Depression - Bipolar Disorder

Depression is not a product of modern times, as is sometimes believed; the condition that goes by the name of depression today was known in the times of Hippocrates as well as the Old Testament and was a cause of worry for the ancient Egyptian medical community as well. In the absence of modern medical techniques, it was described as despondency, or melancholy and was believed to be caused by an imbalance in the so-called 'humors' of the body, which determined the individual's temperament and state of mind.

Depression occurs in various forms, the classification depending on the causes, intensity and duration of the condition. The main categories of commonly seen depressive condition are major depression, dysthymic or moderate disorder, unspecified depression and adjustment disorder. However, there is one form of depression that is very different from these conditions - bipolar disorder. This condition is unlike other kinds of depression because it is characterized by abnormal changes in a person's mood, energy levels and functioning pattern. It is also known as manic-depressive illness. While other categories of depression may stem from a variety if causes, bipolar disorder is generally attributed to genetic reasons. This condition often starts in childhood or adolescence and continues through life; hence, it is termed a chronic illness that, like diabetes or cardiac disease, needs long-term management.

The symptoms of bipolar disorder are drastic and severe mood swings, from very energetic, optimistic and enthusiastic to inactive, despondent and hopeless. These phases are called alternating episodes of mania and depression. A 'manic' episode is characterized by vigorous mental and physical activity, abnormally elevated mood and energy level, sleeplessness and distractibility. The afflicted person experiences extraordinary feelings of power, capability, euphoria and optimism and indulges in aggressive behavior; in fact, it appears as if the personality of the patient has undergone a change. This episode, which is also known as hypomania, may last for a week, to be succeeded by the 'depression' episode, during which the affected person feels helpless, dejected and worthless and is assailed by feelings of failure and self-doubt. This phase often triggers suicidal tendencies and many patients turn self-destructive.

Bipolar disorder obviously imposes a very severe strain on the patient's relationships with family, friends and colleagues; in many cases this manic depression results in loss of education or job, drug abuse, divorce and fractured family relationships. The problem with bipolar disorder is that it takes time to be diagnosed, because people tend to regard these behavioral abnormalities as psychological and temperamental, whereas they are actually manifestations of a biological problem. Any form of depression is caused by physical changes in the brain connected with imbalances in the chemicals called neurotransmitters that carry signals in the brain. Many patients enjoy the manic high episode and refuse to believe that they are suffering from any disorder and consequently refuse treatment. Delayed recognition of the condition is the biggest impediment in the treatment of bipolar disorder.

Effective treatment avenues are available for bipolar disorder; a combination of drug therapy and counseling is normally used to address the condition. The most commonly used drug is lithium, taken together with mood stabilizing anticonvulsants such as carbamazepine and valproate; however, the patient needs substantial counseling and family support to cope with the disease. Bipolar disorder is a life-long disease and needs continued therapy to control and prevent the recurrence of the manic depression episodes. In the United States, where about three million people suffer from the disorder, mutual self-help groups sponsored by the National Depressive and Manic Depressive Association (NDMDA) and National Alliance for the Mentally Ill (NAMI) extend valuable support to patients and their families.