Family doctor

Overview:

• Manic depression is now known as bipolar disorder
• It is characterised by mood swings from elation to depression
• The disorder affects about one percent of the population
• Most people can function well with treatment which may be long term
• There is a high risk of suicide with bipolar disorder
• There is a genetic link in some people with the illness
• Treatment usually involves drug therapy, with supportive counselling and education

What is it?

Manic depression is now also called bipolar mood disorder

This is a serious mood disorder characterised by large mood swings of elation (mania), and depression.

These big mood swings can cause difficulty in taking part in everyday life and some sufferers lose touch with reality and develop psychosis.

The disorder affects about one percent of the population, and normally begins between the ages of 15 and 40.

The majority of sufferers can recover after severe episodes but 20 to 30 percent will experience ongoing problems.

The illness can lead to severe difficulties with relationships, problems with drug or alcohol abuse, and problems with the law.

There is a high risk of suicide with bipolar disorder.

There is a risk of violent behavior during periods of mania or psychotic episodes, during which the sufferer may not be behaving rationally.

It is not known what causes bipolar disorder. There is a genetic link in some cases. People with a family member with the condition have a slightly higher than average risk of developing the condition.

The condition may be caused by changes in the chemical messenger system in the brain.

Stressful life events such as poverty, unemployment, and relationship problems can trigger manic or depressive episodes.

What are the symptoms?

Signs of mental illness may develop suddenly in people who have coped well with stressful problems in the past. In other cases the disorder develops gradually over months or years.

Some people will have had a previous episode of depression.

There is no medical test to diagnose the disorder. Diagnosis is made when there has been a distinct period of abnormally and persistently elevated mood and some of the following symptoms have been present to a significant degree:

Symptoms of mania include:

• Elation and happiness when the person will seem like the and soul of the party. However, their behaviour will seem excessive to those who know them well.
• Irritable mood swings in between feelings of elation
• Rapidly changing emotions from laughter to tears
• Reduced need for sleep. Those with severe mania may go without sleep for days
• Boundless energy
• Increased desire for food, sex and other pleasurable activities. They may end up subsequently regretting their actions
• Increased activities such as doing all the house work at once, but this can lead to disorganisation
• Loud and fast talking
• Racing thoughts, jumping from one subject to another
• Increased sense of self importance. In severe cases a sufferer may believe they have a special relationship with God or other famous figures
• Loss of awareness their behaviour is a result of a mental illness

Sometimes people with severe mania may develop symptoms of psychosis. They may have unusual or altered beliefs, hear voices about their own importance or develop paranoia that they are being wrongly persecuted.

Bipolar disorder sufferers may or may not have episodes of depression.

Symptoms of depression include:

• Persistent low or sad feelings
• Loss of interest in activities normally enjoyed such as loss of interest in sex
• Irritable mood changes
• Problems sleeping or sleeping too much, unrefreshing quality of sleep
• Change in appetite such as not feeling like eating, or alternatively over eating
• Tiredness and fatigue
• Slower movements or sudden activity such as pacing the room
• Thoughts of worthlessness or guilt
• Thoughts of hopelessness or wanting to die
• Problems thinking clearly and concentrating

Episodes of mania and depression may occur one after the other. Many people have isolated episodes with long periods of good mental health in between depression or mania. However, some people's gaps will become shorter between episodes, particularly as they grow older.

What can be done to help?

Treatment involves medication with anti-depressants and mood stabilising drugs. Mood stabilisers such as lithium carbonate, tegretol or epilim are used to prevent further episodes and are used long term to maintain wellness.

Anti-psychotic drugs may used, particularly during a manic episode and possibly longer term, depending on the severity and nature of the illness in a particular patient.

Treatment for an episode is necessary as soon as possible. The earlier the treatment begins the better chance of recovery.

Most people will recover quicker from an episode of mania than of depression.

Psychotherapy and counselling is also useful. Education about the disorder for the patient and family is very important, as well as a good relationship with the doctor involved.

Electro-convulsive therapy (ECT) is sometimes used for severe mania and depression, and can help where other treatments have failed.

Inpatient treatment and hospital care is used in situations when a person's symptoms are endangering their lives or the safety of others.

How can it be prevented?

There is no known way to prevent bipolar disorder at this stage, but sustained use of mood stabilisers can prevent episodes of mania or depression.

Getting help

Your doctor, psychiatrist or local mental health team will be able to help.

The Mental Health Foundation of New Zealand, Ph 09 638 8573

* Information supplied by the Mental Health Foundation of New Zealand