Most people do not know what I am talking about when I tell them I have Bipolar Disorder. When I tell them its the clinical name for manic-depression they usually get a shocked look on their face and no telling what will come out of their mouth. I get a wide variety of reactions. Most people don't really understand what the illness really is. All they know is the wild and crazy stories that they have heard. There is an ugly stigma place on manic-depressive illness. Living with this stigma isn't easy. I am putting this section on this site to try and enlighten people to what manic-depression really is. If you have any questions or comments after reading these next two pages, don't hesitate to email me. At the bottom of this page you will see a "Next' button. Click on it to read my own story of living with manic-depressive illness.

There are different types of manic-depression. I am going to discuss three of them. Bipolar I is the rarest the most talked about, Bipolar II is the most common and Rapid Cycling Bipolar II is the type I have. All three have one thing in common, moods that swing between the two poles of mania and depression. The differences are in degree and how often. Bipolar I is characterized by major depression and full blown manias which can become psychotic. Bipolar II consists of major depression and a milder form of mania known as hypomania. Rapid cycling is a rare subtype of manic-depression that is mostly experienced by Bipolar II patients. Aproximately eight to ten percent are rapid cyclers. All forms can experience mixed states but are most common in the rapid cycler.

Mania

Mania is a a feeling of elation or euphoria. Hypomania (mild mania) is characterized by rapid thoughts and speech. You can understand what a hypomanic person is saying but he may talk so much that you get tired just listening. The hypomanic person has a lot of energy and can get a lot done in a very short period of time. She can function on very little sleep. Many are very creative during this time. Hospitalization is rarely needed for mild mania because the person does have some self control and typically isn't a danger to self or anyone else. Hypomanic people don't seek help because they feel great. If I could bottle it and sell it I would make a fortune. A lot of people envy my hypomanic states. That is until they see the heavy price I pay for it. Depression always follows a mania. You can't have one without the other. In order to get the depression under control you have to give up the mild mania.
Full blown mania is dangerous and requires hospitalization. People experiencing full blown mania have all the same symtoms as hypomanics but its intensified to the point of terror. When untreated the persons behavior is out of control. They feel invincable and believe they can do anything. There is boundless mental, physical and sexual energy. The mind races from thought to thought. It is difficult to keep up with what the manic is saying. His speech is rapid and he moves from subject to subject. There is little need for sleep. A manic can sleep for three hours and feel fully rested. The boundless energy and the euphoria leads the person to believe he can conquer the world. This leads many into wild and destructive behavior. Judgement is poor and the person can not think far enough ahead to consider there will be consequences for his behavior. It is common for manics to go on shopping sprees and run up thousands of dollars worth of credit card bills. The sexual energy leads to dangerous sexual activity. The manic has no self control.
He may become irritable, agitated and argumentative. He might lose touch with reality and become delusional. Many experience audio and visual hallucinations. It is common for one in a full blown mania to believe he is sent on a special mission by God or to become paranoid and believe he is being watched by the FBI. The manic becomes a danger to himself and others. Eventually the manic episode will run its course. A depression follows the mania completing the manic-depressive cycle. The depressions are debilitating and are compounded by the damage done by the person while manic.

Depression

Everyone gets down or has a case of the blues from time to time. Its a normal reaction to life's difficulties and losses. The average person can pull out of these sad blue days and continue on in a normal fashion. People who suffer from major depression cannot 'snap out of it' or 'pull themselves up by their bootstraps'. Major depression is an illness that effects one's mood, thoughts, feelings, behavior and all over physical well-being for long periods of time. According to the American Medical Association, depression is the most debilitating of all chronic illnesses.
People who are depressed often describe what they are feeling as sad, hopeless, empty, anxious and dark. There is a constant feeling of dread or impending doom. The depressed person tends to isolate from others due to the inability to communicate thoughts or feelings. Depressed people feel detached from the world around them.
Robert Burton in his 1621 "Anatomy of Melancholy" paints a clear picture of the depressed mind when he states "They are in great pain and horror of mind, distraction of soul, restless, full of continual tears, cares, torment, anxieties, they can neither drink, eat nor sleep......".
Sadness is a normal reaction to lifes disappointments. It becomes abnormal when it interupts one's ability to function in a normal capacity for a period of two weeks or more. Depression causes both psychological and physical disturbances. Psychologically the depressed person has symptoms of apathy, constant feelings of worthlessness and hopelessness. The overall feeling of hopelessness is the main factor in suicidal thoughts that, for some, lead to death. In extreme cases the depressed person may exhibit psychotic symptoms.
The physical symptoms of depression are equally disabling. Disturbances in sleep, appetite, weight, energy, and psychomotor activity combined with the psychological symptoms leaves a person totally unable to live life as a functional human being.

There is no cure for manic depression or any other mood disorder. These disorders tend to run in families so it is believed that they are hereditary biological illnesses. Even though there is no known cure, mood disorders can be treated and many are able to live a normal life. Treatment includes drug therapy, psychotherapy and sometimes light therapy. In extreme cases electroconvulsive therapy (ECT) may be used. Anti-depressant medications such as Tricyclics (TCA's), Monoamine oxidase inhibitors (MAOIs), Selective Serotonin Reuptake Inhibitors (SSRIs)and a few that do not fit into any of these categories can be used. Bipolar I is the easiest form of manic-depression to treat. Lithium, anti-depressants and sometimes anti-psychotic meds are used to treat Bipolar I Disorder.

Bipolar I and Bipolar II both have periods of depression and mania. Both suffer from debilitating major depression. What seperates these two groups is the type of mania they experience. People who are Bipolar II do not have full blown manias with psychotic features. They have the milder more controlled hypomania. Most people who are manic-depressive are Bipolar II.
It is hard to convince the Bipolar II person to take medication to curb the hypomania. Its hard to give up those fantastic, productive and creative highs. Most are very willing to get help once the depression hits, and it always hits. In my case, this is compounded by the fact that I am a rapid cycler and prone to mixed states

Rapid Cycling

Rapid cyclers are the most difficult cases to treat. With other manic-depressives the mood swings tend to be well defined. They are more predictable in duration and experience two to four episodes a year. Rapid cyclers moods can go from depressed to manic and back again in a matter of a couple of weeks, days or even hours. Where the typical bipolar person may experience two or four cycles in a year, a rapid cycler can cycle that many times in a day. The rapid cycler doesn't know what to expect from one hour to the next. In my case, cycles will start off in a depression for about ten days. I will then swing into a hypomania for about the same length of time. One always follows the other. The higher the mania the deeper I will sink into depression when I crash. As the cycles continue they get closer together. I will begin going from one end to another within a week, then within a couple of days and then within hours. Once the cycles start moving quickly I experience mixed states. That is when the the mania and the depression crash into one another. I have the worst symptoms of both extremes. A typical mixed state for me is a deep depression accompanied with the racing thoughts, agitation, anxiety and mental confusion. It is a relentless hell. I feel like I am trapped in my own mind and am going to come out of my skin at any minute. It is difficult to describe the torment of a mixed state. One has to experience it to know the horror of it. Rapid cylers are difficult to treat because they do not stay in a depression or a mania long enough for doctors to be able to treat them. Anti-depressant medications tend to kick off manias. Rapid cylers have had poor results with lithium. Hospitalization is often neccessary to bring the cycles under control. Rapid cyclers have had some good results with anti-convulsant medications such as Tegretol and Depakote. Prozac and Depakote have proven to be the winning combination for me.

Diagnostic Criteria

The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) by the American Psychiatric Association use the following guidelines to diagnose a manic episode:

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary). The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  • inflated self-esteem or grandiosity; unrealistic belief in ones abilities or powers
  • decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • more talkative than usual or pressure to keep talking
  • flight of ideas or subjective experience that thoughts are racing
  • distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
  • increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The Diagnostic and Statistical Manual, 4th edition (DSM-IV) by the American Psychiatric Association, lists the following symptoms for diagnosing major depression.

At least five of the following symptoms have been present during the same 2 week depressed period.

  • Abnormal depressed mood (or irritable mood if a child or adolescent)
  • Abnormal loss of all interest and pleasure
  • Appetite or weight disturbance, either: Abnormal weight loss (when not dieting) or decrease in appetite.
    Abnormal weight gain or increase in appetite.
  • Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
  • Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).
  • Abnormal fatigue or loss of energy.
  • Abnormal self-reproach or inappropriate guilt.
  • Abnormal poor concentration or indecisiveness.
  • Abnormal morbid thoughts of death (not just fear of dying) or suicide.

There are many treatments available today for people suffering from mood disorders. There is no reason to suffer. It may take awhile to find the right combination but its well worth it once the right treatment plan is found. If you or a loved one is suffering from this awful illness, please seek help. You CAN get your life back



 



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