Manic-depressive illness (bipolar affective disorder)

Description

Who is manic-depressive, fluctuates between "sky-high jubilant" and "to death saddened". The phases of depression and mania alternate. The range of emotions includes everything humanly possible, from the deepest loneliness to euphoria.

Since the mood fluctuates between two poles, the term bipolar affective disorder is used.

How many episodes are experienced varies from person to person. Between two episodes, patients are completely well and symptom-free.

About 1% of the population is affected by this disorder, women and men in about equal numbers.

The first episode usually occurs between the ages of 20 and 30.

Hereditary factors have been demonstrated in family and twin studies. Until now, the development of bipolar affective disorder has been suspected to be due to the interaction of several genes and environmental influences.

Many indications suggest that the regulation and distribution of neurotransmitters (messenger substances) in the brain are disturbed. Drug treatment therefore attempts to achieve a controlled release of e.g. serotonin, noradrenaline or dopamine.

Drugs can also cause manic-depressive states. These include cortisone, methylphenidate, Parkinson's and epilepsy drugs. Drugs such as alcohol, marijuana, cocaine or LSD can also be triggers.

According to rare case reports, the symptoms also occur after brain injuries.

Depressive phase

• Dejection, hopelessness
• Listlessness
• (Through-) sleep disturbances especially in the second half of the night
• Loss of appetite and therefore weight
• Rigid facial expressions and gestures
• Suicidal thoughts

Euphoric phase

• Elevated mood
• Increased drive and energy
• Decreased need for sleep
• aggression, irritability
• Increased sensory perception, hallucinations
• impulsivity
• recklessness, overestimation of one's own worth
• Increased self-confidence
• low inhibition

There are no tests available to confirm this condition. The diagnosis is nevertheless made, usually without problems, on the basis of the characteristic mood changes. Information such as family history can be very helpful.

The doctor will take a detailed anamnesis (medical history), asking about previous illnesses, triggering events, as well as conflicts in the family or at work.

Especially from the age of 40, further examinations must follow in order to exclude brain or metabolic diseases.

• neurological examination
• Blood examination (thyroid, liver, kidney, mineral, vitamin B12 values)
• ECG (electrocardiogram)
• EEG (electroencephalogram)
• MRT (magnetic resonance imaging)

It is essential to provide information on all medications taken recently, as these cannot be ruled out as triggers.

In addition to adequate treatment, relapse prophylaxis is also of great importance.

Acute depressive phase

In the case of mild depression, talk therapy is usually sufficient. This treatment can be supported by the administration of antidepressants, which can be divided into the following groups:

• selective serotonin reuptake inhibitors
• noradrenaline reuptake inhibitors
• tricyclic and tetracyclic antidepressants
• MAO inhibitors (mono-amino oxidase)
• modern neuroleptics

The choice of the right drug depends on age, weight, personal preferences and concomitant diseases. Preferences and concomitant diseases. In severe cases, especially in conjunction with suicidal thoughts, hospitalization may be beneficial.

Manic phase

The euphoric phases are usually treated with neuroleptics, lithium salts or valporic acid. However, because pronounced manics lack the insight of necessary treatment, treatment in a psychiatric facility often becomes necessary.

Long-term therapy

Manic or depressive episodes can be prevented by sustained lithium therapy. Because regular monitoring is essential in this treatment strategy, close trust and cooperation between physician and patient are required.

Preventive therapies with antiepileptic drugs such as carbamazepine, topiramate or valproic acid are less well tested or proven.

A regular life is also very important, as manic episodes can also be triggered by insufficient sleep.

An accompanying psychotherapy is highly recommended, which exactly is to be decided individually.

With consistent and long-term treatment, depressive and manic phases can be brought to an end.

The now greatly improved medication and psychotherapeutic treatments have been proven by studies, as have reduced side effects. Patients are better able to concentrate on work and their social environment.

However, close cooperation between patient and doctor is still essential. This results in advantages such as timely recognition of relapses and precise long-term treatment.

If treatment fails, manic-depressive individuals are severely restricted in their daily and professional lives. Compared to healthy individuals, they have a significantly higher suicide rate.