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Manic depression is a frequently used term that
describes an individual with depressive episodes who also has manic
episodes. A manic episode as described by the DSM-IV is a distinct
period in which there is an abnormal and persistent elevation or
expansive or irritable mood. This disturbance in mood must last
at least one week. Bipolar disorder is a diagnosis which we will
refer to at a later time. Manic episodes can last for days, weeks,
and even months. There are individuals who rapidly cycle, where
individuals have elevation in moods that are brief, brief defined
by only approximately a week, and then abate. During the abatement,
it is not uncommon for these individuals to fall into a depressive
phase where they experience some of the symptoms we discussed earlier
in terms of severe depression. During the manic phase, individuals
are frequently hyper verbal. Increased agitation is common. Grandiosity
and a grossly inflated self-esteem may also be seen. Mood may be
labile, fluctuating between gross euphoria and irritability. There
is a clearly decreased need for sleep. These individuals are full
of energy, and during these phases, it is not uncommon for them
to have an increased sex drive, and to be impulsive with their acting
out behavior. Buying sprees may occur. This author has seen individuals
spend $10-15 thousand dollars within a week using credit cards.
As indicated, grandiosity is common during the manic phase. For
example, an individual may decide to start a clock company, with
no past experience or education regarding clocks, yet will invest
heavily in an attempt to start up a clock business. It is important
to note that manic episodes can also be the direct effect of medication.
Anti-depressants can exacerbate manic episodes, as can steroid use
and using recreational drugs such as cocaine and cannabis. Light
therapy may also exacerbate this condition.
It is quite unfortunate that during a manic episode, an individual
may not recognize that they are ill, which makes treatment extremely
difficult. Other manic behaviors that are commonly exhibited are
gambling and anti-social behaviors such as giving random advice
to strangers passing in the street.
When a manic phase shifts to depression, the depression may last
only hours, or extend into days or weeks.
Causes of Manic Depression
There are different theories regarding the cause of manic depression.
Some believe it is a reactive depression, or an individual’s
response to negative environmental stimuli including perhaps dysfunctional
family dynamics. Others view this as a biological or endogenous
depression, where an individual is born with a failure in his biochemical
makeup. Many studies support a biological basis for manic depression,
with few supporting the reactive foundation. It is this author’s
experience that if a therapist has done research in cognitive behavior
or learning theory, they are more likely to lean towards a reactive
basis for bipolar disorder. This is what we call a strong bias based
on one’s own belief system. With regard to psychiatric diagnoses,
those that have the strongest evidence for a biological predisposition
include schizophrenia and bipolar disorder. It is very difficult
to support environment influence as a cause for bipolar disorder,
especially with the dramatic improvement on pharmacology and resolution
of symptoms. It should be noted that when individuals are diagnosed
with bipolar disorder and treated with Lithium Carbonate, they exhibit
large improvement, with decrease in symptomatology. When medication
is discontinued, the symptoms recur. Again, this clearly supports
a biological foundation for bipolar disorder. There are many studies
that support a biological predisposition to manic depression. Research
studies with monozygotic twins show a 60-70% correlation between
individuals diagnosed with bipolar disorder, and their twin who
goes on to develop the disorder.
There are variations in cycling within bipolar disorder. There
are those with rapid cycles who alternate between depression and
mania within only a few days. Others may spend weeks or months in
depression before switching to a manic phase.
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