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Major
Depression and Manic Depression — Any Difference?
Countless
number of patients and their family members have asked
me about manic–depression and major depression. “Is
there any difference?” “Are they one and the same?”
“Is the treatment the same?” And so on. Each time I
encounter a chorus of questions like these, I am enthused
to provide answers.
You know
why? Because the difference between these two disorders
is enormous. The difference does not lie on clinical
presentation alone. The treatment of these two disorders
is significantly distinct.
Let me begin
by describing major depression (officially called major
depressive disorder). Major depression is a primary
psychiatric disorder characterized by the presence of
either a depressed mood or lack of interest to do usual
activities occurring on a daily basis for at least two
weeks. Just like other disorders, this illness has associated
features such as impairment in energy, appetite, sleep,
concentration, and desire to have sex.
In addition,
patients afflicted with this disorder also suffer from
feelings of hopelessness and worthlessness. Tearfulness
or crying episodes and irritability are not uncommon.
If left untreated, patients get worse. They become socially
withdrawn and can’t go to work. Moreover, about 15%
of depressed patients become suicidal and occasionally,
homicidal. Other patients develop psychosis—hearing
voices (hallucinations) or having false beliefs (delusions)
that people are out to get them.
What about
manic-depression or bipolar disorder?
Manic-depression
is a type of primary psychiatric disorder characterized
by the presence of major depression (as described above)
and episodes of mania that last for at least a week.
When mania is present, patients show signs opposite
of clinical depression. During the episode, patients
show significant euphoria or extreme irritability. In
addition, patients become talkative and loud.
Moreover,
this type of patients doesn’t need a lot of sleep. At
night, they are very busy making phone calls, cleaning
the house, and starting new projects. Despite apparent
lack of sleep, they are still very energetic in the
morning — ready to establish new business endeavors.
Because they believe that they have special powers,
they involve in unreasonable business deals and unrealistic
personal projects.
They also
become hypersexual — wanting to have sex several times
a day. One–night stands can happen resulting in marital
conflict. Like depressed patients, manic patients develop
delusions (false beliefs). I know a manic patient who
thinks that he is the “Chosen One.” Another patient
claims that the President of USA and the Prime Minister
of Canada ask for her advice.
So the big
difference between the two is the presence of mania.
This manic episode has treatment implications. In fact
the treatment of these disorders is completely different.
While major depression needs antidepressant, manic-depression
requires a mood stabilizer such as lithium and valproic
acid. Recently, new antipsychotics, for example risperidone,
olanzapine, and quetiapine, have been shown to be effective
for acute mania.
In general,
giving an antidepressant to manic–depressed patients
can make their condition worse because this medication
can precipitate a switch to manic episode. Although
there are some exceptions to the rule (extreme depression,
lack of response to mood stabilizers, among others),
it is preferable to avoid antidepressants among bipolar
patients.
When considering
the use of antidepressant in a depressed bipolar patient,
clinicians should combine the medication with a mood
stabilizer and should use an antidepressant (e.g. bupropion)
that has a low tendency to cause a switch to mania.
About The
Author
Copyright
© 2004. All rights reserved. Dr. Michael G. Rayel –
author (First Aid to Mental Illness–Finalist, Reader’s
Preference Choice Award 2002), speaker, workshop leader,
and psychiatrist. Dr. Rayel pioneers the CARE Approach
as first aid for mental health. To receive free newsletter,
visit www.drrayel.com.
His books are available at major online bookstores.mike@drrayel.com
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