A normal person has moods that shift from moderate liveliness to moderate lethargy, depending largely on circumstances. A person who has the disorder called manic depression has extreme moods that are not related to external events. Manic depressive illness tends to be cyclical, with periods of elated over activity (mania) irregularly alternating with deep depression . Periods of normality, sandwiched between the extremes, may last a short time or years. Extreme stress may trigger off a sudden attack of mania or depression, particularly in people who seldom have acute attacks. Often, however, there is no direct cause, and phases of the illness begin gradually. Very rarely manic depression is caused by a severe infection, a stroke , or a brain injury.

What are The Symptoms?

Close associates of a person with this disorder are likely to be first to recognize the beginning of the manic phase, which starts gradually with hypomania, a moderate degree of mania. People in this phase begin to wake up earlier and earlier in the morning, until they find themselves leaping out of bed before sunrise. At the same time, their work output often falls because they are easily distracted and increasingly restless. They may be promiscuous sexually, go on spending sprees, and enthusiastically start (but rarely finish) new projects. They are often irritable, and may have sudden attacks of rage.

Hypomania seldom reaches a fully manic stage. If it does, total elation may result in wilder speech, full of rhyming, punning, and illogical word associations. Some people sing and dance or laugh uproariously for no reason. At times an underlying sadness may break through in fleeting moments of withdrawal. Because they lack concentration, manic people often forget to eat, so they tend to lose weight and become exhausted. Eventually, they may have delusions of grandeur or intense anger at their inability to carry out wild schemes.

The depressive phase is like depression, but the symptoms are often more severe. The onset is gradual. The person becomes increasingly withdrawn. Sleep is frequently disturbed. Although there may be early morning wakefulness, late rising becomes habitual. Sex drive decreases, speech and movement slow down, and imagined problems multiply. Some manic depressives become unable to face the world, and simply stay in their rooms.

What are The Risks?

Manic depressive illness is rarer than depression. It is thought to occur in about three per cent of the population. It tends to run in families, and men and women are equally susceptible to it.

Although someone with this disorder may threaten suicide during depressions, he or she usually lacks the energy to carry it through. The danger increases with emergence from deep depression, when renewed energy may accompany a continuing death-wish. In the manic phase, outrageous behavior may ruin social and professional relationships, and lack of judgment can become serious enough to lead to financial disaster.

What Should be Done?

If you suspect someone you are close to is manic depressive, persuade him or her to see a physician. If necessary, ask your own doctor for advice. If you think that you yourself may be becoming manic depressive, see your physician without delay. The illness is easier to treat effectively in its early stages.

What is The Treatment?

After a diagnosis is made, in mild cases it is often possible for medications to be taken at home. Your physician may also refer you to a specialist for psychotherapy. In severe cases, especially when there is a risk of suicide or if irrational behavior gets out of hand, treatment in a hospital is usually necessary.

Drugs that alter brain chemistry are now generally used for manic depressives. Because of possible side effects, however, the person must have blood, kidney and thyroid gland tests before some of these drugs can be prescribed. Electroshock therapy (EST) may also be recommended.

As the treatment in the hospital begins to show results, occupational therapy is added to the treatment to prepare the person for a return to normal life. If somebody in your family has been in the hospital for this disorder, you will probably be told both how to recognize signs of an impending attack and how to reduce the strains on the patient and lessen the risk of further attacks. After release from the hospital, many manic depressives must continue to take drugs. They may need to have monthly checkups to guard against potentially harmful side effects of this drug regime.

What are The Long-Term Prospects?

Not long ago most people who had one episode of manic depressive illness could expect to have further attacks, which might become increasingly severe. However, this gloomy outlook can now often be brightened by long-term drug treatment.