Manic Depression

Manic depression or manic-depressive illness, now almost universally called bipolar depression, is a mood disorder. This article discusses types of manic disorder, symptoms of manic depression, common causes and risk factors for bipolar disorder, and treatment options.

The word bipolar refers to the two opposite ranges of emotion - the depressed and the manic - that one person exhibits, sometimes with very little time between, as a result of this condition. Although it is normal for a person to respond to the events of life with elated moods when exciting events occur and depressed feelings in response to sad events, it is not normal to have the abrupt and severe mood swings from major depression on the one hand to mania or hypomania on the other that characterize manic depression. This article gives an overview of manic depression.

What Are Mania, Hypomania, and Depression?

Mania, or a manic state, is an emotional state characterized by elated spirits, high energy, feelings of power and creativity and often by reckless, irrational choices, behavior, and spending. Hypomania is a milder form of mania - a period of increased impulsiveness, elation, and energy, but not as extreme as a manic state.

Major depression is an extended period of sadness or lack of emotion, accompanied by withdrawal from activities and life, feelings of hopelessness, insomnia, and loss of appetite. When depression is most severe, a person may become suicidal on the one hand and experience delusions or hallucinations on the other hand. For more about major depression, see the article “Major Depression.”

In manic depression, the states of mania or hypomania generally alternate with states of normal functioning and states of major depression. But it is possible to have manic and depressive states occur either in rapid succession or at the same time, which is known as a mixed state.

Types of Manic Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) from the American Psychiatric Association (APA) does not use the term “manic,” each classify the types of bipolar disorder differently.

The DSM-IV splits the disorder into:

Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder not otherwise specified (NOS).

  • Bipolar I Disorder, which covers the range from major depression to full mania.
  • Bipolar II Disorder, which only ranges from major depression to hypomania.
  • Cyclothymic Disorder, which is less severe, but chronic, and ranges from mild depression to hypomania
  • Bipolar Disorder NOS (not otherwise specified)

It further specifies whether the disorder is in remission or active, the level of severity, whether it is accompanied by psychotic features, and the typology of the most recent episode: manic, hypomanic, depressed, or mixed. ICD-10 also accounts for the severity of depression and psychotic symptoms, but appears to ignore the distinction between Bipolar I and II.

Symptoms of Manic Depression

The symptoms of manic depression include the antithetical symptoms of mania (or hypomania) and depression. Seeing them listed together may help reveal why it can be a very confusing disorder to understand.

            Manic or Hypomanic Symptoms

  • agitation, distractibility, irritability,
  • binge eating and abuse of alcohol or drugs;
  • delusions of grandeur
  • elevated mood
  • hyperactivity; increased energy
  • lack of self-control
  • little need for sleep
  • overindulgence in general: overspending; sexual promiscuity
  • racing thoughts and impaired judgment,

            Depression Symptoms

  • confusion, indecisiveness, and mental sluggishness
  • feeling fatigued or lacking energy
  • feeling guilty, worthless, helpless, or self-loathing
  • feeling irritable, agitated, or restless
  • feeling pessimistic and hopeless
  • feeling sad and having a depressed mood
  • having suicidal thoughts or attempting suicide
  • loss of appetite; insomnia
  • withdrawing from normal activities

Causes and Risk Factors

According to APA, a child with a parent or sibling who has manic depression is four to six times more likely to have manic depression than a child with no familial history. But other factors are involved. This is shown by the fact that there are cases in which one identical twin has manic depression, while the other does not. Some research has suggested that there may be brain development factors involved as well.


Psychotherapy and medication are both frequently used to treat manic depression.  Types of therapy may include behavioral therapy, cognitive behavior therapy, social rhythm therapy, or interpersonal therapy. Medications used include mood stabilizers, of which the most well-known may be lithium. More recently, medications originally developed as anticonvulsants have also been found to work well as mood stabilizers. Other medication categories for treating manic depression include atypical antipsychotics and antidepressants.


Related Article: Depression Screening >>