Though less common than major depression, bi-polar depression maintains a high profile because of the many creative artists who have suffered from it. They include; Edgar Allen Poe, Tennessee Williams, Ezra Pound, Virginia Woolfe, Vincent Van Gogh, Alfred Tennyson, Cole Porter and Robert Schumann. In recent times, celebrities such as Abbie Hoffman, columnist Art Buchwald, actress Patty Duke, actress Margot Kidder, writer Peter McWilliams, and CNN’s Ted Turner have also been similarly afflicted. The Bipolar Lifetime Mania Scale is the same test as that undertaken by entertainer Stephen Fry last year when he came to Cardiff to film a BBC documentary about his own bipolar disorder. The test measures an individual’s place on the spectrum of manic behavior. At one end are those who have severe and frequent manic episodes and the other are those who have only mild and infrequent periods of elevated mood. Please feel free to measure your potential level of risk via a questionnaire developed by the Cardiff University School of Medicine http://www.cardiff.ac.uk/medicine/bipolar/
Manic depression has two distinct sides-the depressive state and the manic state. Mania is a seemingly heavenly state of mind in which all the world is beautiful and everything seems possible. Here are some of the most common characteristics of mania:
• little need for sleep
• little need for food
• inflated self concept
• grandiose schemes
• unrealistic thinking
• poor judgment
• loss of inhibition
• delusional thinking
• increased sexual activity
• spending large amounts of money
• socially inappropriate behavior
• heightened sense of awareness
• flight of ideas
• pressured speech
• tremendous energy
• enhanced creativity
• feeling that nothing can go wrong
• outbursts of anger
• alcohol and drug abuse
When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars and you follow them until you find better and brighter ones. Shyness goes. The right words and gestures are suddenly there, the power to captivate others is a felt certainty. Feelings of ease, intensity, power, well-being, financial omnipotence and euphoria pervade one’s marrow.
Upon hearing this description of mania, people often respond, “If this is a disease, where do I sign up for it?” The problem with mania, however, is that due to the impulsivity and poor judgment that it brings, an episode can wreak havoc on family, friends, the community and the law. Moreover, when the high inevitably wears off, the individual comes crashing down into a state of total darkness and despair. As Jamison describes: A floridly psychotic mania was followed, inevitably, by a long and lacerating black, suicidal depression. Everything -every thought, word and movement-was an effort. Everything that once was sparkling now was flat. I seemed to myself to be dull, boring, inadequate, thick brained, unlit, unresponsive, chill skinned, bloodless, and sparrow drab. I doubted, completely, my ability to do anything well. It seemed as though my mind had slowed down and burned out to the point of being totally useless.
A well-known myth that perfectly describes the manic depressive’s fall from grace is the myth of Icarus. Icarus, son of the Greek inventor Daedalus (who built the labyrinth), was given wings of wax by his father. Enamored of his new found ability to fly to great heights, Icarus ignored his father’s warning and in a moment of ecstasy flew too close to the sun. The heat of the sun melted the wax which held his wings together, and Icarus crashed into the sea.
The alternation of mania and depression illuminates a second aspect of manic depression-its cyclic nature. Periods of creativity, productivity and high energy alternate with times of fatigue and apparent indifference. Mania leads to depression, which leads to mania which becomes depression, etc. This extreme flip-flop of mood between peaks and valleys is extremely dangerous, as shown by the fact that 20 to 25 percent of untreated manic depressives (including many of the artists listed earlier) commit suicide.
Fortunately, manic depression is highly treatable, due to the discovery of lithium, a simple salt that in 1949 was accidentally found to have a mood-stabilizing effect on bipolar individuals. The downside of lithium treatment is that therapeutic levels of lithium are dangerously close to toxic levels. Lithium poisoning affects the brain and can cause coma and death. Thus, in the initial stages of treatment, lithium concentration in the blood must be frequently monitored. After the lithium blood level stabilizes, levels can be checked every six months.
The side effects of lithium can include hand tremors, excessive thirst, excessive urination, weakness, fatigue, memory problems, diarrhea, and possible interference with kidney function. Lithium is often ineffective in treating bipolar patients who are rapid cyclers-those who experience four or more manic-depressive cycles per year. For these and other patients who fail to stabilize on lithium, the drugs Depakote and Tegretol (originally anti-seizure medications) are also available. Some doctors prefer natural lithium (for example; Symmetry nasal spray) as it is considered safer.
In addition to taking medication, bipolar individuals can employ a number of preventive strategies to decrease the likelihood of having a full-blown manic attack.
1) Recognize the early warning signs of mania-e.g., insomnia, surges of energy, making lots of plans, grandiose thinking, speeded-up thinking, overcommitment, excessive euphoria, spending too much money, etc. Let friends and family know of these symptoms so that they can also become alerted to the start of a manic episode.
2) Create a stable lifestyle in which you keep regular sleep hours. Studies show that intervals between manic episodes are considerably longer in those people who live in stable environments. In addition, eat a diet that is high in complex carbohydrates and protein, avoiding foods such as simple sugars that can cause ups and downs. Alcohol and caffeine should also be avoided.
3) Use planning and scheduling to stay focused and grounded. Make a list of things to do and stick to it.
4) Try to engage in a daily meditative activity which focuses and calms the mind. If you are too restless for sitting meditation, go for a leisurely walk, taking long, deep breaths along the way.
5) Refrain from taking on too many projects or becoming over- stimulated. If you feel an excess of energy starting to overtake you, channel it into productive physical activities such as doing the dishes, mopping the floor, cleaning out the basement, weeding a garden, etc.
6) Psychotherapy and support groups can help you to explore the emotional aspects of the illness, as well as provide support during times of stress.
7) If you feel that things are getting out of hand, call your doctor or therapist. This is especially true if you start losing sleep, as sleep deprivation is one of the major contributors to mania.
8) Ask a good friend or family member to track your activity level. Sometimes a manic episode can “sneak up on you,” and an objective person may be able to spot it before it gets out of hand.