Addiction Treatment Blog

Mania is for practical purposes the mirror image of depression. Approximately 50% of people affected present with an elated, euphoric mood. They may be grandiose in their attitudes and beliefs uninhibited in their behaviour. However, the remainder may be irritable and tetchy rather than elated and euphoric and paranoid rather than grandiose. Common to both groups is an increased level of activity, so that hyperactivity is perhaps the most consistent diagnostic feature of mania. In addition, there is typically an increase in appetite and a decrease in time spent asleep.

In 1853, Falret and Baillarger independently described a bipolar disorder, in which affected individuals cycled between periods of elation, or mania, and depression. This was variously called folie circulaire or folie à deux periodes. It forms the basis for what is now recognised as manic-depressive disorder. In 1896, Emil Kraepelin divided the major psychiatric illnesses into manic-depressive illness and schizophrenia. The former was primarily a disorder of mood, the latter a disturbance of cognitive functions. The former usually followed an episodic course with individuals recovering to normal between episodes. The latter was more likely to become a chronic illness with a majority of affected individuals not every fully recovering. These distinctions have broadly speaking held to this day. Read more…

There are seven major physical treatments for depression at present.

• Tricyclic Antidepressants (Table 1). These have until recently been by far the most widely used.
• The Monoamine Oxidase Inhibitors (MAOIs) (Table 2).
• Reversible Inhibitors of Monoamine Oxidase (RIMAs) (Table 3).
• 5-HT Reuptake Inhibitors (Table 4).
• Other Antidepressants (Table 5).
• Treatments for Bipolar Disorders or Prophylaxis of Recurrent Disorders (Table 6).
• Others (Table 7)

In the last category, a number of other treatments are marketed for or used for depression and they often work, but whether they are antidepressants in the same sense as electroconvulsive therapy (ECT), imipramine or phenelzine is a matter of dispute. The 5-HT-1a agonist, buspirone, has in addition been marketed as an antidepressant, and a further compound from this group, flesinoxan, looks as though it may also emerge as an antidepressant.

Finally, there is also ECT, the mechanism of action of which, and its use clinically will not be discussed at any length in this article. Its role when antidepressants fail to work and in cases of mania will be considered at a later stage. Read more…

Coping with stress can be hard at times.

The term ‘affective disorder‘ is sometimes taken to encompass both the mood and anxiety disorders. In this blog, it will be restricted to the former. Two disorders will be considered, depression and mania. Depression will be covered first followed by a consideration of mania and then the question of prophylaxis of recurrent episodes of a bipolar disorder, be they depressive or manic.

It is perhaps more difficult to specify exactly what antidepressants do than it is for any other drug that acts on the brain. In the following articles, I will employ an ulcer model of depression in an attempt to clarify the issues. This model, however, simplifies both ulcers and depression and this should be borne in mind. In clear cut cases of depression, an ulcer model performs passably. But in less clear-cut cases, the difficulty in pinpointing what it is that antidepressants do re-emerges.

Another way to consider the issues is by considering what the terms ‘mood’ and ‘emotion’ mean. These are notoriously difficult to define, but one way the problem has been approached is to define them in relation to each other – to compare, for instance, the relation of mood to emotions with the relation between climate and weather, or the relation between the pedal and the keys of the piano. Read more…

Initially, a state of mind reminiscent of how you  felt as a child waking up on Christmas day, multiplied by the power of five. Being hypomanic is like having endless energy, along with wonderful enthusiasm and self-worth. The world around you seems brilliant and a kaleidoscope of opportunities. You feel so multi-talented you are able to complete daily chores in a fraction of their normal time, and to keep occupied you concentrate on learning to speak Russian and play the piano whilst becoming a grandmaster of roulette. It’s possible to believe you are a Superman, Napoleon or Jesus Christ, where you see everyone’s problems and potential, flaws and beauty, and make grand plans to turn the planet into a better place.

Yet as hypomania accelerates into mania, it is like an express train travelling with no brakes, quite slowly at first but gathering speed. Ultimately, you have no fear, and each day you remain high, and any sense of danger diminishes. You may normally be afraid of heights, but you take part in a skydiving event and then sign up to a course to learn to become an instructor. So many brilliant ideas keep coming into your head, you consider hiring Ideas Ltd. Your confidence is so sparkling and powerful, your point of view so tangible, you are able to convince friends, family, work colleagues and complete strangers of anything. Those that cannot quite convince, you temporarily lie to, until the time is right to explain the truth.

Everything you once dared to remotely fantasize or dream about doing now seems within your grasp. How could you have ever been depressed? You need very little sleep and feel capable of achieving anything providing there is enough time. You’ve become super combative and ready and willing to take on anyone in court, the boxing ring or even the three abusive louts shouting down the street. Outlandish but possible business schemes are galloped into with loans from banks or acquaintances. Property acquisition, artistic and charitable endeavours can also be launched with gusto, and often funded by the money borrowed for the business scheme. It’s all the same isn’t it? Anyway, it’s all my money and I’ll balance the books later with a hundred times more. Read more…