A B C D E F G H I J K L M N O P R S T U V W

MANIC DEPRESSION

What is Manic Depression ?

Most people have moods that swing from sadness to happiness. In the person who suffers from manic depression, these moods swings are greatly exaggerated. There are two features to this disorder. The depressive phase often arises out of the blue and with no obvious cause. The depression is quite profound and often associated with guilt feelings which centre on something that may have happened in the past. The person's judgement is impaired and so he does not believe himself to be ill. The manic phase is often the opposite of the depressive phase. The patient becomes elated and has far more energy than normal. He often stays up all night, not because he can't sleep but because he has so much to do. He is very talkative and speaks fast. He often has several ideas but often loses his train of thought. He has great optimism and blind faith and enormous self-confidence, sometimes believing himself capable of irrational deeds. This belief in himself can lead to spending a great deal of money on impractical projects. He is less inhibited and sometimes remarks made can offend or hurt relatives or friends. He does not appear to recognise that he is ill or that his behaviour is irrational. If challenged about this he can often become impatient, irritable and angry. Some sufferers have both manic and depressive illnesses at different times, while others just have a manic phase. The phases may last for weeks or months and there is a tendency for them to recur and become more frequent with age.

How does Manic Depression occur ?

The cause of this condition is not known. Some people think that the underlying illness is depression and that the manic phase is purely a defensive reaction against the depression. Others believe that there is an undiscovered chemical cause for this disorder. Hereditary factors may play a part and it can certainly run in families.

Why does Manic Depression occur ?

It is not clear why the disorder may have been brought on. Sometimes there is an obvious external trigger such as disappointment, or stress at work.

Treatment Involved for Manic Depression

Sometimes admission to hospital is considered necessary. In milder cases, treatment may be started at home. Treatment is mainly in the form of drugs. In the depressive phase, antidepressants are used. The main drugs used here are known as tricyclic antidepressants. Electroconvulsive therapy (ECT) is used occasionally when the depression is very severe and when there has been no response to drugs. In the manic phase, a group of drugs known as the major tranquillizers or neuroleptic drugs are particularly useful. These drugs are often used in the short term to calm the agitated person. Examples of these are chlorpromazine and haloperidol. Lithium (Priadel) is particularly useful in manic depression. This drug appears to lower mood in the manic phase and lessens the frequency and extent of the mood swings. It is therefore more often used to prevent further recurrences.

During Treatment for Manic Depression

Although side-effects are common with antidepressant drugs, they are not usually too troublesome. They consist mainly of drowsiness, blurred vision, dry mouth and constipation. These tend to decrease after a few days of starting the medication. The major tranquillizers can also cause excessive drowsiness and sedation. They can also cause trembling, restlessness and uncontrollable movements. These resemble the symptoms of Parkinson's disease. Sometimes severe muscle spasms or cramps can occur. These particular side-effects can be controlled and prevented by giving anticholinergic drugs at the same time. They reduce the action of a substance in the brain called acetylcholine. The commonest drug used in this group is procyclidine, which may be taken by mouth or by injection. Anticholinergic drugs can cause dryness of the mouth and blurring of vision. Lithium has the potential for side-effects and therefore its dose is usually monitored by regular blood tests to measure the amount of the drug in the blood. If the dose is not carefully maintained, side-effects such as trembling, nausea, diarrhoea, speech difficulties and unsteadiness can occur. Lithium can produce an unusual condition of excessive urination and thirst. It may also affect the function of the thyroid gland, reducing its activity.

If Manic Depression is Left Untreated

Although there is a natural tendency for this condition to get better, the consequences that arise out of the behaviour of the patient may be serious. In the manic phase, it is possible that behaviour may lead to serious financial and marital problems which may be difficult to reverse. Furthermore, there is a potential risk of attempted suicide in the depressive phase. It is therefore recommended that help is sought early.

Effects on Family of Manic Depression

This is a very distressing condition for relatives and friends. The depressive phase can obviously be very worrying and the irrational behaviour in the manic phase can sour relationships, exhaust the family and lead to serious financial concerns. Family and friends have an enormous role to play in the treatment of these sufferers and will need to work closely with the doctors. Sadly, the patient may refuse treatment either in the form of medication or admission to hospital. Tactful advice may be more acceptable from relatives than from a doctor. Sometimes the behaviour of the manic depressive becomes so worrying that compulsory admission to hospital may be required.