Manic Depression: Symptoms, Causes, and Treatments

Manic depression: this concept, hardly used today, refers to one of the most common mood disorders and acquaintances after the depression.

It is one of the old names that is currently known as Bipolar disorder. Although for some this name may have even romantic connotations, the truth is that it is a disorder that generates high suffering and that can cause serious alterations in the daily life of those who suffer it, being essential its treatment.

In this article we will see what is manic depression, what causes are attributed to it and some of the main treatments applied.

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What is manic depression?

Manic depression, manic-depressive psychosis, or bipolar disorder. These different denominations have arisen in different historical contexts in which they also prevailed different orientations and currents of thought, although in practice they refer to the same disorder.

Specifically, in all cases, reference is being made to a mental disorder categorized within the mood disorders and characterized by the presence of one or more episodes of mania and / or hypomania

alternating or absent depressive episodes.

Thus, in this disorder the mood can go from an episode of maximum exaltation and increased activity and energy to a state of deep sadness, hopelessness and passivity. This fluctuation can occur followed or separated by an asymptomatic period, and the passage from one pole to the other can occur in short periods of time.

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Types of bipolar disorder or manic depression

There are two basic types of bipolar disorder: in type 1 there is at least one manic or mixed episode, which can be preceded or followed by a major depressive episode. However, the latter is not essential for the diagnosis. With regard to type 2 bipolar disorder, the presence of one or more episodes is required for its diagnosis major depressive symptoms together with at least one hypomanic episode, without in any case a manic episode or mixed.

An expansive mood appears in manic episodes, euphoric or even irritable in which there is a high level of agitation and activity for most of the day for at least a week. In this state, a feeling of grandiosity usually appears (which can lead to delirium), logorrhea, a flight of ideas or a feeling that the thread of thinking, tachypsychia, distraction, disinhibition, aggressiveness, hallucinations and a tendency to risk and not assess the consequences of one's own acts. Hypomanic symptoms are similar, but they are not as severe, symptoms such as hallucinations and delusions cannot occur, and they last for at least four days.

In depressive episodes there is a low mood and / or loss of interest and the ability to feel pleasure along with other symptoms such as hopelessness, lack of energy and passivity, eating and sleeping disturbances, fatigue, or thoughts of death or suicide for at least two weeks.

Effects of symptoms

The aforementioned symptoms, whether or not manic and depressive episodes alternate, generate a large number of repercussions on the subject that can alter and limit a great variety of elements and domains vital.

At an academic and occupational level, the existence of episodes can affect the ability to develop and follow plans, decrease performance or generate conflictive or unproductive behaviors, as well as decrease the concentration capacity of the subject. It is also possible that you have difficulties when assessing aspects such as the value and use of money due to the extreme impulsiveness that can occur.

The social sphere can also be affected. In the manic phase the subject may show an uninhibited sexuality and / or be irritable and even aggressive, present delusions of grandeur and antisocial behaviors, as well as in depressive phases you may lose interest in socializing.

In any case, one of the aspects with which the greatest care must be taken is with the possibility of suicide. In fact, manic depression is one of the mental disorders in which there is a greater risk of suicide.

• Related article: "Suicidal thoughts: causes, symptoms and therapy"

Possible causes

Although the origin of manic depression is not entirely clear, the proposed explanations generally start from factors of biological origin very similar to those of depression. The existence of imbalances in the synthesis and reuptake of neurotransmitters.

Specifically, it has been observed that norepinephrine levels decrease during depressive episodes and increase in manic ones. The same is true for dopamine. With regard to serotonin, it is found in lower proportions than usual in both types of episodes.

Structures such as amygdala are altered, and hypoperfusion is also observed in different brain areas in the different types episodes (less blood reaches the frontotemporal in mania and the left prefrontal in depression). Likewise, it has been proposed that bipolar or manic-depressive symptoms may be related to problems in the transport of the nerve signal.

The environment also participates in its genesis, destabilizing the stressful events the biological rhythm. In addition, the existence and influence of cognitive distortions that generate dysfunctional schemas. The cognitive triad of thoughts about oneself, the world and one's future would oscillate between depressive negative thoughts and expansive and glorified ones.

Treatments

Treatment of manic depression or bipolar disorder requires a multidisciplinary approach. The main goal of treatment is to keep your mood stable. For it at the pharmacological level mood stabilizers are used, the main one being lithium salts. This substance has a poorly known but generally highly effective mechanism of action, based on its modulation of synaptic transmission. Once the subject has stabilized, it is necessary to establish a maintenance dose to prevent further attacks.

However drug treatment can lead to bothersome side effects. It is therefore necessary to apply strategies such as psychoeducation in order to promote adherence. You can also teach self-assessment strategies for the condition and symptoms that can warn of the arrival of a crisis and prevent it from occurring.

Working with the environment is also essential, so that the relatives of the affected person know the reason for certain attitudes and behaviors, relational problems are resolved and can contribute to helping the affected person and that they know how to identify possible symptom. The subject with manic depression can benefit from other psychological treatments used in depression, like Beck's cognitive therapy.

Likewise, there is interpersonal and social rhythm therapy as a treatment based on regulation of biorhythms and personal relationships that may be helpful for subjects with this disorder.

In some especially severe cases, and especially in cases where there are severe manic symptoms, psychotic symptoms or imminent suicide risk, electroconvulsive therapy has been applied successfully (which is currently applied in a controlled way, with sedation and monitoring).

• Related article: "Aaron Beck's Cognitive Therapy"

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Belloch, Sandín and Ramos (2008). Manual of Psychopathology. McGraw-Hill. Madrid.

• Santos, J.L.; García, L.I.; Calderón, M.A.; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Roman, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE PIR Preparation Manual, 02. CEDE. Madrid.

• Welch, C.A. (2016). Electroconvulsive therapy. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier