5 - Manic-Depression

Lesson 3 on Neurosis discussed depression. Another type of depressive disorder is manic-depressive illness also known as bipolar depression because the person affected displays moods that are as different as day and night. Manic-depressive illness involves cycles of depression with cycles of elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual.

Causes

Studies have indicated that people with the illness have a somewhat different genetic make-up than those who do not get ill. The reverse is not true: people with that genetic make-up do not automatically have manic-depression. Studies have been done regarding the imbalance of the brain chemicals noradrenaline and serotonin, but additional factors such as a stressful environment are also involved.

Symptoms

Exaggerated mood change is the most outstanding feature of manic-depression. One psychologist has described it as the “psychosis of emotional extremes”. The behaviour of the manic-depressive persons varies with the individual. In some cases, the excitement phase predominates; for others, the depression phase is more intense. It usually starts in adult life before the age of 35.

Mania

Usually in the manic or excited phase there is a great sense of elation; the individual seems extremely pleased with himself. The manic patient resembles an intoxicated person in many ways—talkative, cheerful, and humorous one minute, then suddenly hostile and angry. Other characteristics include unrealistic highs in self-esteem, great energy increases, increased talking (cannot be interrupted), distractibility (attention moves constantly from one thing to another), thoughts of suicide, and high risktaking behaviour. Mania often affects thinking, judgment, and social behaviour in ways that cause serious problems and embarrassment. For example, a person might suddenly decide to sell his or her home and move to Hawaii when in a manic phase.

Depression

The depressed phase is very different. Thought and talk alike seem to be slowed. Sadness and self-accusation mark the general mood, and in some cases the individual must be guarded from suicide. Depression may occur in three stages of severity: mild, acute, and depressive stupor marked by immobility and speechlessness. Other characteristics include frequent complaints of illness, major changes in eating or sleeping patterns, persistent sadness, frequent crying, and low energy levels.

Treatment

Effective treatment for manic-depressive illness usually includes education of the patient and family about the illness and psychotherapy (counselling with a psychologist). Medication such as lithium and a group of drugs known as tricyclic antidepressants have been effective. ECT or electroconvulsive shock is sometimes used especially if depression is severe. In recent years, ECT has been much improved. The treatment is given in the hospital under sedation so that people receiving ECT do not feel pain. Usually after a few weeks or a few months, the manic-depressive individual makes a good recovery and is able to resume regular work. Attacks may recur in three out of four eases. But in most instances, patients or their friends notice the signs in time so that these people may be put under medical care. Recovery rate has been recorded at 90% or higher.