- Individuals diagnosed with manic-depressive illness, or bipolar disorder, have mood swings that alternate from periods of severe highs (mania) to extreme lows (depression). These mood swings, which are out of proportion or totally unrelated to events in a person’s life, affect thoughts, feelings, physical health, behavior, and functioning.
- Manic-depressive illness is a neurobiological brain disorder that affects approximately 1.3 million Americans today, or almost one percent of the population. While manic-depressive illness usually begins in adolescence or early adulthood, it can sometimes start in early childhood or as late as age 40 or 50.
- Generally, people with manic-depressive illness consult between three to four doctors and spend more than eight years seeking treatment before they receive a correct diagnosis.
- The average person has four episodes of mania or depression during the first 10 years of the illness. Men are more likely to start with a manic episode, and women are more likely to begin with a depressive episode.
Symptoms of Manic-Depressive Illness
While no single pattern of symptoms fits every individual with manic-depressive illness, there are four distinct types of mood episodes that can occur over the course of the illness, including:
- Mania (manic episode) often begins with a pleasurable sense of heightened energy, creativity, and social ease – feelings that without proper medical treatment can quickly escalate out of control into a full-blown manic episode. People experiencing mania typically lack self-awareness, deny anything is wrong, and angrily blame anyone who points out a problem. In addition to feeling unusually “high,” euphoric or irritable, the person also may exhibit symptoms such as:
- Needing little sleep yet having great amounts of energy; talking so fast that others can’t follow the person’s thinking;
- Having racing thoughts;
- Being so easily distracted that the individual’s attention shifts between many topics in just a few minutes; and
- Having an inflated feeling of power, greatness or importance; and doing reckless things without concern about possible bad consequences, such as spending too much money, inappropriate sexual activity, making foolish business investments.
- Hypomania (hypomanic episode) is a milder form of mania with similar yet less severe symptoms and less overall impairment. In hypomania, for example, the individual may have an elevated mood, feel better than usual, and be more productive. These episodes often feel good, and the quest for hypomania may even cause people to stop taking their medication.
- Depression (major depressive episode) takes away the capacity to experience pleasure, and causes profound sadness and irritability, changes in sleep patterns, a decrease in appetite, an inability to concentrate, low self-esteem, and thoughts of suicide. Severe depressions also may include hallucinations or delusions.
- Mixed Episode is perhaps the most disabling since an individual can experience both mania and depression simultaneously or at different times throughout the day.
Treating Manic-Depressive Illness
While there is no cure for manic-depressive illness, it is a highly treatable disease. In fact, according to the National Advisory Mental Health Council, the treatment success rate for manic-depressive illness is a remarkable 80 percent.
- It is important to diagnose and treat manic-depressive illness as early as possible to help people avoid or reduce frequent relapses and re-hospitalizations. Several promising, large-scale studies suggest early intervention may forestall the worst long-term outcomes of this devastating brain disorder.
- Individuals experiencing mania often lack self-awareness and do not recognize that they are ill and require treatment in the hospital to prevent self-destructive, impulsive, or aggressive behavior. Hospital stays can be as brief as two weeks and as long as six months.
- The two most important types of medication used to control the symptoms of manic-depressive illness are mood stabilizers and antidepressants.
- Mood Stabilizers, the mainstay of long-term preventive treatment for both mania and depression, are used to improve symptoms during acute manic, hypomanic, and mixed episodes; they also may reduce symptoms of depression. The most widely used mood stabilizers include Lithium (Eskalith, Lithobid, Lithonate, and other brands), Valproate (used as divalproex or Depakote), and Carbamazepine (Tegretol). About one in three people will be completely free of symptoms by taking mood stabilizing medications for life.
- In conjunction with the mood stabilizers, antianxiety medications such as lorazepam (Ativan) and clonazepam (Klonopin) and antipsychotic drugs such as haloperidol (Haldol) and perphenazine (Trilafon) are used for insomnia, agitation, or other symptoms, during a manic phase.
- Antidepressants are given together with mood stabilizers to prevent an “overshoot” from occurring in the patient, for if used on their own in the treatment of bipolar disorder, antidepressants can push moods up too high causing hypomania, mania, or rapid cycling. Most experts consider the following two types of antidepressants to be the most effective for bipolar patients: bupropion (Wellbutrin) or selective serotonin reuptake inhibitors such as fluoxetine (Prozac); fluvoxamine (Luvox); paroxetine (Paxil), and sertraline (Zoloft). There are many other choices if these do not work, or if the cause unpleasant side effects, including: mirtazapine (Remeron), monoamine oxidase inhibitors such as phenelzine (Nardil) and tranylcypromine (Parnate); nefazodone (Serzone); tricyclic antidepressants such as amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor); and venlafaxine (Effexor).
- One of the most effective tools in treating manic-depressive illness is by Programs for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Serving as a hospital without walls, PACT professionals are available around the clock and meet their clients where they live, providing at-home support at whatever level is needed, for whatever problems need to be solved. Professionals can make sure that clients are taking their medication and help them meet the challenges of daily life — every day tasks ranging from grocery shopping and keeping doctor appointments to managing money and getting along with others.
While PACT programs are an excellent means for delivering outpatient services, research demonstrates that they improve medication compliance for some, but not all, patients. For example, a recent Baltimore study of 77 homeless individuals with severe mental illness (86 percent with schizophrenia or major affective disorder) were assigned to PACT teams and followed for one year. Medication compliance improved from 29 percent to between 50 percent and 57 percent during the remainder of the year. The study found that approximately one-third of the subjects were noncompliant at any given time during the research year.
- Suicide is the number one cause of premature death among people with manic-depressive illness, with 15 percent to 17 percent taking their own lives as a result of negative symptoms that come from untreated illness. The extreme depression and psychoses that can result due to lack of treatment are the usual culprits in these sad cases. These suicides rates can be compared to the general population, which is somewhere around one percent.