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Do You Have Manic-Depression?

In my practice, some individuals visit my clinic with preconceive notion that they have Bipolar Disorder.

“Dr. Rayel, I’m here because I have Manic-Depression. I read something on the internet and I’m pretty sure I have it. Am I a hopeless case?”

Even before I could speak or ask questions, they have already concluded with no element of uncertainty that they suffer from this rare disorder. Although self-diagnosis is not necessarily wrong, I won’t recommend it. A psychiatric disorder is never easy to diagnose as we assume it is.

Let me give you a hypothetical case of a person with Bipolar disorder (Manic-Depression).

Gloria was doing well until recently when Rex, her boyfriend of 4 years, broke-up with her. It was a shocking development especially after she learned that Phil was going out with her best friend even before the break-up. Since then, Gloria had deteriorated. One evening, she was involved in a car accident because she was driving fast and recklessly in a quiet suburban neighborhood.

During interrogation, the cops observed that Gloria was talking rapidly. In fact, nobody could interrupt her! Also, she was making jokes, laughing loud, and flirting with them. She told them that she was on her way to meet the Premier and his top officials about her invention that could abort global warming.

Eventually, she ended up in the emergency room where she was diagnosed and treated for bipolar disorder after intensive evaluation.

What is Bipolar disorder or manic-depression?

Bipolar disorder or manic-depression is manifested by highs and lows. When a person like Gloria is manic, there is a feeling of euphoria or irritability that lasts for days. Usually, mania is associated with lack of need for sleep, excessive energy, agitation, fast and loud speech, and increase in goal-directed activities such as spending sprees and establishing businesses with no realistic plan.

Some even become hypersexual — wanting to have sex several times a day. Partners end up exhausted and confused as to what to do next.

Furthermore, individuals with this disorder develop poor judgment and impulsivity. They become irritable and can lash out quickly even if not provoked. Some have delusions of grandeur. They believe that they have special powers, talents, influence, or mission.

When not manic, individuals with Bipolar disorder either feel normal or depressed. Depression in this disorder has the same manifestation as major depression. It consists of feelings of sadness associated with neurovegetative signs and symptoms such as inability to sleep, eat, and concentrate. Energy level is also impaired.

In addition, depressed individuals experience a feeling of hopelessness, worthlessness, and helplessness. Thoughts of death or suicidal ideation may even ensue.

For individuals who develop mania, does it always mean that they suffer from bipolar disorder?

Not necessarily. Mania can be caused by various medical and neurologic conditions. For instance, multiple sclerosis and stroke can present with manic symptoms. Moreover, medications and street drugs may precipitate mania. Steroids, cocaine, and amphetamine are some examples. Even some antidepressants can induce mania.

So when a person shows mania, the physician usually does intensive evaluation to rule out medical, neurologic, and medication-induced conditions before diagnosing bipolar disorder. This process is important because the treatment varies depending upon the cause. Once other conditions are ruled out, then bipolar disorder can be safely diagnosed and treated.

What are the treatment options?

The classic treatment for Bipolar disorder consists of mood stabilizers namely lithium carbonate and valproic acid. But for the past few years, atypical antipsychotics, such as risperidone, quetiapine, or olanzapine, have been successfully utilized. These medications in combination with a benzodiazepine (e.g. lorazepam, diazepam, clonazepam, etc.) have helped many individuals suffering from acute mania.

In addition to medication, psychiatric management that includes support, reassurance, psychoeducation, stress management, and individual and family therapy is crucial in treating this condition.

by Michael G. Rayel, MD -

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Dr. Michael G. Rayel — author, game inventor, and psychiatrist — has created the Oikos Game Series to promote emotional health and has provided EQ Webinar for parenting, personal, and career success. For more info, visit or