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In Transition

Manic Depression and the New Year

by

Dr. Peter Melgaard Thompson

The new year is upon us and it seems a fitting metaphor for a discussion of Manic Depression, a.k.a. Bipolar illness. One can think of a New Year's party. Parties are fun until there is an excess of libation - then the party can get out of control. With Manic Depression the hypomania or initial stages of a mania are often periods of heightened energy and feeling. However as the mania progresses, thoughts come faster and faster until they make no sense. The grandiose plans become bizarre and thoughts can become psychotic - that is hearing and seeing things that other people cannot. If the energy stayed at a controllable level, then there would be no need of treatment. In fact most people would refuse treatment, saying 'what is the problem?!' They would be right; however in most cases the mania turns destructive. Patients with Bipolar Illness can ruin both their life and their family's. This is usually done by acting out impulsive behaviors such as excessive spending, entering into new relationships that they would not normally enter into, or acting out a variety of agitated irrational behaviors. Manic Depression is usually a life long illness with periods of mania, depression and normal behavior.

Most scientists studying Bipolar Illness agree that this is genetic illness. That is, it runs in families and is passed on though the genes. It has an incidence of about 1%, or 1 out of 100 people in the general population. In families with this genetic problem the incidence is much higher. In identical twins, if one twin has Bipolar Illness, then there is 70% chance that the other identical twin will also have it.

As in Major Depression there are very good treatments, in this case not with antidepressants but with mood stabilizers. The oldest and most studied is lithium. More recently, the anti-seizure medications have been shown to have anti-manic properties. In most cases these medications eliminate manic behavior within two weeks and greatly reduce the possibility of having another mania.

Lithium is a salt, and is usually taken 2-3 times a day. It is generally a safe medication with little long-term side effects. On the short-term side there are many side effects. The most life threatening is overdose or dehydration. This is because high blood levels can be toxic to the heart. Patients on lithium should have their blood levels checked weekly to every other week. The most common side effects are nausea, weight gain, acne, and thirst.

The other group of medicines that are effective in treating mania are the anti-seizure medications. The best studied of this group are carbamazepine (Tegretol) and valproate acid (Depakene or Depakote). These medications seem to work best in patients that cannot tolerate the side effects of lithium or where lithium is ineffective. This group tends to be a subgroup of bipolar patients - the rapid cyclers and dysphoric manics. A rapid cycler is a bipolar patient who goes through four complete cycles a year (manic, depressed and normal mood). The patient with dysphoric mania is characterized by having symptoms of both mania and depression at the same time. As with lithium, weekly or bimonthly monitoring of blood levels are required. The most common side effects are nausea and weight gain.

So what does all this technical information do for you or your loved one who has Bipolar Illness. My intention is to make you aware that there is hope, that this illness is treatable and that the untreated patient can and probably will do much better on treatment than without treatment. There is a very active patient-run organization The Depressive and Manic Depressive Association that can provide more information; check your local listings.