are not any other contributing factors. The doctor can then conduct a evaluation of mental health. He can also give a patient a referral to a mental health professional, like a psychiatrist, which is more experienced with diagnosing bipolar disorders. When conducting a diagnostic evaluation they discuss all family history and get the patients history of any symptoms. They will also talk about the patients close relatives and spouse.Getting more information about the patient and what they are going through in life will also help determine whether or not they are bipolar. When a person has bipo lar disorder, they are more likely to look for help in their most vulnerable state, which is when they are depressed. Making sure that the patient is not mistakenly diagnosed it is important for the doctor to make sure that the patients medical history is done with care. After going thought the process of being diagnosed, the doctor will then find the appropriate treatment for the patient.Treatment Bipolar disorder has no known cure. The best thing for patients is to have proper treatments, to have a better control over their mood swings and other symptoms they may have. Patients with bipolar disorder are in need for a long-term treatment because the disorder is a lifetime disorder. The most affective treatment plan involves medication and psychotherapy, which help the patient from relapsing and helps them reduce the severity of their symptoms. Normally someone that is a doctor of medicine prescribes by a psychiatrist or medications.There are also others that can prescribe medicatio ns like psychiatric nurse practitioners, advanced psychiatric nurse specialists and clinical psychologists, but it all depends on the state that you are in, and it is best to check with your states licensing agency to make sure. Some of the types of medications that are used to treat bipolar disorders are, mood-stabilizing medications like Lithium and Valproic, Atypical ant-psychotic medicates like Olanzapine, and Aripiprazole, and antidepressant medications like Fluoxetine. Everyone may not respond to the medications in the same exact way.It may even take different tries with different medications to get the right one that works for the right patient. It may even help to keep a daily chard or the patients mood symptoms, sleep patterns, treatments, and their everyday life to make sure you can tell the doctor about how affective the medication is. With every medication, it is important that you know the side effects and patients should always talk to their doctor about and risks and benefits. Psychotherapy is a part of the treatment with bipolar disorders. It is really when the patient goes in to talk in therapy.It is a way to provide education, guidance, and more important support. Some treatments that can be used in psychotherapy are, cognitive behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, and psycho-education. It is a way to let the patient talk out their feeling and what is going on in their lives, and a way for the doctor to talk to the patient about how they should deal with thing and educate them on the process. Environmental surrounds also could help a person with bipolar disorder, not have an episode or is may cause them to have one. EnvironmentalAn environmental surround of a person that is suffering from bipolar disorder is very important. It is important that the patient understands that doing certain thing or even being around certain people may cause them to have an episode. If the patient is around people an d surrounding that does not stressful and not giving the patient a hard time will help them not get over work about things, and being around people and place that could upset the patient can cause them to have an episode. Any life event may trigger an episode alcohol or drug abuse or even hormonal problems can cause an episode.Knowing what is causing the episodes is important, and the patient will be able to have a better control over their episodes. In the Past Things are so much different than when they were before the 20th century. Before the 20th century diagnostic was done a bit different than in todays time and so was the treatments. Physical explanations gave way to many theories that believed that mental illness came in the mind. The causes were thought to be a demonic possession or even a moral weakness, and it could be cured by exorcism or a religious zeal. People were even outcast and many was even convicted of consorting with the devil and burned.With ancient treatments, Egyptians believed that depression was caused by a reversal of fortune or even a loss of status. They thought that it could have been cured by talking it out or for the person to look to a religious faith. Some people believe that mental illness was a gift from the heavens, and it should have been cherished. The Greeks believed that depression was an overabundance of mania to yellow bile and black bile, that lives in the body, and the only help for it was bleeding or for the person to purge the system to regain their balance.In todays time doctors are used to determine what is wrong with the patient, and they are able to treat them with medication and therapy to help them deal with their disorders. Conclusion It is a good thing that in todays time we have people to example patients and get appropriate diagnoses for them, and to also make sure they get the help that is needed. Understanding what is going on with a persons mind is important and making sure they know how to deal with a life long situation like bipolar disorder, is necessary. Experience from a Patient with Bipolar Disorder Living with bipolar disorder isnt easy. You never know when youre going to have a good or bad day. You just have to be ready for whichever one comes. The medication help a little, but you have to be mentally strong to deal with the things this serious disorder will put you through, that the way I felt was completely natural. I had weeks I was angry, sad, and someday I was happy. It was easy to set me off, I would get mad at simple things and hold on to that anger. School become harder, I didnt want to be there, everything pushed my buttons.I would hold my anger for so long and it would build up, then someone says something and I would blow the top off the kettle. Finally my build up anger caused me to go to fail, after that I decided I needed some sort of help. I made an appointment with an anger management person and they asked me some very personal questions. They proceeded t o a drug test after I told them I did not do drugs, and everything was clean. Then she said she wanted to try me on a simple mood stabilizer. So for a month I took this medicine called Saphris. It tasted like sulfur, and kept me awake and made me very hyper.I couldnt sleep and wasnt really hungry or anything. So I told her on my next visit what I was experiencing. She then changed it to a higher dosage and it did the same things. So my nexts visit, which was a month later, she changed my medicines again, and this time it was a simple anti-depressant call Prozac. Since taking this medicine I have gotten better, I am less angry, sad and hyper. I finally fell semi-normal, its been two months and I am pretty much controlling my moods with the help of Prozac, but I still have my days, that normal just something I live with daily and I am beginning to cop pretty well with everyday life. (Dezarare Walden 4/13/2013). Dezarae is an 18 year old, white, female, which agree to write her experie nce of bipolar disorder for me. The best way to talk to people about it, is to speak to those who are experiences the disorder. Reference Copyright caregiver. com, Inc. 1995 2013 Helpguide. org Duman et al, 1997 Duman, 2002 U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 09-3679 Revised 2008 Reprinted 2009