BIPOLAR DISORDER OR MANIC DEPRESSION

What is It?

For all intents and purposes, Manic Depression and Bipolar Disorder are the same illness.  In an attempt to standardize Psychiatric language the scientific community changed the name from "Manic Depression" to "Bipolar Disorder." The disease includes 

Depression (as described in the "Mood Disorders" page) accompanied by Manias or Hypomanias ("little" or simply less severe manias).  There may be also episodes called "Mixed States" during which the individual experiences Mania and Depression at the same time.    Therefore, it is typical for a patient with Bipolar Disorder to cycle randomly through states of Depression, Mania, Mixed states, and a "normal" mood.  Very rarely, people with Bipolar Disorder only experience manias. 

 

When there is a Manic flare to Bipolar Disorder, the experience is very different from Depression.  As opposed to Depression, Mania is characterized by a remarkable surge of energy and a subjective sense of things being sped up.  Patients may describe having racing thoughts or feeling "like I have an engine inside of me."  Very often friends or family will observe a noteworthy increase in energy, talking, and the speed of talking.  Sometimes the patient will slur speech in an effort to "keep up with my thoughts."  Speech and actions may jump from one thing to another without a connection that is obvious to the observer.  Friends or families may suspect the patient is "on drugs."   

 

Generally, the need for sleep will be markedly reduced, and patients will describe an inability to "shut off" their  thoughts and ideas.  At first, a cat nap of a few hours may be all the sleep needed to sail through a full day.   This state of high energy despite little sleep can last for days to weeks.  However, patients may become exhausted and desperate for sleep once a mania nears its end.  Unable to "shut down" their thoughts, patients may stumble from sleepless exhaustion until the mania ends. 

 

Often there is an early feeling of profound productivity and creativity.  Multiple tasks or projects will be explored and started at the same time.  Night hours become dedicated to projects or chores such as cleaning, rearranging, or "fixing up" the house.  The patient may fill multiple notebooks with creative writing, start several drawings or paintings, write songs, or learn a new instrument.  

Just as there are characteristic mood states during a Depressive episode, the same is true during Manic episodes.   For the most part, patients describe a very elevated/happy mood  sometimes experienced as a "natural high" or frank euphoria.  If asked to score his or her mood on a 10 point scale, a patient's response is often "11!" However, irritability or impatience are often present as well.  Patients may become upset that others can't "keep up" with their thinking or energy.  There may be anger that others won't validate grandiose  plans or ideas.   Large sums of money may be spent in pursuit of these plans or there may be an excessive generosity.  It is common for patients with Bipolar Disorder to file bankruptcy one or multiple times.

Boundless enthusiasm, boundless energy, boundless confidence, and boundless appetites seem to drive these episodes.  When manic, patients seek change and excitement.  They often engage in uncharacteristic and risky behavior that the individual later will regret.  Patients may take on "dares" recklessly, engage in flagrant sexual experimentation and behavior, embark on impulsive excursions or trips, abuse drugs and alcohol, buy remarkably expensive items (cars, boats, jewelry) or many unneeded items, witness spiritually to strangers, fill notebook after notebook with artistic work, or lapse quickly into confrontational behaviors such as physical altercations, quitting jobs, or walking out on important and fundamental human relationships.

It is not difficult to imagine that individuals suffering from under-treated Bipolar Disorder very frequently divorce, alienate friends and family, abuse drugs and alcohol, have trouble keeping employment, experience civil and criminal difficulties, and experience terrible difficulty reaching their potential for sustained periods of time.  As with depression, there is marked increase in suicidal behavior and suicide.

 

We are About You
Zionsville Psychiatric Medicine