Complex Features of Manic Depression

by Marcia Purse

In What Is Bipolar Disorder? we gave a basic definition of manic depression, and looked at the two poles of Bipolar I, mania and depression, and the poles of Bipolar II, hypomania and depression. We explained that manic depression affects not just how a person thinks and reacts, but also how that person behaves and feels physically.

But manic depression is more than mood swings. Some of the more complex features of manic depression include:

• Mixed episodes - a mixed episode is when a person experiences aspects of both depression and mania (or hypomania) at the same time. Sometimes mania is prominent, sometimes depression. (See also Dysphoria.)

• Rapid cycling - rapid cycling is when episodes occur four times or more per year. Subtypes are:
  • Ultra-rapid cycling - when episodes occur monthly or more frequently.
  • Ultradian rapid cycling - cycling more than once a day (also called ultra-ultra-rapid cycling).

Bipolar I can have some very frightening characteristics of psychosis - loss of contact with reality. These may include:

• Hallucinations - hearing or seeing things that are not there
• Delusions - persistent beliefs in things that are not true
• Paranoia - believing that a person or group is actively working to harm you, without any basis in fact.

These psychotic features of manic depression are also characteristic of schizophrenia, a mental illness where the patient is out of touch with reality, but without mood swings. Bridging the space between manic depression and schizophrenia is schizoaffective disorder. What distinguishes schizoaffective disorder from Bipolar I with psychotic features is that sometimes (for at least two weeks) the patient has only psychotic symptoms, without mania or depression.

There are additional forms of manic depression beyond Bipolar I and II. Unfortunately for patients, the authorities haven't come to an agreement about how many forms there are or which numbers to give those forms. Additional types of manic depression include:

• Cyclothymia - a milder form, called by some Bipolar III
• Depression along with mania or hypomania caused by taking antidepressants - in some circles called Bipolar IV (and in others, Bipolar III)

Probably the most dangerous aspect of manic depression is the danger of suicide. The completed suicide rate among people with manic depression has been estimated to be five to 15 percent, which means a staggering number of bipolar people make unsuccessful and/or repeated attempts on their own lives, and even more than that consider suicide without acting on the urge. Yet people with manic depression are often highly intelligent, extraordinarily gifted, glowingly talented - people whose brilliance makes the world a better place while they themselves are struggling every day to cope, to function, to stay alive.