Manic Depression

Bipolar affective disorder also called manic – depression:
Patients with this disorder experiences severe pathologic mood swings
from euphoria to sadness. Recovery is spontaneous and mood swings tend
to recur. The cyclic (bipolar) form consists of separate episodes of
mania (elation) and depression. Manic or depressive episodes can be
predominant, or the two moods can be mixed. When depression is the
predominant mood, the patient has the unipolar form of the disease. The
manic form is more prevalent in young patients, and the depressive form
in older ones.

There are no known identifiable predisposing factors or events that
may precede the onset of bipolar disorder, the onset of illness may
include early loss of a parent, parental depression, abuse, incest,
failed relationship, and severe accidental injury.

The cause of manic -depression, or bipolar disorder, is unclear but
are believed to be multiple and complex, and may involve genetic,
biochemical, and psychological factors.

Genetic factors: Studies implicate a dominant X-linked gene. Bipolar disorder occurs twice as frequently in women as in men.

Biochemical factors: Just as lowered
norepinephrine levels occur during an episode of depression, the
opposite appears to be true during a manic episode. An excess of this
biogenic amine may cause elation and euphoria. Other biochemical
factors associated with mania include altered dopamine and serotonin

Psychological factors: According to psychoanalytic
theory, bipolar disorder arises out of the patient’s love – hate
relationship with his mother, the loss of a significant other, or
learned helplessness. * Note – this is only a theory.


Mood swings in someone with bipolar disorder form a extreme low of
depression to an extreme high feeling of happiness ( this can be very
dangerous, this illness is associated with significant mortality
because of the number of patients who commit suicide. The risk
increases as the patient’s depression decreases.)

Depression Phase: symptoms includes, loss of self
esteem, overwhelming inertia (inactivity), hopelessness, despondency,
withdrawal, apathy, sadness, and hopelessness. Elderly patients may
show poor concentration or indecision instead of sadness.
symptoms includes: increased fatigue, difficulty sleeping, difficulty
staying asleep, and or early morning awakening – tiredness on
awakening, anorexia, causing significant weight loss without dieting. –
Psychomotor retardation with slowed speech, movement, and thoughts, and
difficulty concentrating (although usually not disoriented or
intellectually impaired, patient may only offer slow, one – word
answers in a monotonic voice). -Multiple somatic complaints, such as
constipation, chest pains, heaviness in the limbs, headaches, -the
patient may worry excessively about having cancer, or dying of other
severe illness. – Excessive and hypochondriacal. Patient may have
feelings of guilt and self reproach over past events. – feelings of
worthlessness (and a feeling of “I need to be punished”)

Acute manic phase: This phase is marked by
recurrent, distinct episodes of persistently euphoric, expansive, or
irritable mood. It must be associated with four of the following
symptoms that persist for at least 1 week. Symptoms includes:
Increase in social, occupational, or sexual activity with physical restlessness
Unusual talkativeness or pressure to keep talking
Flight of ideas or the experience of on going thoughts
Inflated self esteem (grandiosity)
Decreased need for sleep
Distractibility, attention too easily drawn to trivial stimuli
Excessive involvement in activities that have a high potential for
painful but unrecognized consequences; such as, shopping sprees,
reckless driving.
The manic patient has very little control over incessant pressure of
ideas, speech, and activity; patient ignores the need to eat and sleep.

Hypomania: This is more common than acute mania.
hypomania consists of a classic triad of symptoms: elated but unstable
mood, pressure of speech, and increased motor activity. It is not
associated with flight of ideas, delusions, or absence of discretion
and self control. Patient may have symptoms of hyperactivity, is easily
distracted, irritability, impatience, and impulsiveness.


Patient may require brief hospitalization to provide drug therapy or ECT.
an electric current is passed through the temporal lobe to produce a
controlled grand mal seizure. ECT is an effective treatment for
persistent depression. It is less effective in the manic phase.
However, it is the treatment of choice for middle – age, agitated, and
suicidal patients.

MAO or monoamine oxidase inhibitors such as phenelzine
(Nardil) and tricyclic antidepressants (TCAs) such as imipramine
(Tofranil) relieve depression without causing the amnesia or confusion
that commonly follows ECT.

Lithium therapy can dramatically relieve symptoms of mania
and hypomania and may prevent recurrence of depression. In some
patients, maintenance therapy with lithium has prevented recurrence of
symptoms for decades. Onset of lithium effect takes 7 to 10 days. For
those who fail to respond to lithium, the doctor may prescribed
haloperidol (Haldol) or carbamazepine (Tegretol) which also helps with
this disorder.