Manic Depression
(Bipolar Disorder)

Manic depression, also known as bipolar disorder, is an affective (or mood) disorder characterized by periodic episodes of extreme elation, elevated mood or irritability (the manic part of the disorder) that is opposed by periodic depressive symptoms. The presence of mania distinguishes bipolar disorder from major depression (clinical depression) and dysthymic disorder (dysthymia). Depression is often the initial diagnosis, and the correct diagnosis is not made until a manic episode occurs and is reported.
Causes of Manic Depression
Manic depression affects nearly six million American adults age 18 and older in a given year, according to the National Institute of Mental Health . When symptoms are present before the age of 12, they are often confused with attention-deficit/hyperactivity disorder (ADHD), which is usually characterized by serious and persistent difficulties resulting in inattentiveness or distractibility, impulsivity and hyperactivity.
Manic depression affects men and women equally, although women are more likely than men to experience more depressive and fewer manic symptoms. The disease often begins in adolescence or early adulthood; in fact, the average age for a first manic episode is during the early 20s. Manic depression is likely to run in families and, in some cases, is thought to be hereditary.

Symptoms of Manic Depression
The symptoms of manic depression vary in affected persons, including a different proportion of manic and depressive symptoms. The symptoms of manic depression may resemble those of other psychiatric conditions.
Manic Symptoms 
  • Overly inflated self-esteem
  • Decreased need for rest and sleep
  • Distractibility and irritability
  • Physical agitation
  • Excessive involvement in pleasurable activities that may result in painful consequences (including provocative, aggressive or destructive behavior)
  • Talkativeness
  • Excessive "high" or euphoric feelings
  • Increased sex drive
  • Increased energy level
  • Uncharacteristically poor judgment
  • Denial of manic symptoms

Depressive Symptoms
  • Persistent sadness, anxiety or empty mood
  • Loss of interest in activities once previously enjoyed
  • Excessive crying
  • Restlessness and irritability
  • Decreased ability to concentrate and make decisions
  • Decreased energy
  • Thoughts of death or suicide, or suicide attempts
  • Feelings of guilt, helplessness and/or hopelessness
  • Changes in weight and/or appetite
  • Changes in sleep patterns
  • Social withdrawal
  • Physical symptoms, such as chronic pain or headache, unrelieved by standard treatment

The proportion and intensity of symptoms vary considerably, depending on the severity of the disorder.
Diagnosing Manic Depression
Your doctor will perform a thorough physical exam, obtain a medical and social history and conduct a careful psychiatric examination to diagnose manic depression. You must exhibit both depressive and manic symptoms for a diagnosis of manic depression to be made. Manic depression often co-exists with other medical conditions, and with other psychiatric disorders, such as substance abuse or anxiety disorders.

Treating Manic Depression
Seeking early diagnosis and treatment for bipolar disorder is crucial to recovery because the treatment is different from that of depression alone.
Specific treatment for bipolar disorder will be determined by your individual circumstances:
  • Your age, overall health and medical history
  • The severity and extent of your disease
  • Your tolerance for specific medications, procedures or therapies
  • Your expectations for the course of the disorder
  • Your opinion or preference

Your treatment for manic depression may vary depending on the factors listed above, but will include one or more of the following:
  • Medication (mood stabilizers, anticonvulsants, antidepressants)
  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy that is focused on changing how you view yourself and your environment, working through difficult relationships and identifying stressors and learning how to avoid them)
  • Electroconvulsive therapy (ECT)

The psychiatric specialists at Houston Methodist are highly skilled in recognizing the varied and extreme mood swings associated with manic depression, which is crucial to determining effective treatment and avoiding the potentially painful consequences of the manic behavior. In most cases, long-term preventive treatment is necessary to stabilize the mood swings associated with manic depression.