What is Manic Depression?

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, 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.

What are 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.