Acute Stress Disorder: Reliving trauma

Acute Stress Disorder: reliving trauma
By: Zoe Alekel

It is not uncommon to experience a traumatic event in life. In fact, trauma related incidences range from experiencing a car accident, to experiencing an assault or witnessing a crime. All of these stressful situations can be lead causes to an anxiety disorder known as Acute Stress Disorder (ASD). According to the American Institute of Stress, ASD is defined by Post Traumatic Stress Disorder (PTSD)-like symptoms that occur for a short time after experiencing a trauma—an experience that can be emotionally distressful and painful, and that can cause mental and physical symptoms. After experiencing a traumatic event, it is not uncommon to develop ASD; in fact 5-20% of people that experience traumatic events will develop ASD.

Symptoms of ASD include intrusion symptoms, like involuntary distressing memories; negative mood symptoms, such as the inability to experience positive emotions like love and happiness; dissociative symptoms, like seeing yourself from the outside, the feeling that nothing is real and that time is slowed down; avoidance symptoms, such as avoiding thoughts, feelings, and places associated with the trauma; and arousal symptoms, such as trouble falling or staying asleep, irritable behavior, and difficulty concentrating.

This can be extremely overwhelming and invasive to someone who has experienced a traumatic event, and it is uncomfortable to feel as if you have to relive the event itself. However, ASD does not have to take over your life completely. By implementing an immediate therapeutic intervention right after the trauma, it decreases the likelihood of ASD becoming prolonged and turning into PTSD. Ways to manage the stress and anxiety that comes with ASD are mindfulness and relaxation, talking to a trained trauma specialist, and having a support system that you can confide in.

If you or someone you know is struggling with Acute Stress Disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ Sources: https://www.stress.org/acute-stress-disorder https://www.psychologytoday.com/us/conditions/acute-stress-disorder

Sources:

https://www.stress.org/acute-stress-disorder

https://www.psychologytoday.com/us/conditions/acute-stress-disorder

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Anxiety, Depression, Eating Disorders, ADHD, Et al: How to Support a Friend with Mental Illness

By: Sarah Cohen

When helping a friend with a mental illness, the first step should be assessment of their symptoms. Sometimes they just might be going through a difficult time, but if certain common symptoms associated with mental health issues persist it is imperative to respond sensitively. Majority of the time, friends will just want to know they have your support and that you care about them. A good way to show your support is by talking to them. If you provide a non-judgmental space for them to speak about their issues it will help encourage them to be open with their problems. Let them lead the conversation and don’t pressure them to reveal information. It can be incredibly difficult and painful to speak about these issues and they might not be ready to share everything. If you aren’t their therapist do not diagnose them or make assumptions about how they are feeling, just listen and show you understand. If someone doesn’t want to speak with you, don’t take it personally, just continue to show them you care about their wellbeing and want to help as much as possible. Just knowing they have support can give them the strength they need to contact someone who can help them.

If a friend is having a crisis, such as a panic attack or suicidal thoughts, you must stay calm. Try not to overwhelm them by asking a lot of questions and confronting them in a public setting. Ask them gently what would be helpful to them right now or reassure them. If they hurt themselves, get first aid as soon as possible. If someone is suicidal, contact the suicide hotline at 800-237-8255 immediately.

The best way to help someone is by connecting them to professional help. By expressing your concern and support you can show them that they can get help and their mental health problems can be treated.

If you or someone you know needs support with their mental illness, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem

https://www.mentalhealth.gov/talk/friends-family-members

Marriage During Covid-19

By: Sarah Cohen

During Coronavirus, a lot of extra strain and anxiety have been placed on marriages. While research has shown that disasters uncover strengths in relationships it can also reveal issues. Even in the best relationships, we still always need a little bit of space from each other. 

Since Coronavirus has begun, applications for divorce have risen greatly in the Chinese city of Xi’an. While divorce rates do increase during times of stress, this is unprecedented. There aren’t just changes in routine and close contact without breaks, there are many other factors influencing marital stress during these times. An increased amount of new anxiety about health and keeping safe from Covid-19, unemployment and therefore financial insecurity, caring for elderly relatives with reduced strength immune systems, lacking social connection outside of the spouse, dealing with childcare and school issues, or simply managing chores and uncertainty about what will be in the future are just a few of the issues that could be causing marital stress. In addition, couples may be using different coping mechanisms during stressful times which clash with the other spouse. One might be active and attempt to be cheerful while the other might be hopeless and passive.

There are many ways to fight against this marital strain, here are a couple ways to combat it. By picking your battles you can limit the amount of arguments and issues you create in the home. Even further, you can put a time limit on your arguments in order for them not to affect every moment of the day, when the time limit is up you can put it all behind you. Create some alone time, when you make boundaries stick to them. Another way to get some alone time and be active is to exercise, even just by taking a walk. Speaking to other people over the phone or video chat so your spouse isn’t the only person you talk to is another good way to make sure you can have a little break. Lastly, focus on survival during these difficult times not creating issues and rifts between you and your partner.

If you or someone you know needs support with their marriage, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

https://www.psychologytoday.com/us/blog/the-discomfort-zone/202004/will-coronavirus-infect-your-marriage

https://time.com/5811146/coronavirus-married-relationship/

Race and Mental Health Treatment

Race and Mental Health Treatment
By: Isabelle Siegel

Research demonstrates that individuals from racial and ethnic minorities are significantly less likely to receive treatment for mental health issues than White individuals. In 2015, nearly half (48%) of White individuals with mental illnesses received professional help while significantly smaller percentages of minority individuals—31% of Black individuals, 31% of Hispanic individuals, and 22% of Asian individuals—with mental illnesses received professional help. This begs the question: Why are people from racial and ethnic minority backgrounds less likely to receive mental health treatment?

Financial Barriers. A report conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) reveals that the primary reason that people from racial and ethnic minority backgrounds are less likely to receive mental health treatment is due to the cost of services and/or lack of insurance coverage. People from racial and ethnic minority backgrounds are disproportionately likely to experience poverty and, as a result, to have difficulty accessing healthcare services.

Stigma. Research suggests that mental illness stigma is more acute among certain racial and ethnic groups. For example, studies suggest that feelings of stigma are greater among Asian and Hispanic individuals as compared to among White individuals. This, in turn, renders Asian and Hispanic individuals less likely to seek out mental health treatment when in need.

Lack of Culturally Competent Therapists. The majority of therapists are White and may not directly understand the experiences of people from racial and ethnic minority backgrounds. Becoming a culturally competent therapist requires education and effort that unfortunately does not always take place. In fact, 56% of mental healthcare providers report having no formal cultural competency training.

Language Barriers. Many therapists speak only English, which poses yet another barrier for racial and ethnic minority individuals who wish to seek mental health treatment. As a result, it can be difficult for non-English speaking individuals to receive proper mental healthcare.

It is imperative that we work to increase the accessibility to mental health treatment for all individuals. Regardless of race and/or ethnic background, socioeconomic status, and other demographic factors, all individuals have the potential to benefit from therapy and other forms of treatment.

If you or a loved one needs support, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
Mental Health Facts for Diverse Populations – American …www.psychiatry.org › Mental-Health-Disparities › Ment…
https://www.nimh.nih.gov/news/science-news/2015/a-new-look-at-racial-ethnic-differences-in-mental-health-service-use-among-adults.shtml
https://socialwork.simmons.edu/racial-disparities-in-mental-health-treatment/

https://www.kff.org/other/state-indicator/poverty-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568160/
Image Source: Mental Health Facts for Diverse Populations – American …www.psychiatry.org › Mental-Health-Disparities › Ment…

Mental Illness: How to Support a Spouse with Mental Illness

Mental Illness: How to Support a Spouse with Mental Illness
By: Isabelle Siegel

Every relationship has challenges, but relationships in which one partner has a mental illness can be even more challenging. The presence of mental illness in a relationship can leave both individuals feeling alone and helpless. However, it is not impossible to be in a happy, healthy, and successful relationship with someone with a mental illness. If you are wondering how to support your partner/spouse with mental illness, know that it is possible. Although your partner’s/spouse’s mental illness may at times feel all-consuming, certain steps can ultimately help manage the overwhelming ups and downs.

Develop an understanding of your partner’s/spouse’s diagnosis. It can be helpful to research the symptoms of your partner’s/spouse’s disorder in order to better recognize and label them as they arise. Having a basic understanding of what your partner/spouse is experiencing can help you to put yourself in his/her shoes and to gain insight into his/her struggles.

Just be there. Having a mental illness oftentimes makes people feel alone and as though they are a burden to their loved ones. The single most powerful way you can support your partner/spouse with a mental illness is to be there for him/her. Communicate that you are there for the highs and lows, and be ready to love your partner/spouse through them.

Do not let mental illness take over your entire relationship. Although it is important to communicate, try to keep your relationship balanced by limiting discussions about mental illness. Even when your partner’s/spouse’s mental illness feels all-consuming, continue to engage in activities that pull you and your partner away from thinking about his/her diagnosis and struggles.

Communicate openly how you feel. Regardless of a mental illness diagnosis, open communication is a critical component of any relationship. Be honest with your partner/spouse about how you feel, communicating any emotions with the goal of productively working through them.

Understand that your partner/spouse is trying the best he/she can. It can be easy to assume that a person with mental illness would feel better if only he/she tried harder. Oftentimes, people with mental illness are coping with their struggles in the best way they can.

Accept that it will be challenging at times. Being in a relationship with someone with a mental illness is going to pose challenges. It can arouse difficult emotions such as frustration, anger, resentment, sadness, etc. Allow yourself to feel these emotions and be willing to communicate them with your partner.

Most importantly, take care of yourself. It is important to understand that your partner/spouse is not the only one who needs support. Never feel guilty for prioritizing your own needs, and consider seeking therapy or other support in order to take care of your own mental health.

If you or a loved one needs support, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
https://www.nami.org/Blogs/NAMI-Blog/November-2018/How-to-Be-Supportive-of-Your-Partner-with-Mental-I
https://www.nami.org/Personal-Stories/How-To-Love-Someone-With-A-Mental-Illness
https://www.verywellmind.com/coping-with-a-mentally-ill-spouse-2302988

Image Source: https://images.app.goo.gl/1XXGCnGttHazLixy5

Bipolar Disorder: How to Support a Spouse with Bipolar Disorder

Bipolar Disorder: How to Support a Spouse with Bipolar Disorder

By: Isabelle Siegel

Bipolar Disorder is characterized by alternating manic (“elevated, expansive, or irritable mood”) and depressive (“depressed mood or loss of interest or pleasure in life”) episodes. The disorder causes significant suffering for the individual diagnosed, as well as his/her loved ones. It can be extremely difficult to support a partner or spouse with Bipolar Disorder, but it is possible with the right mindset and preemptive actions.

Develop an understanding of Bipolar Disorder and how it manifests in your partner/spouse. Psych Central suggests creating a list of warning signs that your partner/spouse starts to exhibit before or while entering a manic or depressive episode. This will help you to better understand your partner/spouse, as well as enable you to interpret his/her behaviors in the context of the disorder.

Learn what helps (and what does not help) when your partner/spouse is in a manic or depressive episode. When your partner/spouse is stable, work together to create a list of actions you can take to alleviate symptoms when he/she is in a manic or depressive episode.

Communicate. As cliche as it sounds, open communication is integral to maintaining a relationship with someone who has Bipolar Disorder. It is important that each partner/spouse feels heard and validated at all times.

During manic or depressive episodes, understand your partner’s/spouse’s behavior in the context of the disorder. During episodes, it is important to view your partner’s/spouse’s actions and words as symptoms of a disorder rather than as reflective of his/her true feelings. If your partner/spouse says something hurtful, for example, try to understand the role that the disorder is playing in causing this behavior.

Allow yourself to feel frustration, upset, or any other emotion. Understand that Bipolar Disorder is an illness and that it is normal for difficult or conflicting emotions to arise. Do not feel guilty for feeling frustrated, upset, angry, resentful, or even for wanting to leave your partner/spouse at times. All of these feelings are normal.

Most importantly, take care of yourself and seek therapy. Understand that your partner/spouse is not the only one who needs support and never feel guilty for prioritizing your own needs. It can be beneficial to seek therapy or other support in order to take care of your own mental health and to work through difficult emotions.

If you or a loved one needs support and help understanding yourself and/or a family member, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
https://psychcentral.com/blog/helping-your-partner-manage-bipolar-disorder/
https://www.nami.org/personal-stories/living-with-someone-with-bipolar-disorder
https://www.healthline.com/health/bipolar-disorder/relationship-guide
https://www.psycom.net/bipolar-definition-dsm-5/

Image Source:
https://medium.com/@christinacare/a-guide-to-supporting-a-partner-in-therapy-f0d64575558

Therapy: Reasons Not To Delay Mental Health Treatment

Therapy: Reasons Not To Delay Mental Health Treatment
By: Isabelle Siegel

The median delay between onset of mental illness symptoms and treatment-seeking is a shocking ten years. In other words, people are suffering silently and without help for nearly a decade before they even speak to a professional. Before choosing to delay treatment, it is important to consider the many benefits of seeking therapy sooner rather than later.

Seeking therapy earlier decreases the likelihood that symptoms will worsen. Among those who chose to delay treatment, 37% reported that their symptoms worsened. This can in turn make treatment more difficult when it is finally sought out and, overall, can complicate the therapeutic process.

Seeking therapy earlier decreases the likelihood that physical symptoms will develop. Unaddressed mental illness symptoms can lead to physical consequences including obesity, heart attack, stroke, gastrointestinal issues, and general increased risk for disease.

Seeking therapy earlier decreases the degree to which symptoms interfere with one’s life and relationships. A hallmark of mental illness is interference with quality of life and relationships. People who choose to delay mental health treatment are more likely to lose their jobs, drop out of school, experience financial troubles, and get divorced.

Seeking therapy earlier decreases the risk of comorbid disorders. People with untreated mental illness are more likely to develop comorbid disorders. Comorbid substance use disorders are particularly likely to arise as a result of people self-medicating with alcohol and/or drugs. These comorbid disorders further complicate treatment when it is finally sought.

Seeking therapy earlier decreases mortality rates. Neglecting mental health problems increases one’s risk for self-harm, suicide, and accidents (e.g., overdose, car accidents). In fact, the majority of suicide attempts are due to untreated mental illness.

Seek treatment now. If you or a loved one needs support, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361004/
https://deserthopetreatment.com/co-occurring-disorders/going-untreated/
https://www.theguardian.com/society/2018/oct/09/mental-health-patients-waiting-nhs-treatment-delays

Image Source: https://www.news-medical.net/health/Cognitive-Behavioral-Therapy-for-Anxiety.aspx

COVID-19: Parenting in a Stressful Time

COVID-19: Parenting in a Stressful Time

By: Alexa Greenbaum

Parenting in confinement during COVID-19 has many challenges. For many, the home has become the office and the classroom, making it more difficult to be productive and motivated. During this stressful time in isolation, it can be very difficult to keep children occupied while also working remotely, dealing with finances, and navigating the danger of the coronavirus. However, by creating structure, setting boundaries, and encouraging open communication, parents can improve their family dynamic.

Parents are having to take on more responsibilities than ever before. Especially in a very uncertain time, it is normal for children and parents to feel anxious, stressed, and overwhelmed. As a result, many parents and children are reacting to today’s stressors by acting out or regressing to behaviors long outgrown. Due to the additional stressors that come with COVID-19, parents are taking on too much which is causing parents to feel stressed, frustrated, and resentful. According to the APA’s Stress in America survey, “73% of parents report family responsibilities as a significant source of stress.” This can erode the feeling of mutual support and respect that is crucial to a healthy relationship.

To help, creating some structure in your life, such as a routine and designating a workspace for children to do their schoolwork and homework can be an effective way to set boundaries and help a family cope with stress. Thanking your child for allowing you to do your work, is an effective tool as it positively reinforces your child to continue giving you the space you need to be productive.

Sharing and designating daily responsibilities can improve the quality of a parent’s relationship with their children. Working together as a family and designating different tasks is something you and your children can control, and it teaches children to focus on those things they can control when feeling stressed.

To help parents create a healthy family dynamic in the climate of COVID-19, the way parents talk to their kids may need to be readjusted as well. Initiating regular open conversations with their kids. Giving your children your undivided attention can help a family work together to better understand, acknowledge, and address any stressors children are experiencing. Calming your children’s fears is important.

Take advantage of this time together, it can be an opportunity for your relationship with your kids to grow, but don’t forget to take care of yourself! For support, discussing experiences with friends, relatives, or a telehealth mental health professional can be helpful. At Arista Counseling, we have a multitude of different therapists that can help you.

If you or someone you know is looking for support, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.apa.org/topics/covid-19/parenting-during-pandemic

https://www.apa.org/helpcenter/managing-stress

https://www.psychologytoday.com/us/blog/little-house-calls/202003/parenting-during-covid-19

Image Source:

https://www.parkview.com/community/dashboard/dealing-with-parenting-stress-during-covid-19

Social Anxiety Disorder: More Than Just Being Shy

By: Gabriella Phillip

Social Anxiety Disorder, also known as social phobia, is a mental health condition involving an intense, persistent fear of being watched or judged by others. The fear that people with social anxiety experience in social situations is so strong that they often feel as though it is beyond their control. Social Anxiety Disorder affects around 15 million American adults and is the second most commonly diagnosed anxiety disorder following specific phobia.

Common symptoms for people with social phobia include

  • being extremely anxious around other people,
  • being self-conscious in front of others,
  • being very afraid of being embarrassed in front of other people
  • being the focus of other people’s judgment
  • worrying for days or weeks before a social event
  • having a difficult time cultivating friendships
  • avoiding places where other people will be present

Bodily symptoms for people with social anxiety include

  • heavy sweating
  • trembling
  • nausea
  • blushing
  • having difficulty speaking

Social phobia sometimes runs in families, but no one knows for sure why some people have it, while others don’t. When chemicals in the brain are not at a certain level it can cause a person to have social phobia. Social anxiety usually begins during childhood/ teenage years, typically around age 13. A doctor can tell if the person has this disorder if symptoms are present for at least 6 months. This disorder should be treated in a timely manner to help spare those diagnosed from years of unpleasant feelings and anxiety.

Treatment can help people with social phobia feel less anxious and fearful. Two types of treatments used for Social Anxiety Disorder are psychotherapy, or talk therapy, and medication that’s safe and effective, often used in combination. Cognitive behavior therapy is an effective type of psychotherapy used for anxiety related disorders. Medication used to treat Social phobia include selective reuptake inhibitors (SSRIs), antidepressants, anti-anxiety medicines, and beta blockers. It’s important to choose a method of treatment that is best suited towards your individual needs.

If you or someone you know is struggling with Social Anxiety Disorder, Arista Counseling and Psychotherapy can help. Please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

 

Sources

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml

https://www.verywellmind.com/difference-between-shyness-and-social-anxiety-disorder-3024431

 

Depression: Difference between Unipolar and Bipolar Depression

By Gabriella Phillip

Eliciting a history of brief periods of improved mood is the key to differentiating between unipolar and bipolar depression. Bipolar spectrum disorders typically begin earlier in life than unipolar depression; the usual sign of bipolar disorder in young children could be depression and/or a combination of depression and states of mania/hypomania. It’s significant to ask the patient how old they were when they first experienced a depressive episode. Men have a higher rate of bipolar disorder than women, but the rates for unipolar depression in men and women are more equal.

Some patients with bipolar spectrum disorder can go from normal to severely depressed technically overnight whereas unipolar depressive episodes tend to occur more gradually. Patients with bipolar spectrum depression tend to experience weight gain and crave carbs, while those with unipolar depression usually experience weight loss or loss of appetite. Patients suffering from bipolar depression tend to show irregular responses to antidepressant monotherapy, including switching into mania. Bipolar spectrum disorder is an inheritable mental illness, so it’s vital to take family history into consideration. While patients diagnosed with unipolar depression usually note that their symptoms fluctuate in a more stable, regular pattern, those with bipolar depression have moods that can vary unpredictably, usually with no cause.

When treating bipolar depression, antidepressants are used in combination with some sort of mood stabilizer. Treatment for unipolar depression can include medication like SSRIs and antidepressants, often in combination with cognitive behavioral therapy (CBT) and psychotherapy. Screening instruments including the Bipolar Spectrum Diagnostic Scale and the Mood Disorders Questionnaire can be effective and helpful tools in differentiating unipolar from bipolar depression.

If you or someone you know is struggling with Bipolar Disorder or Unipolar Depression, Arista Counseling and Psychotherapy can help. Please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources

https://www.psychiatrictimes.com/special-reports/major-depressive-episode-it-bipolar-i-or-unipolar-depression

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850601/

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/unipolar-and-bipolar-depression-different-or-the-same/AE364DFBFFBAF1F66A9294A55120C64E/core-reader