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 They become socially withdrawn and can't go to work.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.

Copyright c 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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Major Depression Or Bipolar Depression - What is the Difference?

Many people struggle with depression. Depression itself can be as simple as a sign of a bad day (or few days), or it can be a sign of something bigger - a psychiatric illness such as major depression or bipolar disorder. How, then, can we tell the difference?

Depression affects approximately 21 million Americans. It affects their quality of life on a physical, psychological, and social level. People who have depression often become absent from school or work, and their social life and family life diminishes as their depression increases. They begin to isolate, so that they begin losing friends, family, and others who are close to them.

The most common illness associated with depression is called major depression. According to the National Institute of Mental Health, major depression affects approximately 6.7% of our population. It is characterized by a depressed mood and loss of interest in (or pleasure derived from) normal activities.

Other common symptoms of major depression can include the following: significant weight change; change in sleep habits; fatigue; feelings of worthlessness or guilt; inability to focus; inability to think clearly or make decisions; and recurrent thoughts of death or suicide. Some physical symptoms may include body aches, headaches, and stomach aches.

According to the National Institute of Mental Health, bipolar disorder affects approximately 2.6% of our population. It is completely different from major depression, although it does have depression as one of its symptoms. However, someone with bipolar disorder usually experiences manic symptoms as well. Manic states are characterized by the following: racing thoughts; rapid speech; decreased sleep; and possible delusions and hallucinations. If delusions are present, they generally involve feelings of grandeur (greatness), and hallucinations typically involve seeing or hearing from important people.

People in a bipolar manic episode may exhibit risk-taking behavior such as: excessive spending; reckless driving; risky sexual behavior; gambling; and substance abuse. In most cases, following a manic episode, the person with bipolar disorder will "crash" into a depressive episode before returning to a normal state.

Therefore, there is a difference between major depression and bipolar depression, as major depression does not involve the mood swings of bipolar disorder. In addition, you will not find the manic state that is characteristic of bipolar disorder.

David Oliver has the #1 website for bipolar information, symptoms, causes, medications and treatments.

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