Psychology Degree Guide: Manic Depression

Manic depression, or bipolar disorder, will afflict perhaps as many as 1 in 20 Americans over the course of their lifetime. Misunderstood by the public, misinterpreted by the media, and miscategorized for years, manic depression remains a terrifying and unknown subject to many, even among bipolar people and their families. In this guide to manic depression, we seek to rectify this misunderstanding, illuminating the basics of the condition from a clinical perspective.

What Is Manic Depression?

Manic depression can be defined as extended periods of depression alternating with extended periods of manic behavior to the degree that these mood swings interfere with daily life. These depressive and manic moods can be equally strong or weak, or they can be asymmetrical in strength and duration. Extreme mania and extreme depression may only be separated by a few days, or there may be several-month lulls of moderate mood between them. Manic and depressive phases can be fairly mild, or they can be extreme to the point of psychosis and hallucination.

Psychologists identify four types of episode that define manic depression. The first, and perhaps best-known, is the major depressive episode, in which feelings of depression, melancholy, social anxiety, disinterest, and lassitude dominate in the afflicted individual. Conversely, a manic episode is characterized by intense euphoria and sleeplessness. A hypomanic episode is a diminished form of a manic episode, in which optimism and productivity predominate, and is rarely diagnosed unless it occurs in contrast to more depressive episodes. Lastly, a mixed affective episode is marked by a combination of depressive and manic characteristics. For example, a generally depressed person could suffer from racing thoughts and sleeplessness, or a generally manic person could experience sudden pangs of hopelessness. Most of these episodes occur over the course of a few months, and occur on average once every year or other year. However, many manic-depressives suffer from so-called “rapid cycling,” shifting from episode to episode more frequently.

These four types of episodes are used to help classify manic depression into four distinct subcategories: bipolar I disorder, bipolar II disorder, cyclothymia, and bipolar disorder not otherwise specified (NOS). Bipolar I disorder is diagnosed by the occurrence of at least one manic episode, often with mixed affective tendencies. There are occasionally hypomanic and depressive phases, but the emphasis is on stronger manic episodes. In bipolar II disorder, the emphasis is on the depressive episodes. Manic episodes may or may not be present, but hypomanic episodes alternate with depressive episodes. As a result, psychiatrists often misdiagnose bipolar II disorder as depression. Cyclothymia is a milder form of bipolar disorder, in which both the manic and depressive phases are muted, with mood shifts seeming to be inherent personality traits. Bipolar disorder NOS refers to other bipolar tendencies that interfere with everyday life, and is estimated to affect more people than bipolar I and bipolar II disorders combined.

Causes

As with most psychiatric illnesses, there is a lively debate about the exact cause of the bipolar conditions. And, like with most psychiatric illnesses, the debate is centered around the nature versus nurture issue. Many mental health professionals support both theories; the so-called “kindling” theory argues that while a certain biochemical or genetic profile predisposes one towards manic depression, environmental factors play a role as well.

Within the “nature” side, a number of chemical, genetic, and physiological causes have been discussed. Cases for a genetic cause to bipolar disorder have been put forth for decades, but no conclusive evidence has yet been found. Certain physiological traits in the brain have also seemed to indicate a greater likelihood of bipolar disorder. Whether this relationship is causal, related to genetics, related to biochemical imbalances, or inconsequential remains unknown.

Drawing largely from the psychoanalytic and Freudian tradition, other psychiatrists point to environmental factors. Traumatic childhood, the bogey of most psychiatric illnesses in the analytic tradition, is seen as a key factor in bipolar disorder. As many as 50% of manic-depression sufferers report an abusive or traumatic childhood, and these patients also are far more likely to be afflicted by additional psychiatric illnesses.

Treatments

A wide range of treatments are available for those suffering from manic depression, including both psychotherapy and pharmaceutical therapy. The traditional “first line of defense” has been traditional psychotherapy. Common approaches include family-focused therapy and cognitive-behavioral therapy. Hospitalization is less common, but may be necessary, especially if the patient is prone to suicide attempts and suicidal ideation. Bipolar I disorder also more frequently requires hospitalization when manic episodes become psychotic. Outside of the hospital and beyond therapy, prescription drugs have proven effective. Antidepressants, while once commonly prescribed, have been shown to be ineffective compared to other medications. Lithium carbonate, commonly prescribed as an anti-psychotic, is at present the gold standard for chemical treatment of manic depression.

Further Reading

The links below cover primarily clinical and academic websites, with some support groups and other general-audience sites.

• Clinical guidelines pertaining to bipolar conditions from the UK National Health Service.
• The National Bipolar Foundation supports awareness of the prevalence of bipolar disorder and research for treatment.
• The U.S. National Institute of Mental Health discusses the frequent misdiagnosis of manic depression.
• Stanford University provides a PowerPoint on the benefits of cognitive-behavioral therapy in bipolar treatment.
• WebMD writes about bipolar I disorder.
• Working psychiatrist James Phelps discusses bipolar II disorder.
• The Mayo Clinic defines cyclothymia.
• Konstantinos Fountoulakis writes a scholarly article on the potential benefits of psychotherapy in bipolar disorders.
• Is pharmaceutical therapy necessary? This thought-provoking article discusses the vested interests of drug companies and their influence on the psychiatric community.
• Health.com writes about the potential stigma faced by manic-depressives.
• A 2005 article discusses the possible genetic origins of manic depression.
• http://www.csa.com/discoveryguides/bipolar/overview.php
• PsychCentral discusses other potential causes.
• Psychiatric Services discusses some ways that misdiagnosis of manic depression could be reduced.
• The Mayo Clinic introduces common ways in which bipolar disorder can be diagnosed.
• The Goldberg Quiz is one tool used to diagnose manic depression. Take it online here.

IMAGE: Vincent Van Gogh is believed by many to have suffered from manic depression (Source: Wikimedia Commons)