What is manic depression?

Manic depression is characterized by extremes of mood: periods of deep depression, and periods of overactive, excited behavior known as mania. These severe highs and lows may occur directly after each other, or they may alternate with varying periods of stability. Some people diagnosed with manic depression also experience visual or auditory hallucinations or delusions.

While most people experience highs and lows in daily life, in manic depression these changes are extreme. During the manic or high phase people may feel euphoric, self-important and full of expansive ideas. This could include being extravagant, spending vast amounts of money and building up debts. During these periods they may be unable to sleep and take little time to eat. They may talk so quickly that it is difficult for others to understand what they are saying, and they can be irritable and angry. They may have no awareness of their changed attitude or behavior. After a manic phase some people are shocked at what they have done and the effect that it has had. However, some of those diagnosed with manic depression find that they are very creative during mania, and argue that it is a very valuable experience.

Although mania may flare up, depression is often the primary consistent symptom. People may experience overwhelming despair, guilt and feelings of unworthiness. They might experience difficulty trying to concentrate or remember things, and feel unable to do the simplest task. They may want to kill themselves.

Bipolar and unipolar manic depression

The most common form of manic depression - bipolar manic depression, also called affective mood disorder - involves both highs and lows. However, it is possible to be diagnosed with the condition and experience the depressive phase without a manic period; this is called unipolar affective disorder.


How common is manic depression?

About 1 per cent of the general population are diagnosed with manic depression; they are often intelligent and creative people. There seems to be no difference between the number of men and the number of women who are diagnosed. Manic depression generally appears when people are in their 20s or 30s, although some teenagers are affected.

Experiences of manic depression vary a great deal. Some people experience infrequent episodes, with years of stability. Some people only have a couple of episodes in their lifetime. Others may have frequent episodes. Experiencing four or more episodes of mania a year is sometimes referred to as 'rapid cycling'.

What causes manic depression?

There are several theories as to the cause of manic depression. These theories are not necessarily compatible.

Genetic

It would appear that siblings, parents and children of people with manic depression have a 5 to 15 per cent chance of developing the condition. An identical twin has a 70 per cent chance. However, as yet no particular genes have been identified as responsible for manic depression, and not all experts believe that genes play a part in manic depression. In any event it is generally agreed that genetic make-up alone cannot cause the condition - a 'trigger', often a stressful event, is also needed.

Stressful life events

Some people link the start of their manic depression to stressors such as relationship breakdown, money problems or career changes. Some psychiatrists believe that these events trigger off a biochemical imbalance in the brain.

Family background

Some psychiatrists and psychotherapists believe manic depression can result from severe emotional damage caused in early life, perhaps the result of being overprotected or overcriticized as a child. This can produce in the adult a very fragile sense of self, and difficulties in containing any strong emotion. Those who point to these more developmental causes believe counseling, cognitive therapy or psychotherapy can be beneficial.

Unresolvable problems in everyday life

Another view is that manic depression is a reaction to what are considered unresolvable problems in everyday life. Mania is perceived as an escape from unbearable feelings of depression. Constantly blaming others for everything and being excessively irritable are seen as ways of avoiding emotional dependence on friends and relatives. Again, talking treatments are thought to be helpful once the condition has stabilized.

Seasonal effects

Some people believe that their mood swings are affected by the seasons. At present there is no evidence for this.


Medication

Lithium carbonate is the most common treatment prescribed for manic depression. It is a way to control the condition and not a cure. It should, therefore, be seen as a foundation for a much wider treatment that takes account of an individual's needs. If you are using lithium it is important to have frequent blood tests to ensure that the lithium in your blood does not reach a toxic level. It is also important that you maintain proper salt and water levels.

There are a number of side-effects associated with lithium. Some occur while the body is getting used to the treatment and should disappear. Side-effects such as vomiting or severe nausea, confusion or persistent diarrhoea may suggest that the level of lithium in the blood is reaching a dangerous level and that you should see your doctor.


ECT

This is a controversial treatment which involves passing an electric current through the brain of someone who is under anaesthetic. It is given for severe depression and was used to treat mania before major tranquillizers became available. It is important to bear in mind that ECT can have severe side-effects such as short- or long-term memory loss.

Talking treatments

Counseling or psychotherapy can help people understand why they feel as they do, why they behave in certain ways and perhaps to see the world in a different way. This sometimes helps people to overcome the relationship difficulties often associated with manic depression. Manic depressive episodes can be very stressful, and having the opportunity to talk about those experiences can help people to deal with them.


Hospital admission

If you are particularly distressed you may benefit from shelter and protection in an environment that is not too demanding. At present hospital is often the only place that provides this. It will give staff the opportunity to assess your needs and try to find the best way to help you. And, for those close to you, it may provide some relief.


What can I do to help myself?

During a manic phase you may have been unaware that your actions were distressing or even harmful to others. If you later find out how they felt you may feel guilty and ashamed. It can be especially difficult if those around you seem afraid or hostile. It can help to provide people with information about manic depression so as to increase their understanding.


Self-management

Self-management involves finding out about manic depression and developing the skills needed to recognize and control mood swings. It can be very difficult at first to tell whether a 'high' is really the beginning of a manic episode or whether you are just feeling more confident, creative and socially at ease. It can be a strain to be watching continually for symptoms, particularly when you are first learning about manic depression's effect on your life.


For friends and relatives

It can be very distressing if you are a relative, partner or friend of someone who has been diagnosed with manic depression, particularly when the person is going through a manic phase. The person may not accept that there is anything unusual about their behaviour and may be hostile to you. However, you can be vital in providing support and in helping to get practical assistance.


Giving support

Someone who has been diagnosed with manic depression may find it hard to be organized. They may require some assistance with practical matters; for example in getting proper nourishment and enough rest. They may require help with financial matters, particularly if they have built up debts during a manic phase.