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Bipolar Disorder (Manic Depression) - Part I - Page 3

© John McManamy

Hence the need for vigilance. Many people with bipolar are encouraged to keep mood journals, which their psychiatrists track like meteorologists keeping watch on baby hurricanes in the Caribbean.

Now let's talk about those depressions, the flip side of bipolar disorder. In one way, there is nothing to distinguish bipolar depression from clinical or "unipolar" depression, from mild to severe, with similar suicide rates of about 15 percent. Indeed, a good many of those with bipolar identify most with the depressive aspect of their disorder, in many cases more so, for bipolar is a lifelong condition, with no prospect of ever flushing one's antidepressants down the toilet.

Yes, bipolar depression can be treated with antidepressants, but usually only in conjunction with a mood stabilizer or mood stabilizers. This extra dimension to bipolar makes life a bit more complicated in finding the right "cocktail" of medications, particularly if one's prescribing physician feels obliged to add antipsychotics or tranquilizers to the mix.

But sometimes there is a little extra something about the actual depression. "Rapid-cyclers," for instance, can go up and down and back again in a matter of hours, and those with "mixed states" can be up and down at the same time, with agitated depression or dysphoric mania. Some people with unipolar depression can also experience some of these symptoms, and here is where depression gets especially dangerous, for if one is feeling suicidal while in an agitated or manic state, then one has the energy to carry our the deed.

As an adjunct to medications, people with bipolar respond quite well to talking therapy such as cognitive therapy and group support.

Sadly, the depressive side of bipolar has been overlooked by the experts. Most research has focused on the mania side of the illness, even though one study has found that bipolar patients are depressed for 33 percent of days of the year as opposed to being manic for 10 percent of days of the year. Also, the experts are beginning to wake up to the fact that bipolar depression may be a different animal entirely from unipolar depression, with the probable need for a bipolar antidepressant, though don't expect to see this happen anytime soon.

These ups and downs - the manic highs and the depressive lows - are what define bipolar disorder, and many authorities are content to leave it at that, as if our brains were simple pendulums swinging from one extreme than the other. But the mind, as well as bipolar, is far more subtle and insidious - and occasionally beneficent - than that, and next week we will explore why.

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