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Understanding Depression and Bipolar Disease
An Interview with Ellen Frank, Ph.D.
by Nancy Kennedy
Depression and bipolar illness, also known as manic depression, are often referred to as mood disorders, but according to Ellen Frank, Ph.D., Director of the Depression and Manic Depression Prevention Clinic at UPMC, a more accurate term may be “energy disorders.” Both of these serious mental health problems are characterized by significant changes in an individual’s energy level, along with other symptoms. Mood (or energy) disorders differ from the ups and downs that are part of normal, everyday experience. The ups and downs of depression and mania are extreme and can lead to poor job or school performance, damaged relationships, social isolation and even suicide.
Frank states that an episode of major depression involves marked negative changes in one’s mood or interest, plus four or five of the following symptoms, that persist for at least two weeks: change in sleeping patterns – either sleeping more or sleeping less; change in appetite, also in either direction; decrease in energy level; problems with memory, concentration or decision making; and feelings of low self esteem, hopelessness and helplessness. There may be agitation and recurrent thoughts of death or suicide.
“Most people will not come for treatment until these symptoms have existed for four to six months. There is a tendency to attribute the loss of energy and pleasure to other causes, such as fatigue, stress or nutritional causes. In younger people, the change in energy level is likely to be more quickly noticed, simply because they have higher energy levels to begin with,” says Frank.
Depression is more common by far than bipolar disorder, with 15% of Americans experiencing at least one episode of major depression in a lifetime, often in midlife. By comparison, bipolar disorder occurs in 1-2 % of the population.
Those with bipolar disorder experience dramatic “mood swings” - episodes of depression alternating with episodes of mania, which Frank defines as distinct periods of persistently elevated and abnormal mood or irritability. The symptoms of mania are the opposite of the symptoms of depression: high energy, high self esteem bordering on grandiosity, little need for sleep and expansive mood. “People who are experiencing a manic episode have boundless energy,” says Frank. “They are talkative, easily distracted and jumping from one idea to the next. They are very active, but this activity is goal directed, so that they can be quite productive. A woman who normally would do 30 minutes of exercise may suddenly have the energy to do 4 hours. There is also typically an increase in sexual interest.”
One woman, Linda C., who has been diagnosed with bipolar disorder, gives this description of her manic periods: “I feel like I am unstoppable, that I can do anything. There is a heightened awareness of everything and incredible energy. I find myself talking non-stop, but it takes a toll because the energy turns into irritability and then aggression.”
All that energy and activity may seem like a good thing, but the problem is that, in a manic state, this behavior will eventually have painful consequences and will impair the person’s ability to function. They may spend excessively and deplete their bank account; they may lose a job; they may drive too fast and get a ticket or cause an accident. Most common of all is the damage to relationships that inevitably occurs. A person in a manic state is likely to be argumentative and even mean. According to Linda C., “I felt that if I was suffering, I had to make everyone around me suffer too. I was a bully. I said cruel things to people that I loved.”
Spouses, children, family members and friends may feel hurt, angry and frustrated by this behavior. Families experience difficulty trying to understand the person’s lack of judgment about what is appropriate or not. In severe mania, the person may even become psychotic, unable to distinguish reality.
The good news is that there are multiple approaches to treatment that have proven to be effective for both major depression and bipolar disorder. Treatment for depression consists of medication with one of a range of effective medications as well as specific therapies. Psychotherapies for depression were developed in the 60’s and 70’s and remain useful today. One approach, called cognitive therapy, focuses on recognizing and correcting negative patterns of thinking. Interpersonal therapy, on the other hand, deals with social roles and relationships.
While depression can be treated with either medications or therapy, bipolar disorder requires the use of both to achieve stabilization of mood and energy. Therapies for bipolar disorder include modifications of cognitive and interpersonal therapy and focus on structuring the person’s routine so that it becomes regular and predictable. This is because bipolar disorder is believed to be associated with a weakness in the circadian system, which regulates sleep-wake cycles. Bipolar disorder, even more than depression, is a long-term condition that must be monitored and managed, just like diabetes or high blood pressure.
At UPMC, therapists have pioneered a form of therapy for bipolar disorder known as Interpersonal and Social Rhythm Therapy. Frank encourages persons with symptoms of either disorder to seek diagnosis and treatment. With appropriate treatment, people with depression and bipolar disorder can restore balance to their lives and achieve full, productive, happy lives.
For more information or a confidential screening interview, call the UPMC Program Hotline at (412) 246-5566.
An excellent resource that Frank recommends is the Depression and Bipolar Support Alliance. Go to www.dbsalliance.org for information.
