What is manic depression, (bipolar disorder)?
Depression is the most frequent form of mood disorder. The manic depressive or what is now termed "bipolar" mood disorder is the next most common. It is characterized by wide mood fluctuations ranging from deep depression and despair to extreme happiness, euphoria and mania.
During a depressed phase, bipolar depression is indistinguishable from unipolar depression. If a person is having their first episode of depression, it is not possible to tell which type of depression is present. About thirty percent of people having their first episode of depression are in fact bipolar but the swinging mood pattern has not yet emerged.
People with mania are full of energy and ideas
During a manic phase a person will talk excessively and loudly with words pouring out in an animated continuous stream, interspersed with wit and humour. They will be unable to sit still or relax and there is continuous agitation. They will be distractible, changing topics rapidly, never totally finishing one thought and over committing themselves to any task. Being the "life of the party," they show endless energy, developing grandiose plans based on gross overestimations of their own ability. Their thoughts are continuously racing with exciting plans or jobs to do which demand immediate attention. When opposed they may show intense rage and irritability. They have poor judgment especially when spending money. They need very little sleep and consider rest and eating to be a waste of time only for the weak. Lack of sleep can trigger a manic phase and then continuing lack of sleep will fuel and intensify a manic episode. During this phase they may act totally out of character and impulsively take risks of a sexual, personal, or financial nature. During a "high" they are very reluctant to seek treatment since they feel so great and powerful. Manic episodes are often followed by periods of profound depression which are triggered by the slightest disappointment. A complete list of symptoms can be found by clicking "Am I normal?."
Milder mood swings can also be found in bipolar illness. This condition is called cyclothymic mood disorder. There is still a fluctuating mood with racing thoughts but the elevated mood symptoms are not as intense as the ones listed above. In this milder condition, the times of mood elevation can be very productive and entertaining. I have noticed that many actors and entertainers have this mood pattern since it gives them the confidence to be in front of audiences. Unfortunately, the times of mood elevation are still followed by depressions.
Figure 5:
Bipolar illness causes wide mood swings into both
ranges
of abnormal mood
The usual age of onset of bipolar depression is in late adolescence and the early twenties, the same as in other mood disorders. It is usually not recognized until symptoms have been present for on average 10 years. In the years preceding diagnosis there is usually unpredictable mood and behavior with marked irritability. This is commonly seen during the adolescent prelude to being diagnosed when this behavior is called "a normal phase." Those with bipolar mood disorder are very prone to abuse alcohol and street drugs as a way of self medicating their confused and tormenting thoughts.
Bipolar mood swings can easily become so severe that they slip into what is known as "psychosis." We will discuss psychosis in more detail in the chapter on schizophrenia. Psychotic thinking means that a person has lost touch with reality. It can happen at the extremes of depression or elation. A person in psychosis may hear voices when there is no one around, may feel that they are being watched or followed by strangers, or may feel that others can read their minds. They may also develop strange delusional beliefs that they have superhuman abilities. When psychotic thinking is present, it is impossible to distinguish the condition from schizophrenia. What I do in my clinic to separate the two conditions is that I ask what their mood was like in the few days leading up to the psychotic episode. If there was depression or elation then the cause was likely a mood disorder, otherwise schizophrenia would be the probable cause.
Bipolar mood disorder responds well to treatment as we will discuss later.
The text of this section contains excerpts from "Healthy Moods".
Illustrations by Rev. Jim Keddy
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