manic depression
by Sally Burningham
Manic depression is the name given to a condition in which people experience mood swings either to very severe depression or to mania (a state of abnormal excitement and over-activity) or both. You may also hear it referred to as 'manic depressive disorder' or 'bipolar affective disorder'. These mood swings are much more extreme than the ordinary mood changes where we feel rather low or down at times and energetic and optimistic at others. In manic depression the mood swing may be so great that the person is no longer in control of their own actions and some sort of help will be needed.
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However, doctors are often reluctant to make a diagnosis of manic depression until the person has experienced several episodes.
For more information on depression see also the feature on depression.
facts about manic depression
- About one in a hundred (1%) adults will experience manic depression at some time in their life.
- Approximately one fifth (20%) of people who experience one episode will not have another.
- It affects approximately equal numbers of men and women.
- A first episode can occur at any time in life from adolescence on but it seems more common for people to have their first episode in their 20s.
no set pattern
The fact that manic depression follows no consistent pattern means it is difficult for people with the condition to know what the future may bring. Some people experience swings to both mania and depression while others are only affected by one extreme, either mania or depression, or the pattern may change over time. In the same way the frequency and length of episodes vary very much from person to person and may also vary at different times in a person's life. In addition, some people may also experience less severe bouts of depression or milder symptoms of mania, known as 'hypomania'.
Some people have regular mood swings over weeks or months or find that times such as the spring or autumn are bad for them, while for others mood swings seem quite random, sometimes with several months or years between episodes.
causes
There is still uncertainty about the causes of manic depression. However, research shows that in some cases genes have a role to play. The likelihood of a child of a parent with manic depression developing the condition is about one in ten.
Mood swings in people already affected by manic depression can sometimes be triggered by factors such as stressful events, physical illnesses, alcohol or drugs, for example. Sometimes a mood swing will occur without any obvious trigger.
symptoms
There are a wide range of symptoms in both the manic and depressive episodes of the condition. These will vary among individuals and even among the same individual at different times. Occasionally someone may even experience a mixed state with symptoms of both mania and depression.
depressive episodes
Among the more common symptoms of severe depression are:
- persistent low mood, loss of energy and motivation
- feeling sad, worthless, hopeless or inappropriately guilty
- increased anxiety, agitation or restlessness
- slowing down of thoughts and physical movements
- difficulties in remembering, concentrating or making decisions
- loss of interest in activities that were once enjoyed
- loss of appetite or waking early with feelings of despair
- feeling cut off from other people, even those who are close
- recurrent thoughts of death or suicide, or even suicide plans or attempts.
manic episodes
Some of the symptoms of mania are almost the reverse of those of depression. Symptoms may include:
- greatly increased energy and activity
- feelings of elation and over exuberance
- excessive self confidence and lack of self criticism
- lowering of social and sexual inhibitions
- loss of judgement and of the normal ability to recognise risks
- short attention span
- accelerated speech, often talking all the time and allowing no interruption
- becoming easily irritated or angry, often over trifles
- reduced need for sleep, often accompanied by a failure to eat proper meals, that can eventually result in exhaustion.
In early stages ideas may flow rapidly, often sounding witty or perceptive and the person may seem at their most creative or productive. In later stages, however, thoughts begin to race out of control and speech often becomes incoherent. Loss of inhibitions may mean that the person behaves in a way that is unlike their normal self, perhaps becoming verbally abusive or highly critical of others, often in a very hurtful way, or sexually promiscuous, for example. Loss of judgement may lead to disastrous spending sprees or impulsive decisions such as suddenly putting the house up for sale without consulting a partner.
In more extreme forms of mania symptoms such as unintelligible speech, delusions (false ideas about the world) and hallucinations (false perceptions that others do not share) can occur.
Unfortunately it is very hard to persuade people with mania that they need help since in the early stages they feel elated and at later stages they often lose insight into what is happening due to the nature of the condition.
treatment
It is important to seek help before symptoms become too acute as they are much easier to deal with at an earlier stage. Early treatment can limit the severity and length of an episode of mania or depression.
Treatment may involve medication, practical and social support and psychological therapy. Admission to hospital may sometimes be necessary, particularly if the person is a danger to themselves or others or has completely lost touch with reality.
medication
Drugs may be used in manic depression to control acute episodes and as a maintenance therapy to prevent their recurrence.
Antidepressant drugs are used to treat depressive episodes in manic depression. For more about dos and don'ts of antidepressant medication see feature on depression. For details of individual antidepressants see feature antidepressants and tranquillisers.
warning
Great care needs to be taken with all drugs but this is particularly the case with lithium. This is because there is only a very narrow margin between an effective dose and one that is dangerous and this varies from person to person. If you are prescribed lithium:
- you will need regular blood tests to check the level of lithium in the body.
- you should be aware of danger signs that may indicate the level of lithium in your body is too high and contact your doctor if they occur. These signs include nausea, vomiting, diarrhoea, blurred vision, drowsiness, excessive thirst, shakiness and confusion.
- you need to make sure you are drinking adequate amounts of fluid as dehydration could cause a dangerous build-up of lithium in the body.
- you should make sure you eat a balanced diet containing normal amounts of salt. Too little salt or too much salt will affect the levels of lithium in the body.
- your heart, thyroid and kidneys should be regularly checked to make sure they are not being adversely affected by the lithium.
Ask your doctor or pharmacist for further advice or contact the Manic Depression Fellowship (see help and info).
Antipsychotic drugs are frequently prescribed initially for mania to help control symptoms such as overexcitement and hyperactivity. Drugs to counter possible unwanted side effects of antipsychotics, such as dry mouth or stiffness, may also be given. A mood stabilising drug such as lithium is also likely to be prescribed.
Mood stabilising drugs, of which lithium is the most common, may also be used for longer term maintenance therapy. If you have experienced several bouts of manic depression your doctor may suggest putting you on lithium to try and prevent future episodes or reduce their severity. Lithium does seem to be effective in stabilising mood for many people with manic depression although it doesn't help everyone. Your doctor may be able to prescribe an alternative drug or combination of drugs that suit you better.
practical and social support
Treatment for manic depression should never consist solely of medication. It should always include regular supportive discussions with a professional who can provide information and explanations about the illness and help the person to try to re-establish some sort of structure in their life.
In some cases some form of organised social support may be needed. This might involve regular visits from a community psychiatric nurse, for example or attendance at a drop-in centre or encouragement to make the best use of local facilities.
psychological therapies
Once you have started to recover from an episode of mania or depression you may find that some sort of psychological therapy such as counselling or cognitive behaviour therapy is helpful in rebuilding your self confidence and enabling you to make the best possible choices for yourself. You may like to check out these therapies in abc of mind. For more information see our feature on cognitive behaviour therapy.
picking up the pieces
Many people return to their normal selves after an episode of manic depression. However, they are likely to encounter a number of problems which may include:
- embarrassment or regret about behaviour during the illness
- anxiety about the possibility of a further episode
- loss of confidence.
In addition some people may have to cope with a broken relationship, loss of a job or financial difficulties.
Try to make sure you get all the support you can to help you through this difficult time. You may find the feature on self-help strategies helpful.
Friends and relatives too have probably been through a period of great strain where their patience and tolerance has been tested to the limit. They may need support for themselves (see friends and family).
self management
Self management courses, devised by people with manic depression to help others with the same diagnosis are organised by the Manic Depression Fellowship, see help and info. Over a three-day residential course and for a nominal fee members learn:
- to recognise their own warning signs and triggers for an impending episode, which vary from person to person.
- what action to take to prevent impending episodes or reduce their severity should they occur. This might include taking appropriate medication, alerting friends or doing a calming activity such as a relaxation exercise.
- maintenance strategies to make future episodes less likely such as avoiding stress or building up a good support network.
Each person is also encouraged to devise their own action plan which they can give to people they choose when they are well. The action plan explains what steps they want these people to take if they do become ill. It might involve taking over the management of their finances, for example or keeping an eye on their elderly relatives as they are unable to do so. For more details contact the Manic Depression Fellowship.
help and info
Channel 4 is not responsible for the content of third party sites.
You might like to check out the science site where there are three features which discuss depression and its treatment: The Biology and Treatment of Clinical Depression, Tailor-made Drugs of the Future and Depression Timeline.
To read about one parent's experience of his son's manic depression and how the whole family copes, have a look at our feature managing manic depression.
organisations
Depression Alliance
35 Westminster Bridge Road
London SE1 7JB
Tel: 0845 123 23 20
E-mail: information@depressionalliance.org
Website: www.depressionalliance.org
National network of self-help groups for people experiencing depression. Offers a newsletter, national pen friend scheme and correspondence service with advice, guidance, support and fellowship to people experiencing depression, and their carers. Produces booklets and leaflets on various aspects of depression.
Manic Depression Fellowship (MDF)
21 St George's Road
London SE1 6ES
Advice and information: 08456 340 540 (Mon-Fri 9am-5pm)
E-mail: mdf@mdf.org.uk
Website: www.mdf.org.uk
Provides advice and information for people with manic depression, and their families, carers and mental health professionals. Offers a quarterly journal Pendulum, a network of self-help groups for people with the condition, as well as their relatives and friends, self management training courses, employment advice, travel insurance, and members also have access to a legal advice line. MDF will send out an info pack upon request, which includes a publications list.
Mental Health Foundation
Sea Containers House
20 Upper Ground
London SE1 9QB
Tel: 020 7803 1100
E-mail: mhf@mhf.org.uk
Website: www.mentalhealth.org.uk
Working to improve the support available for people with mental health problems and people with learning disabilities. Offers information and literature on all aspects of mental health, including where to get help, information about specific mental health problems, treatments and rights.
Mind (National Association for Mental Health)
15-19 Broadway
London E15 4BQ
Mind Infoline: 0845 766 0163 (Mon-Fri 9.15am-4.15pm)
Tel: 020 8519 2122
E-mail: contact@mind.org.uk
Website: www.mind.org.uk
Campaigns for better mental health services in England and Wales, through its national office, regional offices and network of over 200 local branches, some of which also provide services. Publishes a range of helpful books and leaflets. Contact them for details of your nearest local group and for more information.
Rethink
5th Floor Royal London House
22-25 Finsbury Square
London EC2A 1DX
Tel: 0845 456 0455 (general enquiries) (Mon-Fri 9am-5pm)
National advice line: 020 8974 6814 (Mon-Fri 10am-3pm)
E-mail: advice@rethink.org
Websites: www.rethink.org
Dedicated to improving the lives of anyone affected by severe mental illness, by providing information, advice and advocacy services, raising awareness of mental health issues, and challenging the attitudes that create stigma. Website has sections on employment, money, benefits and legal rights.
Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org.uk
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website).
SANE
40 Adler Street
London E1 1EE
SANELINE: 0845 767 8000 (every day 12pm-2am)
E-mail: london@sane.org.uk (admin queries only)
Website: www.sane.org.uk
SANELINE is a national mental health helpline providing information and support for people with mental health problems, and those who support them. They can provide information on illnesses and symptoms, local and national mental health services, medication, treatments and therapies.
websites
Depression and Bi-Polar Support Alliance
www.dbsalliance.org
The DBSA fosters an understanding about the impact and management of these illnesses by providing up-to-date, scientifically-based tools and information written in language the general public can understand.
Royal College of Psychiatrists
www.rcpsych.ac.uk
Website contains informative factsheets on manic depression, and other mental illnesses.
Swings and Roundabouts
www.swingsround.mhmedia.com
Swings and Roundabouts are a group of volunteers who came together to produce Insight in Mind, a 27 minute film with an accompanying booklet which give an insight into mania and depression, as well as anti-psychotic medications. The aims of Insight in Mind are to enable carers, health professionals, family and friends to focus on the emotional and practical needs of individuals in distress and to challenge stereotypes, attitudes and prejudices. Visit the website for further information or to purchase a copy of the video and accompanying booklet.
reading
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Bipolar Disorders: A guide to helping children and adolescents by Mitzi Waltz (O'Reilly UK, 2000) |
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Coping with Depression and Elation by Patrick McKeon (Sheldon Press, 1995) |
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Living with Mental Illness: A book for relatives and friends by Elizabeth Kuipers and Paul Bebbington (Souvenir Press, 2004) |
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Survival Strategies for Parenting the Child and Teen with Bipolar Disorder by George Lynn (Jessica Kingsley Publishers, 2000) |
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(March 2002, resources updated December 2004)
