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Manic-depressive illness, known in medical terms as
bipolar illness, is the most distinct and dramatic of
the depressive or affective disorders. Unlike major
depression, which can occur at any age, manic-depressive
illness generally strikes before the age of 35. Nearly
one in 100 people will suffer from the disorder at some
time in their lives.
People with bipolar illness differ from those with
other depressive disorders in that their moods swing
from depression to mania, generally with periods of
normal mood between the two extremes. The length of this
cycle, from towering elation to near despair, varies
from person to person.
Symptoms
When patients first suffer a manic phase, they feel a
rather sudden onset of elation, euphoria or extreme
irritability that increases in a matter of days to a
serious impairment. Symptoms of the manic phase are:
- A mood that seems excessively good, euphoric,
expansive or irritable. The patient feels
"on top of the world," and
nothing--bad news, horrifying event or
tragedy--will change his happiness. However,
this euphoria can quickly change into
irritability or anger. In either case, the mood
is way out of bounds, given the situation and
the individual's personality.
- Expressions of unwarranted optimism and lack of
judgment. Self-confidence reaches the point of
grandiose delusions in which the person thinks
he has a special connection with God,
celebrities, or political leaders. Or he may
think that nothing--not even the laws of
gravity--can stop him from accomplishing any
task. As a result, he may think he can step off
a building or out of a moving car without being
hurt.
- Hyperactivity and excessive plans or
participation in numerous activities that have a
good chance for painful results. Patients become
so enthusiastic about activities or involvements
that they fail to recognize they haven't enough
time in the day for all of them. For example, a
person with bipolar illness may book several
meetings, parties, deadlines and other
activities in a single day, thinking he or she
can make all of them on time. Added to the
expansive mood, mania also can result in
reckless driving, spending sprees, foolish
business investments, or sexual behavior unusual
for the person.
- Flight of ideas. The person's thoughts race
uncontrollably like a car without brakes
careening down a mountain. When the person
talks, his or her words come out in a nonstop
rush of ideas that abruptly change from topic to
topic. In its severe form, the loud, rapid
speech becomes hard to interpret because the
patient's thought processes become so totally
disorganized and incoherent.
- Decreased need for sleep, allowing the patient
to go with little or no sleep for days without
feeling tired.
- Distractibility in which the patient's attention
is easily diverted to inconsequential or
unimportant details.
- Sudden irritability, rage or paranoia when the
person's grandiose plans are thwarted or his
excessive social overtures are refused.
Untreated, the manic phase can last as long as three
months. As it abates, the patient may have a period of
normal mood and behavior. But eventually the depressive
phase of the illness will set in. In some, depression
occurs immediately or within the next few months. But
with other patients there is a long interval before the
next manic or depressive episode. The depressive phase
has the same symptoms as major or unipolar depression:
- Feelings of worthlessness, hopelessness,
helplessness, total indifference and/or
inappropriate guilt; prolonged sadness or
unexplained crying spells; jumpiness or
irritability, withdrawal from formerly enjoyable
activities, social contacts, work or sex.
- Inability to concentrate or remember details.
- Thoughts of death or suicide attempts.
- Loss of appetite or noticeable increase in
appetite; persistent fatigue and lethargy,
insomnia or noticeable increase in the amount of
sleep needed.
- Aches and pains, constipation, or other physical
ailments that cannot be otherwise explained.
Theories About Causes
Recent studies into the roots of bipolar illness have
centered on genetic research. Scientists believe these
studies will eventually help them identify the genetic
culprits that cause manic depressive illness in its
various forms among different populations. This research
will also help psychiatrists to understand the
biochemical reactions that are controlled by these genes
and that contribute to the disorder.
Close relatives of people suffering from bipolar
illness are 10 to 20 times more likely to develop either
depression or manic-depressive illness than the general
population. In fact, between 80 and 90 percent of people
suffering from manic-depressive disorder have relatives
who suffer from some form of depression. If one parent
suffers from manic-depressive illness, a child has a
12-15 percent risk of suffering from a depressive
disorder; if both parents suffer from manic-depressive
illness, the children have a 25 percent chance each of
developing a depressive disorder or manic-depressive
disorder.
Other studies hint that environmental factors may
contribute to the illness. Psychoanalytic studies
suggest that such environmental factors as difficult
family relationships may aggravate manic-depressive
illness.
Still other studies suggest that imbalances in the
biochemistry controlling a person's mood could
contribute to manic-depressive illness. For example,
people suffering from either manic-depressive disorder
or major depression often respond to certain hormones or
steroids in a way that indicates they have
irregularities in their hormone production and release.
Some research points to the possibility that bipolar
patients' neurotransmitters--chemicals by which brain
cells communicate--become imbalanced during various
phases of the disease. Finally, some people suffering
from depressive illnesses have sleep patterns in which
the dream phase begins earlier in the night than normal.
These studies indicate that manic-depressive illness and
major depression may be caused by biochemical
imbalances. Such research also helps develop scientific
theories about how medications work, and offers hope
that psychiatrists some day will use laboratory tests to
identify unipolar or bipolar illnesses.
Diagnosis
Anyone who suspects they or a loved one suffers from
manic-depressive illness should receive a complete
medical evaluation to rule out any other mental or
physical disorders. Many other medical disorders can
mimic manic-depressive illnesses. For example, a person
with symptoms of manic depression could be reacting to
substances such as amphetamines or steroids or could
suffer from thyroid, liver or kidney problems or other
illnesses, such as multiple sclerosis. A comprehensive
medical and psychiatric evaluation by a qualified
psychiatrist or other physician is vital to an accurate
diagnosis. With this diagnosis a psychiatrist can then
work with the patient to design the right treatment
plan.
Treatment
Though manic-depressive disorder can become
disabling, it is also among the most treatable of the
psychiatric illnesses. Proper medication is essential to
this treatment, and psychotherapy may also be helpful.
The most common medication, lithium carbonate,
successfully reduces the number and intensity of manic
episodes for 70 percent of those who take the
medication. Twenty percent of those who use lithium
become completely free of symptoms. Those who respond
best to lithium are patients who have a family history
of depressive illness and who have periods of relatively
normal mood between their manic and depressive phases.
In recent years psychiatrists have also been successful
with several medications--such as carbamazepine and
valproate--in treating those for whom lithium is not
effective.
Very effective in treating the manic phase, lithium
also appears to prevent repeated episodes of depression.
Lithium works by bringing various neurotransmitters
in the brain into balance. Scientists think the
medication may affect the impact neurotransmitters have
on the brain cells, thus altering moods.
Like all medications, lithium can have side effects
and must be carefully monitored by a psychiatrist. The
physician should measure the level of lithium in the
patient's blood and determine how well the patient's
kidneys and thyroid gland are working. Among the side
effects are weight gain, excessive thirst and urination,
stomach and intestinal irritation, hand tremors, and
muscular weakness. If a patient overdoses on medication,
it may cause confusion, delirium, seizures, coma and may
result, rarely, in death.
However, when properly monitored, lithium, sometimes
used with other medications, has returned thousands of
people to happy, functioning lives that would not be
possible without medication.
Like all serious illnesses, manic-depressive
disorders disrupt a person's self-esteem and
relationships with others, especially with spouses and
family. Without treatment, people with the illness may
risk consequences such as financial and occupational
disintegration, or even suicide. Because of these
consequences of their illness, people under treatment
for manic-depressive disorder also benefit from
psychotherapy.
The patient and the psychiatrist work out the
problems created by the disorder and reestablish the
relationships and healthy self-image that are shaken by
the illness. In many cases, a patient needs the
psychiatrist's support to ensure that he complies with
his treatment.
Family members of manic-depressive patients also may
benefit from professional care. This illness can cause
serious disruptions of the family's life, as the
stresses of living with a person suffering from manic
depression are intense. Not only may family members
learn coping strategies from the psychiatrist but they
can also learn to be an active part of the treatment
team.
(c) Copyright 1988, 1990, 1992 American Psychiatric
Association
Produced by the APA Joint Commission on Public
Affairs and the Division of Public Affairs. This
document contains text of a pamphlet developed for
educational purposes and does not necessarily reflect
opinion or policy of the American Psychiatric
Association.
Additional Resources
Bohn, John, R.Ph., and James W. Jefferson, M.D.
Lithium and Manic Depression: A Guide. Lithium
Information Center, Department of Psychiatry, University
of Wisconsin Center for Health Sciences, 600 Highland
Ave., Madison, WI, 53792, revised 1990.
Corfman, Eunice. Depression, Manic Depressive
Illness, and Biological Rhythms (Science Reports).
National Institute of Mental Health, Rockville, MD,
1979.
DePaulo, J. Raymond, and Keith Ablo. How to Cope with
Depression: A Complete Guide for You and Your Family.
McGraw Hill, NJ, 1989.
Jefferson, James, M.D. and John H. Greist, M.D.,
Valproate and Manic Depression: A Guide. Lithium
Information Center, Department of Psychiatry, University
of Wisconsin Center for Health Sciences, Madison, WI
53792, revised 1991.
Medenwald, Janet M.D. with John H. Greist, M.D., and
James W. Jefferson, M.D. Carbamazepine and Manic
Depression: A Guide. Lithium Information Center,
Department of Psychiatry, University of Wisconsin Center
for Health Sciences, Madison, WI 53792, revised 1990.
Morrison, J.M. Your Brother's Keeper. Nelson-Hall,
Chicago, Il, 1981.
Papolos, Demitri, and Janice Papolos. Overcoming
Depression. Harper & Row, New York, 1987.
Books published by
The AMERICAN PSYCHIATRIC PRESS, INC.
l400 K Street, N.W.
Washington, DC 20005
(800) 368-5777
Greist, John, M.D., and James W. Jefferson, M.D.
Depression and Its Treatment. 1992. 157 pgs. $17.95.
Korpell, Herbert S., M.D. How You Can Help: A Guide
for Families of Psychiatric Hospital Patients. 1984. 145
pgs. $18.50 (hardcover), $12.50 (paperback)
Other Sources of Information
Depression Awareness Recognition & Treatment,
(D/ART)
(301) 443-4140.
National Alliance for the Mentally Ill
(703) 524-7600.
National Depressive and Manic-Depressive Association
(312) 642-0049
National Institute of Mental Health Division of
Communications
(301) 443-4536
National Mental Health Association
(703) 684-7722
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