Manic-depressive illness, also called bipolar disorder, is a condition in which periods of depression alternate with periods of mania or lesser degrees of excitement. Manic-depressive illness affects slightly less than 2% of the population to some degree. The illness is believed to be hereditary, although the exact genetic defect is still unknown. Manic-depressive illness is equally common in men and women and usually first encountered from the teenage years through to early thirties.
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.
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.
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. 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.
Hypomania shares symptoms and characteristics similar to the mania aspect of manic depression, but to a less severe degree. The characteristics of a hypomanic episode include:
- Euphoric mood lasting for at least several days on end which can switch to irritability, intolerance and rage
- Increased activity and high energy levels
- Rapid speech and flow of ideas
- Extrovert nature, seeking out people, including strangers
- Exalted self-esteem
- Loss of judgment
- Spending too much money
- Lack of inhibitions and increased sexual drive
- Increased productivity and creativity
- Feeling a need for less sleep
You can feel very good during a hypomanic episode and will probably disagree with anyone who argues to the contrary. “I felt great, really successful, like an achiever.”
Hypomania is episodic so if you experience more than one episode, you will have periods where your mood is stable between them. People diagnosed with hypomania rarely experience delusions. Diagnostic manuals state that hypomania should not be diagnosed if the person experiences delusions. Hypomania is usually not so problematic as to severely affect a person’s work or social life. It is also unusual for someone with this diagnosis to need to stay in hospital. Hypomanic episodes are usually rapid in onset and can last from several weeks to months.
Regarding the following, please see your scoring for these separate conditions.Bipolar disorder is not a single condition, but an umbrella term which includes a number of very different biochemical abnormalities. I'm bothered by any attempt to generalize over the bipolar phenotypes & to blindly recommend any formulation or therapy for all of them. The key is to determine a patient's biochemical individuality, and to provide focused appropriate treatment. In our database of 1,500 bipolar patients, about 25% are overmethylated, 35% are undermethylated, and the remaining 40% do not exhibit a methylation disorder.
The three primary biochemical classifications of bipolar disorder are the following:
A. Undermethylation: This condition is innate & is characterized by low levels of serotonin, dopamine, and norepinephrine, high whole blood histamine and elevated absolute basophils. This population has a high incidence of seasonal allergies, OCD tendencies, perfectionism, high libido, sparse body hair, and several other characteristics. They usually respond well to methionine, SAMe, calcium, magnesium, omega-3 essential oils (DHA & EPA), B-6, inositol, and vitamins A, C, and E. They should avoid supplements containing folic acid. In severe cases involving psychosis, the dominant symptom is usually delusional thinking rather than hallucinations. They tend to speak very little & may sit motionless for extended periods. They may appear outwardly calm, but suffer from extreme internal anxiety.
B. Overmethylation: This condition is the biochemical opposite of undermethylation. It is characterized by elevated levels of serotonin, dopamine, and norepinephrine, low whole blood histamine, and low absolute basophils. This population is characterized by the following typical symptoms: Absence of seasonal, inhalent allergies, but a multitude of chemical or food sensitivities, high anxiety which is evident to all, low libido, obsessions but not compulsions, tendency for paranoia and auditory hallucinations, underachievement as a child, heavy body hair, hyperactivity, "nervous" legs, and grandiosity. They usually respond well to folic acid, B-12, niacinamide, DMAE, choline, manganese, zinc, omega-3 essential oils (DHA and EPA) and vitamins C and E, but should avoid supplements of methionine, SAMe, inositol, TMG and DMG.
C. Pyrrole Disorder: This condition, also called pyroluria, is a genetic stress disorder associated with severe mood swings, high anxiety, and depression. The biochemical signature of this disorder includes elevated urine kryptopyrroles, a double deficiency of zinc and B-6, and low levels of arachidonic acid. Pyrolurics are devastated by stresses including physical injury emotional trauma, illness, sleep deprivation, etc. Symptoms include sensitivity to light and loud noises, tendency to skip breakfast, dry skin, abnormal fat distribution, rage episodes, little or no dream recall, reading disorders, underachievement, histrionic behaviors, and severe anxiety. They usually respond quickly to supplements of zinc, B-6, Primrose Oil, and augmenting nutrients.
To me, a bipolar patient who becomes "well" with greatly-reduced medication requirements may have achieved complete success. I don't believe that medication doses need to go to zero, as long as side effects are absent and long-term effects are minimal or absent.
[Willam Walsh, Ph.D., past senior scientist, Pfeiffer Treatment Center www.hriptc.org