Complex Psychology behind Manic Depression: Symptoms, Causes, and Treatment

Manic depression, also known as bipolar disorder, is a mental health condition characterized by intense mood swings between emotional highs (mania or hypomania) and lows (depression). This chronic mood disorder affects about 2.6% of the U.S. population, causing significant shifts in energy, activity levels, and concentration.

There are several types of manic depression, including bipolar I disorder, bipolar II disorder, cyclothymia, and other specified/unspecified bipolar disorders. In this comprehensive guide, we’ll explore the symptoms of manic and depressive episodes, discuss potential causes and risk factors, and examine various treatment approaches, including psychotherapy techniques, medications, and coping strategies for managing this lifelong condition.

Symptoms of Manic Episodes

Manic episodes are characterized by a distinct cluster of symptoms that reflect a state of elevated mood, energy, and activity levels. These symptoms can significantly impact an individual’s daily functioning and interpersonal relationships. Some of the key symptoms associated with manic episodes include:

1. Abnormally Elevated Mood

• Feeling excessively happy, euphoric, or elated
• Experiencing an abnormally and persistently upbeat, jumpy, or wired mood

2. Increased Energy and Activity

• Decreased need for sleep without feeling fatigued
• Increased talkativeness and rapid speech
• Racing thoughts and distractibility
• Increased goal-directed activity or psychomotor agitation

3. Impaired Judgment and Impulsivity

• Inflated self-esteem or grandiose beliefs
• Excessive involvement in pleasurable activities with potential for adverse consequences (e.g., unrestrained buying sprees, sexual indiscretions)
• Poor decision-making and reckless behavior

In severe cases, manic episodes can also involve psychotic symptoms, such as hallucinations (seeing or hearing things that are not real) or delusions (firmly held false beliefs). These episodes can significantly disrupt an individual’s ability to function effectively in various aspects of life, including work, social relationships, and personal well-being.

Symptoms of Depressive Episodes

During a depressive episode, individuals with manic depression often experience a range of debilitating symptoms that can significantly impact their daily functioning and overall well-being. These symptoms include:

1. Persistent Sadness and Low Mood

• Feeling intensely sad, empty, or hopeless for most of the day, nearly every day
• Frequent bouts of crying or tearfulness

2. Loss of Interest and Pleasure

• Markedly diminished interest or pleasure in activities once enjoyed
• Withdrawal from social interactions and hobbies

3. Changes in Appetite and Weight

• Significant weight loss or gain (a change of more than 5% of body weight in a month)
• Increased or decreased appetite

4. Sleep Disturbances

• Insomnia or hypersomnia (sleeping too little or too much)
• Waking up frequently during the night or early morning

5. Fatigue and Low Energy

• Persistent feelings of tiredness or lack of energy
• Reduced productivity and difficulty completing tasks

6. Cognitive Impairments

• Difficulty concentrating, remembering details, or making decisions
• Slowed thinking or indecisiveness

7. Feelings of Worthlessness or Guilt

• Overwhelming feelings of worthlessness or excessive guilt
• Recurrent thoughts of death or suicidal ideation

It’s crucial to note that the severity and duration of these symptoms can vary among individuals, and professional evaluation is necessary for an accurate diagnosis and appropriate treatment plan.

Causes and Risk Factors for Manic Depression

The exact cause of bipolar disorder, also known as manic depression, is not fully understood. However, several factors are believed to play a role in its development:

Biological Factors

1. Genetics: Bipolar disorder has a strong genetic component. People with a first-degree relative (parent, sibling, or child) who has the condition are at a higher risk of developing it themselves. Studies suggest that if one identical twin has bipolar disorder, the other has a 40-70% chance of developing it as well.
2. Brain Structure and Function: Research has identified differences in the brain structure and function of individuals with bipolar disorder compared to those without the condition. These differences may involve the areas of the brain responsible for regulating mood, energy levels, and cognitive functions.

Environmental Factors

1. Stress: Stressful life events, such as trauma, abuse, or the loss of a loved one, can trigger the onset of bipolar disorder or precipitate mood episodes in those already diagnosed with the condition.
2. Substance Abuse: The use of certain substances, such as alcohol or recreational drugs, can increase the risk of developing bipolar disorder or exacerbate its symptoms.

Other Risk Factors

1. Age: Bipolar disorder often develops in late adolescence or early adulthood, with the average age of onset being around 25 years old. However, it can also manifest in childhood or later in life.
2. Gender: While bipolar disorder affects both males and females equally, some studies suggest that females may experience more rapid cycling between mood episodes.
3. Socioeconomic Status: Some research indicates that individuals with lower socioeconomic status may have a higher risk of developing bipolar disorder, although the reasons for this association are not entirely clear.

It’s important to note that bipolar disorder is likely the result of a complex interplay between genetic and environmental factors. More research is still needed to fully understand the underlying causes and risk factors associated with this condition.

Diagnosis and Assessment

The diagnosis of bipolar disorder, also known as manic depression, involves a comprehensive evaluation process to accurately identify the condition and rule out other potential causes. Here’s how the diagnosis and assessment typically proceed:

1. Initial Evaluation

• A physical examination is performed to rule out any underlying medical conditions that could be contributing to the symptoms.
• Blood tests may be ordered to check for thyroid disorders, vitamin deficiencies, or other potential physiological factors.

2. Psychological Assessment

• The doctor or mental health professional will conduct a detailed interview to gather information about the patient’s symptoms, their duration, severity, and impact on daily life.
• The patient will be asked about their family history of mental health conditions, substance use, and any suicidal thoughts or behaviors.
• Standardized questionnaires or rating scales may be used to assess the presence and severity of manic and depressive symptoms.

3. 3. Collateral Information
   • With the patient’s consent, the doctor may seek input from family members, friends, or partners who have observed the patient’s behavior and mood changes.
   • This collateral information can provide valuable insights into the patient’s symptom patterns and help confirm the diagnosis.
   4. Differential Diagnosis
   • Bipolar disorder can share symptoms with other mental health conditions, such as major depressive disorder, schizophrenia, or borderline personality disorder.
   • The doctor will carefully evaluate the patient’s symptoms to differentiate bipolar disorder from these other conditions and ensure an accurate diagnosis.
   5. Subtype Determination
   • Once bipolar disorder is diagnosed, the doctor will determine the specific subtype, such as bipolar I disorder (with full-blown manic episodes) or bipolar II disorder (with hypomanic episodes).
   • This distinction is crucial for selecting the appropriate treatment approach.
   6. Ongoing Monitoring
   • Patients may be asked to maintain a daily mood diary or log to track their symptoms and identify potential triggers or patterns.
   • Regular follow-up appointments with the doctor or mental health professional are essential for monitoring the patient’s progress and adjusting the treatment plan as needed.

   It’s important to note that diagnosing bipolar disorder, especially in children and adolescents, can be challenging due to the variability and overlap of symptoms with other conditions. A thorough and comprehensive assessment is crucial for ensuring an accurate diagnosis and effective treatment plan.

   Treatment Approaches for Manic Depression

   The primary treatment approach for manic depression, or bipolar disorder, involves a combination of medication and psychotherapy.

   Medication Management

   Medications play a crucial role in managing the symptoms of bipolar disorder. The most commonly prescribed medications include:

   1. Mood Stabilizers: These medications help regulate mood swings and prevent manic and depressive episodes. Examples include lithium, valproic acid (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol).
   2. Antipsychotics: These medications are often used in combination with mood stabilizers to control manic symptoms. Examples include olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel).
   3. Antidepressants: These medications may be prescribed to treat depressive episodes, but they are typically used in conjunction with mood stabilizers or antipsychotics to avoid triggering manic episodes.

   It’s important to note that finding the right medication and dosage can be a process of trial and error, as individuals may respond differently to different medications. Regular monitoring and adjustments by a healthcare professional are often necessary.

   Psychotherapy

   In addition to medication, various forms of psychotherapy are recommended as part of a comprehensive treatment plan for bipolar disorder:

   1. Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and modify negative thought patterns and behaviors that contribute to mood episodes.
   2. Interpersonal and Social Rhythm Therapy (IPSRT): This therapy focuses on stabilizing daily routines and improving interpersonal relationships, which can help regulate mood and prevent episodes.
   3. Family-Focused Therapy: This approach involves educating family members about bipolar disorder and teaching effective communication and problem-solving strategies.
   4. Psychoeducation: This involves educating individuals and their families about bipolar disorder, its symptoms, and effective management strategies.

   Lifestyle Changes and Self-Management

   Certain lifestyle changes and self-management strategies can also play a crucial role in managing bipolar disorder:

   1. Maintaining a regular sleep schedule and routine
   2. Engaging in regular exercise and physical activity
   3. Avoiding substance abuse (alcohol and drugs)
   4. Developing stress management techniques (e.g., meditation, yoga)
   5. Building a strong support system of family and friends

   It’s important to note that treatment for bipolar disorder is typically tailored to the individual’s specific needs and may involve a combination of medication, psychotherapy, and lifestyle changes. Regular monitoring and adjustments to the treatment plan may be necessary as the condition progresses or symptoms change.

   Psychotherapy Techniques

   Cognitive Behavioral Therapy (CBT)

   Cognitive Behavioral Therapy (CBT) is considered one of the most effective psychotherapies for managing bipolar disorder. It focuses on identifying and modifying negative thought patterns and behaviors that contribute to mood episodes. CBT teaches individuals to be more aware of their thoughts and how they influence emotions and behaviors. Through CBT, people learn to challenge distorted thinking patterns and rehearse more adaptive ways of thinking and behaving.

   Family-Focused Therapy (FFT)

   Family-Focused Therapy (FFT) involves the whole family unit in the treatment process. It provides education about bipolar disorder, recognizing symptom changes, and improving communication and conflict resolution skills within the family. FFT helps the person with bipolar disorder and their family members develop effective strategies to address family conflicts and support each other.

   Interpersonal and Social Rhythm Therapy (IPSRT)

Interpersonal and Social Rhythm Therapy (IPSRT) focuses on stabilizing daily routines and improving interpersonal relationships. Individuals are guided to keep daily records of their sleep/wake times, activities, and routines. The therapist then coaches them on regulating their daily rhythms and sleep-wake cycles, as disruptions in these areas can trigger mood episodes. IPSRT aims to help individuals maintain a consistent routine and improve their social interactions, which can positively impact mood stability.

Medications and Side Effects

Medications play a crucial role in managing the symptoms of bipolar disorder, also known as manic depression. Here are some commonly prescribed medications and their potential side effects:

Mood Stabilizers

Mood stabilizers are often the first line of treatment for bipolar disorder. These medications help regulate mood swings and prevent manic and depressive episodes. Common mood stabilizers include:

1. Lithium: One of the most widely prescribed and studied medications for bipolar disorder. It can reduce manic symptoms within 2 weeks, but may take weeks to months to fully manage symptoms. Potential side effects include thyroid and kidney problems, as well as lithium toxicity symptoms like blurred vision, irregular heartbeat, and confusion.
2. Valproic Acid (Depakene)and Divalproex Sodium (Depakote): These anticonvulsant medications can cause side effects like nausea, shaking, weight gain, dizziness, drowsiness, and blurred vision.
3. Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol): Another anticonvulsant mood stabilizer that may cause side effects similar to valproic acid.
4. Lamotrigine (Lamictal): This medication can also be used as a mood stabilizer, but it has a risk of serious rash, especially when starting treatment.

Antipsychotics

Antipsychotic medications are often used in combination with mood stabilizers to control manic symptoms. Common antipsychotics prescribed for bipolar disorder include:

1. Aripiprazole (Abilify), Asenapine (Saphris), Cariprazine (Vraylar), Lurasidone (Latuda), Olanzapine (Zyprexa), Quetiapine Fumarate (Seroquel), Risperidone (Risperdal), and Ziprasidone (Geodon): These newer antipsychotics can cause side effects like drowsiness, dry mouth, shaking, increased appetite, weight gain, and reduced libido.
2. Haloperidol (Haldol) and Loxapine (Loxitane): Older antipsychotics that may have more severe side effects, including involuntary movements (tardive dyskinesia).

Antidepressants

Antidepressants may be prescribed to treat depressive episodes in bipolar disorder, but they are typically used in conjunction with mood stabilizers or antipsychotics to avoid triggering manic episodes. Common antidepressants used include fluoxetine combined with olanzapine (Symbyax), lumateperone (Caplyta), lurasidone (Latuda) alone or with lithium or valproic acid, and quetiapine fumarate (Seroquel). Potential side effects of antidepressants include sexual dysfunction, dizziness, insomnia, and weight gain.

It’s important to note that regular monitoring and blood tests may be necessary when taking these medications to check for potential side effects, such as liver damage, kidney damage, or changes in white blood cell or platelet counts. Additionally, it’s crucial to take medications as prescribed and not stop them without consulting a healthcare professional, as bipolar disorder is a lifelong condition that requires ongoing treatment to manage symptoms and prevent recurring episodes.

Coping Strategies

Developing effective coping strategies is crucial for managing the symptoms of manic depression (bipolar disorder) and promoting overall well-being. Here are some key strategies that can help individuals cope with this condition:

1. Establish Healthy Routines

Maintaining regular habits and routines can help regulate mood and energy levels. It’s essential to establish a consistent sleep schedule, engage in regular physical activity, and follow a balanced diet. These routines can provide structure and stability, which can be beneficial in managing the fluctuations associated with bipolar disorder.

2. Practice Mindfulness and Self-Care

Engaging in mindfulness practices, such as meditation, deep breathing exercises, and journaling, can help individuals become more aware of their thoughts and emotions. These practices can promote a sense of calm and help identify potential triggers or early warning signs of mood episodes. Additionally, making time for enjoyable activities and hobbies can provide a sense of fulfillment and contribute to overall well-being.

3. Build a Support Network

Avoiding isolation and maintaining social connections can be invaluable in coping with manic depression. Reaching out to friends, family members, or support groups can provide emotional support, understanding, and a sense of community. It’s essential to have a reliable network of people who can offer encouragement and assistance during challenging times.

4. Collaborate with Healthcare Professionals

Working closely with healthcare professionals, such as psychiatrists, therapists, and counselors, is crucial for managing bipolar disorder effectively. Individuals should discuss their symptoms, concerns, and any changes in their condition with their healthcare team. This collaboration can help ensure that treatment plans are adjusted as needed and that appropriate support is provided.

5. Identify and Manage Triggers

Recognizing and avoiding potential triggers that can worsen manic or depressive episodes is an important coping strategy. These triggers may include alcohol or substance abuse, sleep deprivation, stressful situations, or certain medications. By being aware of these triggers and developing strategies to manage them, individuals can better control their symptoms and prevent episodes from escalating.

6. Develop a Crisis Plan

Creating a comprehensive crisis plan can be invaluable in preparing for and managing severe mood episodes. This plan should include contact information for healthcare providers, details about medications and treatment plans, and strategies for addressing specific symptoms or behaviors. It’s also helpful to identify a trusted individual who can assist in making decisions or providing support during a crisis.

Remember, coping with manic depression is an ongoing process that requires patience, perseverance, and a multifaceted approach. By incorporating these strategies into daily life and working closely with healthcare professionals, individuals can better manage their symptoms and improve their overall quality of life.

Support and Resources

Support Hotlines and Organizations

For individuals and families affected by manic depression (bipolar disorder), several organizations offer support hotlines, educational resources, and local support groups. The National Alliance on Mental Illness (NAMI) HelpLine (800-950-6264) provides information and support. The Depression and Bipolar Support Alliance (DBSA) focuses on supporting those with bipolar and depressive disorders through local chapter meetings and online resources.

Educational Materials and Self-Management Tools

The DBSA offers a ‘Wellness Toolbox’ with resources like a Wellness Wheel, Wellness Tracker, and recovery courses to help individuals manage their manic depression. Organizations like the American Academy of Child and Adolescent Psychiatry (AACAP), American Psychiatric Association, and American Psychological Association (APA) provide information on manic depression, medication options, and prevention strategies.

Finding Treatment and Participating in Clinical Trials

The American Society for Clinical Psychopharmacology (ASCP) maintains a link for finding a psychopharmacologist and other helpful patient information about psychopharmacology for manic depression. The Substance Abuse and Mental Health Services Administration (SAMHSA) is a government resource for locating treatment resources. Clinical trials are available to study new treatments for bipolar disorder, and resources are provided to help find and participate in relevant studies.

FAQs

1. What typically triggers manic depression?
   Manic depression, also known as bipolar disorder, can be triggered by various factors including chemical imbalances in the brain, side effects from certain medications like antidepressants, life-changing events such as a divorce or the death of a loved one, and challenging life circumstances like trauma, financial issues, or prolonged loneliness.
2. What is an early warning sign of bipolar disorder?
   A significant early warning sign of bipolar disorder is a change in sleep patterns, particularly needing less sleep. This symptom is often more noticeable than the mood swings associated with mania and can be a critical indicator for monitoring the onset, presence, or fading of mood episodes.
3. How can someone manage a manic episode?
   Managing a manic episode involves several self-care strategies:

• Endeavor to maintain a regular sleep schedule, even if you don’t feel tired.
• Avoid substances that can disrupt sleep or mood, such as alcohol and caffeine.
• Keep up with regular meals, even if your appetite is lacking.
• Steer clear of overstimulating activities and environments that are noisy, bright, or crowded.
• Seek out quiet, soothing environments and engage in activities that you find relaxing.

4. What are the primary treatments for manic depression?
   The most common approach to treating manic depression involves the use of mood-stabilizing medications. Some of the widely used mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro), and lamotrigine (Lamictal). In some cases, antipsychotic medications may also be prescribed.

Here are few certified therapists who you can get in touch and book a therapy session with:

Sylvia Cowell

Diego Tinte

Sandra Retmanski