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Manic Depression Defined
Manic depression is a mood disorder that occurs as a result of biological changes in mood. The effect on mood is much more severe, longer lasting and more disruptive than ordinary moods. The experience of manic depression, or bipolar disorder as it is now classified, can vary according to the severity of symptoms, their frequency and the disruption this has to the lives of those affected.
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Diagnosing Manic Depression Symptoms
The diagnostic trends relating to manic depression vary somewhat. Manic depression is a difficult condition to identify and it is estimated that, on average, diagnosis takes around 12 years. Earlier anxieties about under-diagnosis has resulted in more recent concerns that doctors may be over-sensitized to missing manic depression symptoms and are now over-diagnosing.
There are no blood tests, scans or examinations that can help to identify manic depression. Diagnosis relies entirely on descriptions and observations of past and current symptoms and how these match criteria for diagnosis. Although manic depression symptoms normally appear during adolescence or the early twenties, they can also occur in childhood. For a diagnosis of bipolar disorder (manic depression) to be made, at least one episode of mania or hypomania, or a mixed episode, must have been experienced. It is however the experience of depression that is most common.
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Manic Depression Symptoms
Depression is diagnosed if five or more specific symptoms are present. Those symptoms must include a depressed mood in which intense sadness, emptiness and/or irritability are present, or, a general loss of interest or pleasure which lasts nearly all day for most days. Other symptoms may include:
- Restlessness or lethargy.
- Changes in diet.
- Sleep problems.
- Feelings of guilt or worthlessness.
- Poor concentration.
- Thoughts about suicide and death.
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Symptoms of Mania
Most people think of mania as something involving excessive or ‘wacky’ behavior. This may sometimes be the case but more commonly the symptoms involve an excessively happy or expansive mood. In other cases excessive irritation may be more common. For a diagnosis of mania to be made at least three of the following symptoms must be present (four if the mood is irritable):
- Racing thoughts.
- Pressure of speech.
- Easily distracted.
- Marked increase in self-esteem.
- Restlessness or agitation.
- Pleasure over consequences (spending sprees, gambling, high sex drive).
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Symptoms of Hypomania
The prefix ‘hypo’ means low or less than. Therefore the symptoms of hypomania are similar to those of mania but milder or briefer. Although behavior may be obvious enough to be noticed it is far less disruptive than mania and the chances are that the person is able to carry out normal daily activities.
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Mixed Episode Symptoms
Mixed episodes sound like a contradiction in terms. How can someone be depressed and manic at the same time? In fact mixed episodes take two forms. The first is simultaneous symptoms of mania and depression. For example, symptoms of depression may be accompanied by racing thoughts and a reduced need for sleep. The second form involves a rapid switching between symptoms of depression and then mania (happy, sad, irritable).
People with mixed states are more at risk of developing psychotic symptoms such as hearing voices or having paranoid thoughts.
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American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, Washington DC, American Psychiatric Association.
Goodwin, F & Redfield Jamison, K (2007) Manic-depressive illness, New York, Oxford University Press.