Manic depression (also known as bipolar disorder) is a mental illness in which there are swings from both excessive high and low. Lows typically follow the pattern described above in the section on depression but Highs are states of ‘ excitation’ where thoughts become too fast, there is over- confidence and a sense of overwhelming well-being (euphoria), lack of sleep, excessive sexual interest and thought patterns that may even go out of control and become terrifying. Lack of sleep can lead to exhaustion and rarely even death. In many ways it can be similar to drug effects, though in this circumstance without the drugs. Everyone, save the most unfortunate, have sensed ‘joy’ in their lives, whether being in love, having won at the races, passed an exam seeing a loved one again after a period of absence. This sensation is then multiplied by 5. The other characteristic is that for a diagnosis it must continue for certain length of time- typically a week to fit the exact medical definition, unless hospitalisation has been necessary. There may be ‘mixed’ states where there is a combination of symptoms of the high and the low.

Manic depression often runs in families, and although less common than ‘unipolar’ depression (the low only)- perhaps 1% very serious illness and 5% for milder forms- the fallout can be huge to the individual or the family. The inheritance can be studied in twins- where in pairs of identical twins (with exactly the same genes) 60% will have the same problem. The fact that not all the identical twins have it though shows the importance of the ‘environment’ in the cause- life circumstance is fundamental.

Treatment has been infinitely advanced over the last sixty years by the discoveries of drugs that can help stabilise mood swings. The first of these was lithium and there are many more now, from different chemical groups that are equal to or sometimes better than lithium. Apart from pharmacological management psychotherapeutic approaches can be very helpful enabling the patient to take control of his/her life and the illness; this may be sufficient so that drugs are not required, but anyone contemplating medicine withdrawal should only do this under careful supervision. Talking to health professionals, family and friends is of vital importance, and coming to terms with the problem is really essential, and accepting that medications may be necessary, just like a diabetic needs to take insulin. Groups, such as the Manic Depression Fellowship, offer great support. If an individual is using alcohol or drugs to excess in addition
AA (Alcoholic’s Anonymous) or NA offer invaluable structures for helping change lives for the better. The sufferer of manic depression will need to look after themselves as well as they can to reduce the effects of the illness, taking as much responsibility as possible for it, and, with careful management, many sufferers say they would prefer their lives with it rather than without it, as usually with a mild ‘high’ there is a very special take on life.