OVERVIEW
Manic Depressive Illness (MDI) is a common medical condition affecting approximately 6% of the population (Epidemiology).
MDI can cause periods of excitation (Mania) or inhibition (Depression). Both affect emotions (mood), thoughts (cognitive functions), and activity (motor functions).
The Diagnosis of MDI is clinical -- there are no blood tests available for this purpose, and relies on a combination of several factors: Symptoms, Family History, Course of Illness, and Response to Treatment.
Diagnostic criteria have been developed and used to diagnose Bipolar Disorder, a form of MDI.
The most common Symptoms are mood swings, including depression, anxiety, irritability and anger.
-Mood varies from euphoric and grandiose or irritable in Mania to anxious, sad or melancholic during periods of Depression.
-Thoughts are many and quick in mania, few or sluggish in depression.
-Self-esteem changes from self-confidence to worthlessness, demeanor from overconfident to insecure.
-Activity: a manic person is agitated and restlessness, while a depressed person might move slowly or little.
MANIA (UP) EUTHYMIA (NORMAL) DEPRESSION (DOWN)
HIGH/HAPPY/ANGRY NORMAL MOOD FLAT/SAD/BLUE
HIGH SELF-ESTEEM SHAKY SELF-ESTEEM LOW SELF-ESTEEM
QUICK THOUGHTS NORMAL THOUGHTS SLOW THOUGHTS
MANY INTERESTS NORMAL INTEREST LACKS INTEREST
LESS SLEEP NORMAL SLEEP MORE SLEEP
HIGH ENERGY NORMAL ENERGY LOW ENERGY
FAST MOVEMENTS NORMAL MOVEMENTS SLOW MOVEMENTS
Mania and Hypomania are states of emotional, physical and cognitive excitement with increased activity, interest and marked euphoria or irritability depending on the mood.
Manic movements are rapid, effortless, energetic, and sometimes destructive or dangerous. The ideas are flowing easily and distracted by many interests. As Mania accelerates thinking, thought can become crowded, and sometimes disorganized and confused.
In Depression feelings of sadness, lack of interest and low self-esteem accompany a slowing down of motor and cognitive activity. The movements are few, slow and the product of effort. The mind often ruminates over past events, mostly in guilt or sorrow. There is a feeling of lack of wellbeing, or dis-ease.
Mixed States are the result of overlapping or coexisting symptoms of Depression and Mania. In the course of a Mixed State, depressed mood and negative thinking can be present, along with motor agitation, and at times restlessness and aggressive behavior.
Psychosis can be present during episodes of both Mania and Depression, often leading to Misdiagnosis. The Differential Diagnosis from conditions that can mimic Mania and/or Depression is extremely important in order to provide appropriate treatment.
MDI can Onset at an early age, in childhood, adolescence or early adulthood. It can remain silent until late in life until a medical or neurological illness might precipitate an episode of illness in someone with the genetic vulnerability. The study of predisposing or premorbid Temperament has revealed the importance of baseline conditions on the development and evolution of this illness.
The cause(s) of MDI remain unknown. As MDI patients usually have a positive Family History: a genetic or hereditary predisposition is considered likely. The role of biological and environmental factors in the development and course of MDI has been suggested by many observations but remains unclear.
Comorbidity is the presence of two disorders at the same time yet independent from one another. The most common comorbid diagnosis occurring in patients with MDI are Alcohol/Substance Abuse and Anxiety Disorders. Less common are eating disorders and impulse dyscontrol disorders.
Many patients with MDI attempt to self-medicate, mostly with mood altering drugs, either legal (i.e., alcohol, tobacco and caffeine) or illegal (i.e., hashish, marijuana, amphetamines, cocaine, opiates, ecstasy). Patients with MDI are often diagnosed with other disorders, a phenomenon called comorbidity.
Precipitants and life-events can have a very profound effect on a sensitive person like the person with MDI. It is not uncommon to see a life event, including losses, emotionally charged events, alcohol or substance abuse be in close temporal relationship to an episode.
Several Forms or subtypes of MDI can be defined based on symptoms and on the course over time of clinical manifestations.
MDI is a chronic illness and follows a recurrent Course. Phases of illness (episodes) can switch from one to the other or be separated by symptom-free intervals. Over 90% of those that experience an episode of mania experience a recurrence of either mania or depression.
MDI can cause major disruptions in one’s life involving family, social and occupational (Quality of life).
-Outcome measures or estimates of the impact of MDI on an individual’s life have differentiated between symptomatic and functional outcome.
-The presence of symptoms and their severity has a profound impact on their life (symptomatic outcome). Outcome studies show major impairment of a person’s ability to function (functional outcome) even when the symptoms have remitted.
MDI causes significant disability and mortality, and is a leading cause of Suicide.
The Cost to society has been estimated at $ 45 billion/year in the US alone (1994 estimate).
MDI can remain in remission -- spontaneous or due to treatment, or follow a severe course with brief or no intervals.
The Treatment of MDI can require hospitalization or intensive outpatient treatment during acute phases of illness. Treatments used in MDI include medications, psychotherapy and changes of lifestyle. If stabilization is achieved, maintenance treatment can be effective in preventing recurrences, and often result in prolonged remission of symptoms.
Obtaining and maintaining remission often requires careful management of medications and through psychotherapy, the development of ways to reduce the impact of life events or residual mood swings on a person’s life.