Bipolar Disorder: Don't Let Manic Depression Capture Your Soul…Bipolar Disorder, today's topic for discussion, is a disabling and recurrent psychological disorder that affects about 1 percent of adult Americans, over 2 million, and is characterized by extremes of mood. This illness was formerly called "Manic-depression."Many readers will remember "Manic Depression" as a song by Jimi Hendrix. "Manic Depression has captured my soul," Jimi sings over his psychedelic guitar-playing track. As a psychologist I wish that Jimi had consulted me when he was writing the song. I would have told him…, well, read on. Bipolar Disorder is characterized primarily by an inability to regulate mood states and a tendency to experience extremes of both depression and mania. There are variations, for example, some people have less mania, but experience excessive irritability. These people can shift unexpectedly and stay in high or low gear for protracted and disabling periods of time. The diagnosis is given most often to people between the ages of 15 and 30 years. This is a life-threatening illness, with as many as one in 5 victims committing suicide and is complicated by the fact that many Bipolar individuals are not yet in treatment. Bipolar disorder seems to come in different forms for males and females, with the males often presenting first with mania, but women seeking treatment for the depressed pole first. Besides that, Bipolar Disorder may come in different phases, with some people having more classic mania, followed by either normal or depressed states and others having their polarity shift from depression to more normal states. More severe variations include rapid and mixed states with the mood instability shifting quickly or having simultaneous symptoms of mania and depression. In other words, this condition is serious and needs the care of an astute and attentive clinician. The word "mania" is derived from one of the Greek root words for "mind" and in particular seems to reference back to one of the nymphs who attended the Dionysian rituals of those ancient Greek times — from this we get the sense of maniac as one who acts like a madman. So, the original maniac was quite a party animal? Speaking of partying, everybody knows what it's like to feel really good or even "high" at times — in psychological terms, this is called "euthymia." When you feel high or energized for a protracted period of time, this is called "hypomania" — which is a milder form of mania. When the high starts to keep you up through the night or is associated with energy that has no off switch, then it's called mania, or a manic episode. In manic episodes a person may engage in excessive and risky behavior. An otherwise well behaved person may become sexually promiscuous, go on spending sprees, gamble, clean the house all day or all night, or make very ill advised investments. Other typical symptoms of mania include racing thoughts, talking excessively fast, distractibility, or inflated feelings of importance. In more severe manic states, actual psychosis can take place, with hallucinations or delusions. Bipolar delusions typically follow the mood: in the manic state, themes like grandeur and excess are common; in the depressed state themes of worthlessness or emptiness rule. Bipolar Disorder is presently a life-long condition. We know that there's a genetic link because relatives of family members are more prone to developing it, but it's clear that some other factors have to trigger the onset of the first episodes. Once manic episodes begun, they become recurrent and the primary goals for treatment are to reduce the number of episodes and to shorten the length and severity of episodes. We do that by combining medication and psychosocial therapies. Lithium, which is actually an elemental salt, was discovered to have anti-manic properties. This was actually figured out by a veterinarian. This is a medicine that has to be dosed and monitored carefully by a psychiatrist. In recent years a number of additional anti-manic medications have been developed, many of which were first used to treat seizures. Some researchers are hypothesizing that there may be an explanation why anti-seizure drugs regulate manic states: this seems to lie in the basic physiology of the way that the brain controls its own levels of activation. It's very important that people with mania or some of the symptoms that we've mentioned receive a medical work up and that those with Bipolar Disorder get into treatment and stay in treatment as needed. Psychotherapy and Family-based therapy approaches can be vital, providing an understanding of the condition and for teaching what we know about controlling these internal states. Sleep and activity regulation, stress management, and other strategies can help a lot to reassert control when things start to take off. Everyone should help with treatment compliance and early detection of the need for medication changes to deal with potential relapses. This is one of the serious brain-based mental disorders with serious complications, including a lot of substance abuse, some of which is no doubt an attempt to re-regulate from the lows to the highs. Bipolar people need our support and our compassion. When they're back in control, they're pretty much like you and me. |
