Manic Depression
Manic Depression/manic depressive illness, or bipolar affective disorder as it is sometimes know, is a medical term used by psychiatrists to describe a form of mental distress which affects someone's mood and behaviour. It can mean that people affected by it experience mood swings - periods of feeling terribly low and depressed, as well as periods of feeling high and elated. These changes of mood are not like the general ups and downs of everyday life. They are much more extreme and can be distressing and frightening. They can affect how we behave, how we get on with other people and how we manage our lives.
What is Manic Depression?
Manic Depression is a condition which affects both men and women from all walks of life and of all ages, from early adulthood onwards. It can mean that we experience repeated changes in our mood, with periods of elation when we seem to have endless energy, and other periods of depression and despondency when we are barely able to cope with even the simplest tasks. The pattern manic depression follows varies from one person to the next. These spells of highs and lows may occur one after another, or elements of both may be experienced at the same time. Some people find their mood tends to veer more in one direction, so that they are prone to becoming either depressed or manic. A number of people only have one bout or episode of manic depression but the majority do have some recurrence. Often there are long periods of stability between bouts. Equally, the impact that manic depression has on someone's life differs from one person to another. However, the experiences that people describe have a number of common elements.
If we are going through a manic phase and are high we may:
Be excited and elated and find our thoughts racing. We may talk quickly and rather incoherently.
Have boundless energy and come up with all kinds of apparently wonderful schemes and ideas other people view with some scepticism.
Find we need much less sleep than usual or have difficulty sleeping.
Have difficulty concentrating.
Lose our sense of proportion in dealing with other people and handling our day to day business. We may spend money with unusual extravagance and beyond our means. Or we may become much less inhibited in how we behave towards other people.
At the time we will probably not be aware that anything is wrong or that we are acting at all out of the ordinary. Sometimes we may not have such an extreme experience of elation. There is also a milder form - hypomania - which makes people overly active and excited, and possibly irritable and angry. This can lead to a full blown high.
During a low period when we feel depressed we may:
Feel tired and exhausted all the time.
Become irritable and frustrated.
Find ourselves struggling to cope with even the simplest demands upon us.
Be unable to concentrate or make decision of any kind.
Feel overwhelmed by feelings of utter helplessness and despair.
Find our sleep patterns becoming disturbed so that it is hard to get to sleep, or to sleep long enough. Or we may want to sleep all the time.
Our appetite may be affected, making us eat large amounts, or making us lose interest in eating at all.
Understanding Manic Depression
It is difficult to say what precisely causes someone to develop manic depression. A number of different suggestions have been put forward. Some of the possible causes include:
Genetic factors which would mean that a tendency to develop manic depression could be passed on from one generation to the next.
Biochemical imbalances in the body which then influence how we feel and think.
Early chilhood experiences which may have left someone emotionally fragile and vulnerable.
Stressful events or major changes in someone's life, such as the death of a loved one.
Possible hormonal changes - sometimes manic depression occurs in women after childbirth or during the menopause.
Many people now agree that a combination of these factors is probably involved, and that the significance of each varies from person to person. It is also possible to make a distinction between what may have caused someone to develop manic depression in the first place, and what may trigger off a recurrence of symptoms subsequently. For instance, someone's genetic or biochemical make-up may mean that they are particularly susceptible to developing manic depression if they run up against traumatic events in later life.
Medical Treatment
Often a family doctor will refer someone with manic depression to a psychiatrist for expert advice and help. At times some people become very distressed or may be at risk of harming themselves or other people, either because they are extremely depressed and withdrawn, or because they are high and very agitated. Under these sort of circumstances a person may be taken into hospital for assessment and treatment. There are now a number of leaflets outlining your rights and the conditions under which you may be taken into hospital on a doctor's recommendation. For other people this may not be necessary, and medication combined with other forms of support can be sufficient.
The drug most commonly used to treat manic depression is lithium. Many people find it helpful both in reducing symptoms and in preventing a further recurrence of mood swings. It is not a cure however. People taking lithium need to have regular tests to ensure the level of lithium in their blood is sufficient for effective treatment, but does not become excessive. Sometimes lithium can have unpleasant side effects. These may be minor and may not last. Many people decide to put up with the side effects because lithium helps control symptoms. A small number of people react more severly to lithium. If you experience severe nausea, vomiting, confusion, or persistent diarrhoea, you should contact your doctor immediately, as your lithium level may have risen too high.
Carbamazepine is sometimes used in conjunction with lithium, or as an alternative. It helps curb mood swings and has a mild tranquillising effect.
You may be advised to continue taking these drugs even when the symptoms have subsided, as they can help prevent relapse. Other types of drugs which may be prescribed for particular symptoms include antidepressants, major tranquillisers and benzodiazepines. As each person is affected in a particular way by manic depression, the medication that suits best varies from person to person.
It is important that you get your doctor to explain the treatment recommended. You are entitled to information about the likely benefits and disadvantages of each drug prescribed for you. If you are to keep taking medication for some time, it is important that it is reviewed regularly to ensure the dosage continues to be correct and to check for unwanted side effects. You may want to discuss with your doctor what immediate steps you might take if you realise that you are becoming high or low.
Some people may decide that they do not want to coninue on medication in the longer term, perhaps because of the side effects experienced. It is not advisable to suddenly stop taking medication without first consulting your doctor and other advisors about what is best for you. No matter how effective medication proves to be, you may well find other forms of support useful to help you find you feet again.
Counselling and Therapy
It can be valuable to talk things over with someone outside our circle of family and friends. Counselling and therapy are sometimes called "talking treatments" because they give people an opportunity to talk through their difficulties and feelings. Counselling tends to have a practical focus and to concentrate on present day feelings and difficulties. Therapy, of which there are many types, tends to be longer-term and to be more concerned with explaining and coming to terms with past events. In either it is important to find a counsellor or therapist you can relate to and trust, and whose approach seems appropriate to your own situation.
Self Help
A lot can be gained from meeting other people who have experienced manic depression themselves. It can be valuable to find out how others cope with similar sorts of difficulties, and to realise that we are not alone. Self help groups can sometimes be more accepting and welcoming that other people. Members know at first had what we're going through, whereas even those closest to us may be at a loss about how to react towards us. The direct experiences of others in the group can be an important influence on how we learn to adapt to living with manic depression.
What You Can Do
Manic depression can be very distressing. You may feel frightened both by the symptoms and by being told you have manic depression. Or you may find it hard to accept that other people think that there is something wrong, particularly if you are high and feel better than ever before!
Without necessarily being aware of doing so, you may upset and disturb those close to you. They may be left not knowing what to do for the best. You may take important decisions and take actions which later seem misguided and may have unfortunate consequences. Looking back, this can all be extremely bewildering and un-nerving, as your life seems to be out of control. However with help, you can begin to set about putting your life in order again. It is important to remember that if you did anything unwise during a bout of illness, it was because you were ill. Try to talk things over with your professional helpers and those who've been through similar experiences. You may want to make some adjustments to your life so that you are in better position to take more control rather than letting manic depression control you.
What helps may be different for each of us, but here are some general suggestions which other people have found helpful:
Try to seek help early, rather than waiting until you are very distressed or unwell.
Avoid situations which may be stressful, as far as you can.
Learn to recognise the early warning signs which may mean symptoms are likely to come back.
However, try to keep this in proportion, and don't let it rule your life. For example, it is only to be expected that certain situations, such as moving house, will make most people very tense and anxious, and this does not necessarily mean that you are becoming unwell again.
When you are feeling depressed or down:
Take care of yourself, pamper yourself, give yourself small treats.
Try to get enough rest, get into a routine at bedtime to help you unwind.
Do some excercise to help you relax, it needn't be anything strenous, a short walk or a swim.
Try to eat regular meals, if you have no appetite, tell yourself food is medicine, in time your appetite will return.
Take one day or even part of a day at a time, try to pay attention to the good times and good feelings, rare as they might seem just now, the will become more frequent.
Make an effort to keep in touch with people if you can.
Allow yourself time, and the dark spell with gradually pass, but it isn't easy and it isn't quick.
When you feel you're getting high:
See you doctor, your medication may need adjusting.
Remember to take care of yourself, eat and rest regularly, even though you may not feel you need to.
Find ways of using all that energy, perhaps by writing or excercising.
Avoid taking decisions of any importance.
Write down ideas and plans as they come to you, to look at later when your're calmer.
Steer clear of situations that could be difficult - meetings, social events, work situations.
Try to listen to the advice of those close to you. Remember how things went when you were high before.
Family and Friends
Being close to someone who is experiencing manic depression can be emotionally distressing. It can also cause a great deal of disruption and put an enormous strain on family and friends. The person you thought you knew may behaving in unexpected ways which are hard to understand. You may be angry or embarrassed at how you friend or relative is acting. You may feel exhausted at trying to keep up with their apparently boundless energy. You may feel deeply worried or guilty that in some way you have contributed to their feelings of misery.
When you friend or relative is high, he or she may not realise that anything untoward is happening. Your attempts to help and calm them down are likely to be rebuffed in no uncertain terms. When he or she is depressed it can feel as though they are out of your reach.
But there are ways in which you can help the person you care about. It can be important for them to know there is someone there to offer support and encouragement as they try to cope. You can let them know that you are prepared to be there for them when they are depressed or high, even though it can be hard to understand or tolerate their mood. When they are calm you can discuss how you might handle things in the future should they show signs of becoming unwell again.
Try to respect their wishes as far as possible. However, there may be times when you have to seek help whether they consent or not, because of your concern for their well-being. If they are becoming seriously unwell again, you should encourage them to get in touch with their family doctor or other professional helpers. If they fail to do so you should seek help on their behalf.
There are practical ways in which you may be able to help - doing some of the daily chores, encouraging them to keep doctor's appointment or finding out about self-hlep groups in the area. Try not to be overprotective though. Your friend or relative needs to be able to regain control of his or her life when well again. Part of that may mean working out for themselves how much stress they can cope with. Your encouragement and support will be important in helping them rebuild their self-confidence. It will not help in you are overly anxious about the possibility of another spell of depression or a high recurring
Your Needs
It is important that you take care of yourself too. Try not to let the needs of your friend or relative dominate your life. Find an outlet for you feelings, someone to talk to about your concerns. It might be you family doctor, a close friend or a support group for people in situations like your own. Make sure you find time to do the things you enjoy. Take regular breaks if you can manage to, keep up with your friends and interests.
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