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Manic Depression

The disease, commonly known as manic depression, is called bipolar disorder in psychiatry. Bipolar disorder is a treatable disease characterized by extreme changes in mood, energy, thoughts and behavior.

Bipolar disorder is called manic depression because of the characteristic symptoms of mood swings between both mania and depression. These mood swings can last for hours, weeks, or months.

Although not as common as depression, about 1% of the population is known to have bipolar disorder once in their lifetime. Manic depression usually develops as a result of depression at the end of adolescence, and can also appear in childhood and old age. There is little difference in the incidence of manic depression between men and women, but men often appear in manic form and women often in the form of depression.

Types of bipolar disorder

Bipolar disorder is divided into several types according to the nature or severity of the symptoms.

The two most common of them are type I and type II bipolar disorders.

Type I bipolar disorder can be diagnosed when you experience more than one manic episode in your life. Depressive episodes or hypomania episodes are often accompanied but not essential to diagnosis.

Type II bipolar disorder can be diagnosed when you experience hypomania and major depression episodes more than once. Hypomania episodes are mild but distinctly painful, rather than manic, that change in social, professional, or other important functional areas. However, type II bipolar disorder may change the diagnosis to type I bipolar disorder even if manic episode appears.

1. Normal mood

It is natural that mood fluctuations occur in normal mood, but that does not lead to mania or severe depression.

2. Depressive disorder (Unipolar)

There is a period of severe stagnation below normal mood. It can range from mild depression to severe depression, but it doesn’t increase your mood to mania.

3. Type I bipolar disorder

Type I bipolar disorder is a type of mania and severe depression. It is easy to misunderstand that manic and depression are repeated regularly, but in general, the number of depression episodes is greater than the number of manic episodes. The duration of normal mood during these pathological moods can vary from person to person.

4. Type II bipolar disorder

Type II bipolar disorder is a type of mild mania and severe depression that does not show enough mania to be diagnosed with mania.

This can be mistaken for depressive disorder (unipolar).

5. Cyclic mood disorder

Circulatory mood disorder is a type of circulation in which hypomania and mild depression circulate for at least two years and more than half.

6. Rapid circulation

A disorder that occurs more than four times in a year, such as mania, hypomania or depression. Due to severe fluctuations in symptoms, it does not respond well to treatment, resulting in a poor prognosis.

7. Unipolar Manic State

It is a type of condition in which manic and normal moods appear repeatedly. Classifications correspond to type I bipolar disorder. It’s relatively uncommon, and in fact, when you look closely at the history of unipolar manic patients, you’ll often find invisible depression.


Bipolar disorder is a clinically distinct disease from depressive disorder (depression), but when it comes to depression, it is similar to the common depressive disorder.

Most people with bipolar disorder say they have experienced extreme extremes of fullness of energy, high mood, and deep pain and despair. These severe amplitudes of mood swings and severe symptoms of illness that make normal life impossible are hallmarks of bipolar disorder that can be distinguished from changes in daily mood.

1. Symptoms of Manic State

  • In addition to physical behavior, mental activity is also active, energy increases.
  • Feeling high, overly optimistic, full of confidence.
  • Easily irritable, showing aggressive behavior.
  • It does not feel tired and the desire to sleep is reduced.
  • Fall into an accident, and self-esteem is enhanced.
  • Horse speeds up, feels like a quick turn.
  • Becomes impulsive, poor judgment, easy attention to things around.
  • Irresponsible behaviors such as drunk driving, speeding, abnormal sexual relations.
  • If symptoms are severe, you will experience hallucinations and become delusional.

2. Symptoms of the Depressed State

  • The sadness persists or tears for no reason.
  • Great changes in appetite and sleep habits.
  • Annoyed, angry, worried, anxiety symptoms.
  • Become pessimistic and less interested in everything.
  • It feels energyless.
  • Feels guilty or self-useless.
  • Concentration is reduced and indecisive.
  • Previously enjoyed work is not fun, social life is reduced.
  • It hurts here and there for no reason.
  • Repeat thoughts about death or suicide.


According to the American Psychiatric Association’s Statistical Manual on Diagnosis of Mental Disorders (DSM-5), the criteria for diagnosing Manic episodes are:

A. There is a definite period of time when abnormally elated, overactive or sensitive moods and abnormal or persistent goal-oriented activities or energy increases last at least one week (regardless of the duration if hospitalization is required).

B. During the period of mood disorders, three or more of the following symptoms persist (four if you are sensitive) and are severe.

  • Expanded pride or severely exaggerated confidence
  • Reduced need for sleep (e.g. just 3 hours of sleep is enough)
  • More talk than usual or continue talking
  • Elimination of accidents or subjective experiences
  • Distraction (e.g., too easily attracted attention to unimportant or irrelevant external stimuli)
  • Increase in goal-oriented activities (social or sexual activity at work or school) or nervousness
  • Too immersed in pleasure activities that will cause painful consequences (e.g., hoaxing, buying, reckless sex, foolish business investment)

C. Mood disorders are severe or psychotic in nature, requiring hospitalization to prevent obvious damage to occupational functions, daily social activities, and interpersonal relationships caused by mood disorders and to harm oneself or others.

D. Symptoms are not due to the direct physiological effects of the substance (eg, substance abuse, medication, or other treatment) or general medical conditions (eg, hyperthyroidism).

Cautions: If the manic episodes that occur during the course of antidepressant therapy (eg, medication, electroconvulsion therapy, phototherapy) continue beyond the physiological effects of the treatment to a level that fully satisfies the diagnosis, sufficient evidence of manic episode Can be diagnosed as bipolar disorder type I.

The diagnostic criteria for depressive episodes are common to depressive disorders.


There are many ways to treat bipolar disorder, including medication, interviewing, education and social support. Patient safety should be considered first, and a thorough diagnostic assessment and future health plan should be aimed at. Therefore, during the course of treatment, you should pay attention to the stressors involved in relapse as well as medication and psychotherapy.

It is important to realize that bipolar disorder is a chronic condition that requires continuous treatment even if symptoms improve temporarily.

1. Medications

In some cases, such as diabetes, a single insulin treatment can be used. However, bipolar disorder requires the proper administration of several medications for effective treatment.

If these drugs are largely classified, they are:

1) Mood stabilizers

Mood stabilizers are effective in freeing the patient from the symptoms of extremes that sink and sink. Some mood stabilizers are classified as antiepileptic drugs because they are also used to treat the liver. Drugs with ingredient names such as Lithium, Valproate, and Carbamazepine fall into this category, and brand names may vary by manufacturer. It usually works within two to three weeks after administration.

2) Antipsychotic drugs

The main prescription for antipsychotics is to alleviate the mania, and quickly resolve the symptoms of mania even without hearing or delusions. Recently, many drugs with less side effects have been developed to replace the previous drugs.

3) Anti-anxiety drugs

If you have severe anxiety or severe mania, it may be helpful to use benzodiazepine anti-anxiety medications for a short time.

4) Antidepressants

Antidepressants may be given if the mood stabilizer alone fails to treat a bipolar disorder. Although not common, antidepressants can lead to a state of rapid circulation, which translates mood mood into mania or repeats between mania and depression. You should carefully monitor and evaluate whether your mood returns to mania while taking antidepressants.

2. Inpatient treatments

If you have mild symptoms of depression or mania, your outpatient can be safely treated if your psychiatrist can evaluate you often. However, many people with mania have taken the treatment as completely unnecessary because they lack awareness about their illness. In such cases, we recommend that you consult your guardian and proceed with the treatment plan according to the detailed evaluation and judgment of the expert psychiatrist. You may need to be hospitalized depending on the severity of your symptoms and your family’s support.

3. Maintenance treatments

Maintenance should be decided based on the severity of the disease, the risk of side effects of the drug, and the support system for the patient. In general, preventive maintenance is highly recommended for patients with bipolar disorder who have relapsed more than once. In maintenance therapy, treatment with mood stabilizers is effective, but maintenance therapy with other drugs, such as atypical antipsychotics, may be considered.

4. Psychotherapies

Short- and long-term treatment of bipolar disorder is centered on medication. But psychotherapy also plays an important role in treatment. Psychotherapy covers the role of psychosocial stressors in a person’s life that make symptoms worse or recur, and the mental burden, interpersonal or social consequences of being sick.

In bipolar depressive episodes, interpersonal therapy and cognitive behavioral therapy combined with drug therapy were more effective. Psychodynamic psychotherapy can also be considered.

Bipolar disorder is a chronic, recurrent disease. Therefore, patients and their families should be educated to take medication regularly and for long periods of time. In combination with cognitive therapy or family therapy medications, relapse rates are significantly lower than with medication alone.

Frequently Asked Questions

1. Do I still need to take medicine when my symptoms go away?

Yes that’s right. If you stop the drug because your symptoms are gone, your symptoms are very likely to reappear. I am currently living without any symptoms because I am taking medicine well. Medication is the most important factor in mood control. If you think you have side effects from taking your medication, talk to your doctor to adjust your dose or type of medication. Under no circumstances should you stop the drug without your doctor’s judgment.

2. What is the probability of recurrence of bipolar disorder?

In type I bipolar disorder, more than 50% relapse within one year and more than 90% relapse within five years on average, experiencing depression, mania, hypomania, and mixed (depressive and mania) once every two years. It is known.

3. How long do I have to take my medication?

The information on the bipolar disorders studied so far does not provide a clear answer as to when the medicine should be cured. The main thing is not to stop the medicine on purpose. In addition, it is important to know your bipolar disorder best and discuss it with your doctor, who is the most expert on treating bipolar disorder.

The general duration of treatment for bipolar disorder is:

Medications require at least two years of maintenance, even if bipolar disorder first develops. This is because improvement of mood symptoms does not end the treatment, but it requires maintenance to normalize the neurobiochemical changes in the brain so that it does not recur. Moreover, the more severe the relapse, the worse the symptoms and the worse the response to the drug. Considering this aspect, long-term medications are needed when bipolar disorder recurs, and in some cases, lifelong medication is recommended.

4. Is bipolar disorder inherited?

The development of bipolar disorder is partly inherited. The likelihood of developing a person with no bipolar disorder in a family is about 1 in 100, but if one of the siblings has a bipolar disorder, it is 5 to 10 out of 100. It also increases the likelihood that a parent will have bipolar disorder. In conclusion, the greater the number of members of a family with bipolar disorder, the more likely they are to develop bipolar disorder.

5. Is bipolar disorder a condition that can be overcome with only one’s own will and help around him?

The cause of the bipolar disorder has not been elucidated yet, but it is known that the symptoms are caused by the imbalance of neurotransmitters in the brain. While most people think that illnesses caused by weak will or psychological shock are psychiatric disorders and want to deny biological causes, bipolar disorder is an obvious brain disorder. Therefore, medications are the most important, and while the medication is in progress, the patient’s willingness to fight and overcome the disease and the proper support of the surroundings can be more effective in overcoming the bipolar disorder.

6. I am suffering from bipolar disorder and I am being treated. Should I hide the fact that I have bipolar disorder?

Many people with bipolar disorder worry about this problem. When you make a new person or get a job, you are afraid of being rejected or unable to get a job. The answer to this question that cannot be answered with yes or no is to determine how confident you are in the current situation. If you are rejected, judge yourself to be confident enough to withstand it.

Also, talk to someone you trust. Do not hide the facts of disability for those who are close. You will receive help and advice from more people than you have worried.

7. Can children develop bipolar disorder?

Yes that’s right. However, bipolar disorders in children tend to be difficult to diagnose because they often do not show typical symptoms and are often indistinguishable from attention deficit and hyperactivity disorder.

8. I have a family member who suspects a bipolar disorder. What should I do?

For bipolar disorder, it is of utmost importance to start treatment with an accurate diagnosis as soon as possible after the onset. Encourage and persuade family members with bipolar disorder to discuss current issues with your doctor.

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