Major Depression And Manic-depression -- Any Difference?
By Michael G. Rayel, MD, Fri Dec 9th
Countless number of patients and their family members have askedme about manic–depression and major depression. “Is there anydifference?” “Are they one and the same?” “Is the treatment thesame?” And so on. Each time I encounter a chorus of questionslike these, I am enthused to provide answers. You know why? Because the difference between these two disordersis enormous. The difference does not lie on clinicalpresentation alone. The treatment of these two disorders issignificantly distinct. Let me begin by describing major (officially calledmajor depressive disorder). Major is a primarypsychiatric disorder characterized by the presence of either adepressed mood or lack of interest to do usual activitiesoccurring on a daily basis for at least two weeks. Just likeother disorders, this illness has associated features such asimpairment in energy, appetite, sleep, concentration, and desireto have sex.
In addition, patients afflicted with this disorder also sufferfrom feelings of hopelessness and worthlessness. Tearfulness orcrying episodes and irritability are not uncommon. If leftuntreated, patients get worse. They become socially withdrawnand can’t go to work. Moreover,
about 15% of depressed patientsbecome suicidal and occasionally, homicidal. Other patientsdevelop psychosis—hearing voices (hallucinations) or havingfalse beliefs (delusions) that people are out to get them. What about manic-depression or bipolar disorder? Manic-depression is a type of primary psychiatric disordercharacterized by the presence of major (as describedabove) and episodes of mania that last for at least a week. Whenmania is present, patients show signs opposite of clinicaldepression. During the episode, patients show significanteuphoria or extreme irritability. In addition, patients becometalkative and loud. Moreover, this type of patients doesn’t need a lot of sleep. Atnight, they are very busy making phone calls, cleaning thehouse, and starting new projects. Despite apparent lack ofsleep, they are still very energetic in the morning — ready toestablish new business endeavors. Because they believe that theyhave special powers, they involve in unreasonable business dealsand unrealistic personal projects. They also become hypersexual — wanting to have sex several timesa day. One–night stands can happen resulting in maritalconflict. Like depressed patients, manic patients developdelusions (false beliefs). I know a manic patient who thinksthat he is the “Chosen One.” Another patient claims that thePresident of USA and the Prime Minister of Canada ask for heradvice. So the big difference between the two is the presence of mania.This manic episode has treatment implications. In fact thetreatment of these disorders is completely different. Whilemajor needs antidepressant, manic-depression requiresa mood stabilizer such as lithium and valproic acid. Recently,new antipsychotics, for example risperidone, olanzapine, andquetiapine, have been shown to be effective for acute mania. In general, giving an antidepressant to manic–depressed patientscan make their condition worse because this medication canprecipitate a switch to manic episode. Although there are someexceptions to the rule (extreme depression, lack of response tomood stabilizers, among others), it is preferable to avoidantidepressants among bipolar patients. When considering the use of antidepressant in a depressedbipolar patient, clinicians should combine the medication with amood 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’sPreference Choice Award 2002), speaker, workshop leader, andpsychiatrist. Dr. Rayel pioneers the CARE Approach as first aidfor mental health. To receive free newsletter, visitwww.drrayel.com. His books are available at major onlinebookstores.
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