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Bi-polar disorder (manic depression)

Bi-polar disorder, also known as manic depression, is a mood disorder, characterised by swings in a person's mood from high to low - euphoric to depressed.


What is bi-polar disorder?


Bi-polar disorder, also known as manic depression, is a mood disorder, characterised by swings in a person's mood from high to low - euphoric to depressed.

 

In the manic phase (also referred to as hypomania or going high), you may have excessive amounts of energy and feel little need for sleep. Your thinking and speech tend to be faster than usual, and your thoughts can jump rapidly from one subject to another, making conversation difficult. Inflated self-esteem, loss of inhibitions, and grandiose ideas or delusions are typical features. When you are manic you may behave in ways which can have serious consequences when the episode is past, for example leaving your job, spending a lot of money, or giving away your possessions

 

During a severe depressive episode, you may have feelings of hopelessness and despair, of lethargy, broken sleep, overwhelming negativity and difficulty in carrying on with the activities of day-to-day life. When you are depressed you may want to withdraw from society or even contemplate suicide.

 

About 1 in 100 people are diagnosed as having bi-polar disorder. The depressive phase usually comes first and about ten per cent of people thought to have pure depression have a manic episode six to ten years later. About 15% of those who have an episode of mania never experience another.

 

There are great variations in the pattern of mood swings in bi-polar disorder. For example, in some people, the swings in mood can occur every few days. Some people can have long periods without experiencing problems, and many will hold down demanding jobs. However, a significant minority have their lives ruined by the disorder, and may be as disabled as someone with a diagnosis of severe schizophrenia.

 

Cyclothymia, also called cyclothymic disorder, is a less intense version of bi-polar disorder. The highs and lows of cyclothymia are less extreme than the highs and lows of bi-polar disorder, although they are more troublesome than the usual ups and downs of life.

 

It is not clear what causes bi-polar disorder, although the following factors may be important

 

  • 10 to 15 per cent of the nearest relatives of people with a bipolar disorder have a mood disorder

  • Biochemical changes in hormones and neurotransmitters that are found during the manic and depressive phases.

  • Deprivation of maternal affection in early life and severely stressful life events

 

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Symptoms

 

In the depressive phase symptoms may include:

 

  • mental and physical slowing
  • loss of interest and energy
  • loss of concentration
  • sadness
  • pessimism
  • self-doubt
  • self-blame
  • early morning waking
  • thoughts of suicide

  

The manic phase usually comes after two to four depressive episodes and may include:

 

  • speeding up of thought and speech
  • poor judgment
  • flights of ideas
  • constant elation or euphoria
  • inappropriate optimism
  • grandiose notions
  • gross over-estimation of personal ability

 

The latter may be reflected in unrealistic plans and expressed intentions or even in socially and financially ruinous behaviour. You may sleep poorly and may engage in an unusually high level of sexual activity.

 

Both phases may have the characteristic psychotic features of sensory experience-seeing, hearing, feeling, smelling things-without external cause (hallucinations) and obviously irrational beliefs (delusions). The spontaneous recovery rate in manic-depressive illness is very high-about 90 per cent recover. The relapse rate, however, is also high.

 

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Prevention

 

There are a number of things you can do to stop yourself becoming depressed.

 

  • Take control. Some people find it helps if they have some control over what happens to them. This helps to guard against the kind of 'hopelessness' which is associated with depression.
  • Make a 'fresh start'. This has been shown to help people recover from long-lasting depression. Similarly, learning to set small or manageable goals can give you a sense of achievement and make you feel better.
  • Keep in touch with your friends. If you are already depressed you may find it very difficult to be sociable, and this can make you feel more depressed.
  • Keep active. Outdoor activity seems to be particularly important in staving off depression in older men.
  • Review your eating habits. Research has suggested that people who are depressed may have low levels of certain essential fatty acids, which are found in fish oils.
  • Investigate self-help techniques. Some people have reported benefits from various self-help techniques such as meditation, and listening to music.

 

There are a number of things you can to prevent yourself going high.

 

  • Take control. Be aware of how you are feeling and when you are heading towards hypomania so that you can plan for and reduce the worst effects.
  • Sleeping tablets and tranquillisers may help if taken early on but be careful not to overdo this
  • Get plenty of rest, even if you don't really feel like it.
  • Cancel most of your plans for the next few weeks. The fewer things you have to think about the better.
  • Avoid stimulants, like alcohol, coffee and any kind of recreational drugs.

 

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Treatment

 

Depressive episodes, if untreated, last for about six months to one year. The average person suffers five or six episodes over a 20-year period. Most treated episodes clear in about three months, but if treatment is stopped before six months of full recovery, the risk of relapse is doubled.

 

The most common treatment during the manic phase is lithium carbonate, a mood stabilising drug. It is also sometimes prescribed to people with severe depression. High levels of lithium in the blood are dangerous so anyone taking lithium must have regular blood tests. The depression may also be treated with anti-depressants and talking treatments, like cognitive behavioural therapy or counselling. Some people have reported benefits from other techniques, such as acupuncture.

 

Learning to recognise and self-manage the signs and triggers to the mood swings is also an invaluable tool for stabilising the condition.

 

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Written in 2000

 

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