Manic Depression (Bipolar Affective Disorder)

Background

Manic depression is commonly referred to as bipolar disorder. It is a major affective disorder, or mood disorder, characterized by dramatic mood swings. When in a manic state, it causes sleeplessness, sometimes for days, along with hallucinations, psychosis, grandiose delusions, and/or paranoia. Bipolar disorder is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes.

 

What is Bipolar Affective disorder?

Bipolar disorder is a complex disorder that affects about 1% of the general population. The mood swings associated with it alternate from major, or clinical, depression to mania or extreme elation. The mood swings can range from very mild to extreme, and they can happen gradually or suddenly within a timeframe of minutes to hours. When mood swings happen frequently, the process is called rapid cycling.

Along with the dramatic mood swings, patients with bipolar disorder may have disturbances in thinking. They may also have distortions of perception and impairment in social functioning. Marked by relapses and remissions, bipolar disorder has a high rate of recurrence if left untreated. Patients with severe mania usually require hospitalization to keep them from risky behaviours. Those who are severely depressed also might need hospitalization to keep them from acting on suicidal thoughts.

Any person can develop Bipolar Affective Disorder; however, studies indicate that highly creative, sensitive people, people tending to be perfectionists and high achievers, have a higher prevalence of bipolar affective disorder. Biological factors seem to play a major role in producing Bipolar Affective Disorder. A person’s personality make up and/or stresses in the environment (for example, death of a loved one, separation, divorce, etc.) may also play a part in bringing on depressive or manic states.

 

Manic episodes

Mania is the defining feature of bipolar disorder. Mania is a distinct period of elevated or irritable mood, which can take the form of euphoria, and lasts up to a week (or less if hospitalized). People with mania commonly experience an increase in energy and a decreased need for sleep, with many often getting as little as three or four hours of sleep per night. Some can go days without sleeping. A manic person may exhibit pressured speech, with thoughts experienced as racing. Attention span is low, and a person in a manic state may be easily distracted. Judgment may be impaired, and sufferers may go on spending sprees or engage in risky behaviour that is not normal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behaviour may become aggressive, intolerant, or intrusive. They may feel out of control or unstoppable, or as if they have been “chosen” and are “on a special mission”, or have other grandiose or delusional ideas. Sexual drive may increase. At more extreme levels, a person in a manic state can experience psychosis, or a break with reality, where thinking is affected along with mood. Some people in a manic state experience severe anxiety and are irritable (to the point of rage), while others are euphoric and grandiose. The severity of manic symptoms can be measured by rating scales such as the Altman Self-Rating Mania Scale and clinician-based Young Mania Rating Scale.

 

The onset of a manic episode is often foreshadowed by sleep disturbances. Mood changes, psychomotor and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.

 

Hypomanic episodes

Hypomania is a mild to moderate level of elevated mood, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Generally, hypomania does not inhibit functioning as mania does. Many people with hypomania are actually more productive than usual, while manic individuals have difficulty completing tasks due to a shortened attention span. Some hypomanic people show increased creativity, although others demonstrate poor judgment and irritability. Many experience hypersexuality. Hypomanic people generally have increased energy and increased activity levels. They do not, however, have delusions or hallucinations.

Hypomania may feel good to the person who experiences it. Thus, even when family and friends recognize mood swings, the individual often will deny that anything is wrong. What might be called a “hypomanic event”, if not accompanied by depressive episodes, is often not deemed as problematic, unless the mood changes are uncontrollable, volatile or mercurial. If left untreated, an episode of hypomania can last anywhere from a few days to several years. Most commonly, symptoms continue for a few weeks to a few months.

 

 

What Causes Bipolar disorder?

Like with other mood disorders, what causes bipolar disorder is not known. What is known is that bipolar disorder has a genetic component and can potentially run in families. Environmental factors are also implicated and considered major elements. Physiological abnormalities may also be a cause.

Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions. There is fairly consistent evidence from prospective studies that life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression. There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders such as posttraumatic stress disorder (PTSD). The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child’s own behaviour.

 

What Are the Symptoms of Bipolar Disorder?

The clinical depression symptoms which vary per individual seen with bipolar disorder include:

  • Decreased appetite and/or weight loss, or overeating and weight gain
  • Difficulty concentrating, remembering, and making decisions
  • Fatigue, decreased energy, being “slowed down”
  • Feelings of guilt, hopelessness, pessimism
  • Insomnia, early-morning awakening, or oversleeping
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
  • Persistently sad, anxious, or “empty” moods
  • Restlessness, irritability
  • Thoughts of death or suicide, suicide attempts

 

Treatment of Bipolar Disorder

Bipolar disorder is often treated with mood and psychotherapy. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behaviour or depressive episodes with suicidal ideation. There are widespread problems with social stigmastereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia.

In some cases, the patient has feelings and emotions which need to be expressed and counselling is often the best course of action. The ideal case is for sufferers to speak about their emotions and feelings to close family and friends. Medical treatment is generally not a long-term solution to the disorder itself and will not remove the problem on its own. It is, however, a common treatment and can be used for the remainder of one’s life to keep them stable. Mood-stabilizing medication is often used as a remedy with doses slowly decreased over an extended period of time until the patient is stable enough and no longer dependent on them. Counselling, support groups and psychotherapy can help identify the trigger which causes mood swings and can potentially help alleviate the disorder or prevent future mood swing episodes.

 

People with Manic Depression / Bipolar Disorder and Similar Mental Illnesses

  • Ludwig van Beethoven, Classical music composer and pianist
  • Kurt Cobain, Musician / Lead singer of Nirvana
  • Catherine Zeta Jones, Actress
  • Isaac Newton, Scientist and mathematician
  • Jim Carrey, Actor
  • Winston Churchill, Prime Minister of Great Britain
  • Charles Dickens, Writer
  • Heath Ledger, Actor
  • Abraham Lincoln, U.S. President
  • Michelangelo, Artist and poet
  • Albert Einstein, Scientist
  • Alexander the Great, Emperor
  • Mark Twain, Writer
  • Robin Williams, Actor and comedian
  • Pablo Picasso, Artist and painter
  • Johann Sebastian Bach, Classical music composer
  • Amy Winehouse, Musician
  • J.K. Rowling, Writer
  • Wolfgang Amadeus Mozart, Classical music composer
  • Vincent van Gogh, Artist
  • John Nash, Mathematician
  • Napoleon Bon aparte, Emperor and political leader
  • Axl Rose, Musician / Member of Guns N’ Roses