Manic-depression: Alternating moods of abnormal highs (mania) and lows (depression). Called bipolar disorder because of the swings between these opposing poles in mood. A type of depressive disease. Not nearly as prevalent as other forms of depressive disorders. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic recurring condition.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness. Some people with bipolar disorder become suicidal.
Most people with bipolar disorder -- even those with the most severe forms -- can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time. Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available:
- Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
- Anticonvulsant medications, mostly valproate (Depakote), lamotrigine (Lamictal), topiramate (Topamax) or carbamazepine (Tegretol), also are widely used as mood stabilizers. Valproate was FDA-approved in 1995 for treatment of mania.
As an addition to medication, psychosocial treatments -- including certain forms of psychotherapy (or "talk" therapy) -- are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psych education, family therapy, and a newer technique, interpersonal and social rhythm therapy.