Manic-depressive illness affects slightly less than 2% of the population to some degree. Manic-depressive illness is equally common in men and women and usually first encountered from the teenage years through to early thirties.
The illness is believed to be hereditary, although the exact genetic defect is still unknown.
Manic-depressive illness usually begins with depression and includes at least one period of mania at some time during the illness. Episodes of depression typically last 3 to 6 months. In the most severe form of the illness, called Bipolar I Disorder, depression alternates with intense mania. In the less severe form, called Bipolar II Disorder, short depressive episodes alternate with hypomania (mild mania). Symptoms of Bipolar II Disorder often change with the seasons, for example depression in the fall and winter, and brief excitement in the spring or summer.
In an even milder form of Manic-depressive illness called Cyclothymic Disorder, periods of elation and depression are less severe, typically lasting only a few days and recurring fairly often at irregular intervals. Although Cyclothymic Disorder may ultimately evolve into Manic-depressive illness, in many people it never leads to major depression or mania. Having a Cyclothymic Disorder may contribute to a person's success in business, leadership, achievement, and artistic creativity. However, it may also cause uneven work and school records, frequent change of residence, repeated romantic breakups or marital failure, or alcohol and drug abuse. In about a third of people with Cyclothymic Disorder, these symptoms can lead to a mood disorder that requires treatment.
Most people with Bipolar Disorder have extreme cycles only once every few years. Those with rapid cycles may go through four or more episodes of mania and depression per year; those with ultra-rapid cycles have episodes shorter than a week, with distinct and dramatic moods shifts within a 24-hour period. Some people with Bipolar Disorder may have weeks, months, or even years with absolutely no extreme ups and downs at all. Manic-depressive illness recurs in nearly all cases.
The diagnosis of Manic-depressive illness is based on the distinctive pattern of symptoms. A doctor determines whether the person is experiencing a manic or depressive episode so that the correct treatment can be given. About one in three people with Bipolar Disorder experience manic (or hypomanic) and depressive symptoms simultaneously. This condition is known as a Mixed Bipolar State.
People who cycle rapidly are more difficult to treat.
In some cases, alternative methods may work in a complementary way to the use of conventional medications, helping them to work better or, in some cases, to lower necessary dosages. In other cases, alternative treatments may be effective on their own, allowing a reduction in existing medications or lessening mood swings to the point where patients can lead more normal and satisfying lives.
People with this condition generally require life-long treatment with lithium or other drugs to control manic episodes, sometimes with antidepressants to control the depression. Some doctors believe that a significant bipolar disorder will not respond sufficiently to alternative interventions alone.
Lithium has been the first choice for years for the treatment of bipolar disorder, sold under the names Carbolith, Duralith, Eskalith, Lithane, Lithizine, and Lithobid. Effectiveness is maximized when serum concentrations are maintained at 1.0-1.2 mmol/L. Lithium has long been used to reduce suicide risks.
One of the main reasons that lithium is still used in treatment is its effectiveness in reducing symptoms and frequency of episodes. "The response rate is 70-80% for the initial and maintenance of mania, with a good response defined as fewer, less severe, and shorter manic or hypomanic episodes, although these episodes may continue to occur." [Larson, R. (1998) Lithium Prevents Suicides. Insights on the News, 14 (18), 39]
A number of studies suggest that lecithin has significant effects on the manic-depressive, with some claiming that it stabilizes moods or serves as a mood depressant. Although lecithin may be useful in helping to stabilize moods, it should be used cautiously since there may be a predominantly depressing action in certain individuals.
Several studies have shown that essential fatty acids may be beneficial in treating Bipolar Disorder. The omega-3 metabolite responsible is believed to be EPA. At least one study found DHA, the other common metabolite, to be ineffective. [Omega-3 Fatty Acids in Bipolar Disorder: A Preliminary Double-blind, Placebo-controlled Trial. Arch Gen Psychiatry. 1999;56: pp.407-412]
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