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Symptoms of Manic Depression:
Manic Depression is a mood disorder. Usually with its onset in early adolescence, an individual shows marked mood swings into either a manic or depressive phase. According to the Diagnostic and Statistical Manual of Mental Disorders Manic Depression is characterized by one of more manic or mixed episodes". The episodes may start with either mania or depression and is succeeded by the alternate state. The manic phase is characterized by an elevation in mood activity, feelings of confidence, happiness, and of a high capability to undertake nearly any task. According to the Diagnostic and Statistical Manual of Mental Disorders IV "a manic episode is a distinct period of abnormally and persistently expansive or irritable mood". The manic episode is supposed to have at least three of the following characteristics; increased self esteem or grandiosity, decreased need for sleep, talkativeness, racing ideas, distractibility, increased goal directed activity, and/ or psychomotor agitation (Rosenbaum, 1988). The depressive phase, on the other hand, is characterized by extreme sadness. The individual may loose interest in the things that would normally be pleasurable, have feelings of worthlessness, hopelessness, and blame. Further, most studies suggest that "psychotic symptoms are less frequent during the depressive phase than during the manic phase" (Winokur, 1991). The swing form the manic phase to the depressive stage, or vice versa, varies from person to person. For example, some people may experience a strong manic episode followed by a brief depressive one, and others may have short periods of disturbance and long periods of no disturbance. Thus, the popular notion of a pendulum like function in the disorder is an overly simplistic explanation of the actual course of the disorder. To meet the diagnostic criteria for manic depression laid out by the Diagnostic and Statistical Manual of Mental Disorders there has to "have previously been at least one manic episode or moxed episode, the mood symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning".
Causes of Manic Depression:
There has been a debate over the causes of Manic Depression. In discussing the possible causes of Manic Depression the distinction between reactive and endogenous disorders needs to be defined. "Reactive disorders are conditions in which the person seems to be reacting to environmentally precipitated problems. Endogenous disorders seem to be independent of life events and to come from with in the patient" (Encyclopedia of Psychology, Second Edition). Some people view Manic Depression to be a biological illness and others view it as a failure of adaptation to personal and/or interpersonal problems. Others see it as an interaction between the two. Manic Depression has been proven to fit into the endogenous, rather than the reactive pattern. Thus, suggesting a biological cause for this disorder.
Several different kinds of studies have been conducted to support the biological link to Manic depression. Studies have specifically looked at neural transmitter substances found at the nerve synapses when discussing the biological roots of Manic Depression. Insufficiency of specific neurotransmitters such as Norepinephrine and Serotonin has been suggested as a link to Manic Depressive Disorder. "One theory, called the catecholamine hypothesis, believes that increased levels of norepinephrine produce mania while decreased levels produce depression" (Alloy, 1996). This hypothesis is very difficult to test. Thus, the only way to really come to any resolve about this hypothesis it to use research conducted with animals. The hope is that this research will give some information that will tell us something about the process by which mood disorders develop.
Twin studies and family studies are other avenues of research being conducted in search of the cause of Manic Depression. Research has repeatedly supported claims that relatives of manic-depressive patients are significantly more likely to suffer from bipolar mood disorders than are the relatives of non-patients. Claims like this one further the idea that biological causes are at the root of this disorder. Twin studies have been conducted to support this claim. Studies have been done with both monozygotic (identical twins) and dizygotic (fraternal twins). Data shows that "concordance rate from the disease is significantly higher in MZ as compared with DZ twins" (International Encyclopedia of Psychiatry, Psychology, Psychoanalysis, and Neurology). There have been challenges to this finding because it is conceivable that being identical twins increases the liability to psychiatric disorders because identification is stronger between twins. Nonetheless, twin studies are of great value in estimating heretibility of Manic Depression. "A tabulation of all twin studies of affective disorders show that the concordance rate for MZ twins varies between fifty and ninety two percent as compared to zero and thirty eight percent for DZ twins" (International Encyclopedia of Psychiatry). Other studies using twins have aimed to separate the effect of biology and environment to demonstrate the biological roots of Manic Depression. One particular study used twelve pairs of MZ twins who have been reared apart since early childhood. Among these pairs, eight were confirmed with the disease. Another type of study done, with the same goal of separating environment and biology, was an adoption study. In a study using biological and adoptive parents of manic-depressives adoptees a "thirty one percent prevalence of mood disorders in the biological parents of manic depressives, as compared with a two percent in the biological parents of normal adoptees" was cited (Alloy, 1996). These results tend to support the notion of genetic predisposition to Manic Depression is significant regardless of the early environment.
Lastly linkage studies have been conducted to determine if there was a gene that 'controls' the disease. "In a study of fifty nine bipolar probands and their families, almost twice as many female as male probands were found. There was a deficit of ill father/ ill son pairs, but ill mothers has several ill sons" (Winokur, 1991). The idea that father son linkages are rare in Manic-depressive Disorder, suggest a possible X chromosome linkage. There have been many studies that have been conducted to examine this hypothesis. Some of the studies done support the idea and others do not. However, overall the preponderance of evidence is in favor of x linkage, though some researchers still question whether it has been proven beyond a shadow of a doubt.
Although the majority of the literature that is done about Manic Depression does lean in favor of a genetic explanation for this disorder some psychological approaches to understanding Manic Depression do exist. Psychoanalysis, Cognitive theorists, and Learning theorists are some professionals that use psychological approaches to explain Manic Depression. Psychoanalysis, concentrated in early childhood and unconscious motives suggest that depressive individuals are usually dependent and have strongly incorporated values and standards of others into their own personality structures. Therefore failing to form adequate differentiation between the self and others. In addition, Psychoanalysts see mania as "massive denial and reaction formation underlying depression" (Encyclopedia of Psychology, Second Edition). Further, Cognitive theorists have proposed that affective disorders have to do with faulty thinking about self, the world, and the future. The depressed person may over emphasize personal faults and inadequacies, and see the world as an openly hostile place. They, however, do not have an explanation for the manic phase of the disorder. Lastly, Learning theorists suggest that the depressive behavior is "analogous or perhaps identical to the extinction of learned responses" (Encyclopedia of Psychology, Second Edition). Learning theorists deal mostly with reinforcement. Their idea is that when reinforcement is withdrawn the more the depressed person will withdraw them self. Here, as with the Cognitive theorists, again Learning theorists do not propose a cause for the manic phase. At the very least it has been noted that there are psychological consequences that result for having a psychological disorder. For instance, many people have a hard time understanding that it is the disorder that creates their mood swings. They usually think their mood swings are just part of them, and that they cannot be helped. In addition many people do not want to accept that they need to take medication to treat Manic Depression because they do not want to feel anything is wrong with them. Finally, when some people actually agree to take medication to treat their severe mood swings, they may not 'feel like themselves', and may refuse to continue with their prescribed medications. There are approaches that exist that combine a biological and psychological approach to explain both mania and depression. Although most of the evidence supports the idea that Manic Depression has its roots in biological imbalances, it is absolutely necessary to address the psychological difficulties that may exist in conjunction with the disorder.
Treatment:
Treatment for Manic Depression needs to address both these facets, biological and psychological. Treatment depends upon the practitioner’s theoretical approach to understanding a mental illness. The prognosis for patients with mood disorders is surprisingly good. "These disorders have a limited duration and will change even when untreated" (Encyclopedia of Psychology, Second Edition). The most common treatment for patients with mood disorders is drugs. Drugs such as MAO inhibitors and the tricyclic antidepressants have been useful in the treatment of depressive states while lithium carbonate has been the treatment choice in manic states. Monoamine oxidase (MAO) serves to degrade certain neurotransmitters, by using MAO inhibitors and blocking action of it, the deficiency is thought to be corrected. Tricyclics seem to have the same effect as MAO inhibitors. Electroconvulsive therapy is used to relieve the individual of depression. This treatment involves "administering a shock of approximately seventy to one hundred and thirty volts" (Alloy, 1996). Proponents of this kind of therapy claim that when electroconvulsive therapy is used and when proper muscle relaxants have been administered, most patients will show rapid improvement in both mania and depression with few complications. It should not go with out mentioning that there is a strong opposition to this treatment because of the possible dangerous side effects that exist. Psychological approaches suggest that psychotherapy has also been found to be useful for treatment of Manic Depression. Thus, employing other methods of treatment, besides drug therapy, can be quite beneficial. An eclectic approach could be the most beneficial approach because it can address both the biological and psychological aspects of a disorder.
When dealing with an abnormal psychiatric disorder, it is important to keep in mind that we all might have symptoms of a specific disorder, but it is when these symptoms escalate to a level that they interfere with our daily functioning that they become a disorder. Manic Depression is a complex disorder where the causes, the course, and the treatment can all be a variety of things. This disorder is s struggle to live with but it is not untreatable.
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