Depression

I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless . . . [I am] haunt[ed] . . . with the total, the desperate hopelessness of it all . . . Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?

Hypomania

At first when I'm high, it's tremendous . . . ideas are fast . . .like shooting stars you follow until brighter ones appear . . .all shyness disappears, the right words and gestures are suddenly there . . .uninteresting people, things, become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria . . . you can do anything . . . but, somewhere this changes.

Mania

The fast ideas become too fast and there are far too many . . .
overwhelming confusion replaces clarity . . . you stop keeping up with it--memory goes. Infectious humor ceases to amuse. Your friends become frightened . . . everything is now against the grain . . . you are irritable, angry, frightened, uncontrollable and trapped.

Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment and suicide.

Manic-depressive illness is often not recognized by the patient, relatives, friends or even physicians.

• An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability and impulsive or reckless behavior.

• Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.

• In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.

• If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.

Most people with manic-depressive illness can be helped with treatment.

• Almost all people with bipolar disorder--even those with the most severe forms-can obtain substantial stabilization of their mood swings.

• One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.

• Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.

• Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.

• Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.

• Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania.

• The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia.

• Thyroid augmentation may also be of value.

• For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine or valproate.

• Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.

• As an adjunct to medications, psychotherapy is often helpful in providing support, education and guidance to the patient and his or her family.

• Constructing a life chart of mood symptoms, medications and life events may help the health care professional to treat the illness optimally.

• Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.

Disease Information Sources: The National Institute of Mental Health (NIMH) and The University Hospital Psychiatric Services.