Manic depression: this concept, hardly used today, refers to one of the most common and known mood disorders after depression.

This is one of the old names for what is now known as bipolar disorder. Although for some this name may even have romantic connotations, the truth is that it is a disorder that generates a great deal of suffering and can cause serious alterations in the daily life of those who suffer from it, making its treatment essential.

In this article we will see what is manic depression , what causes are attributed to it and some of the main treatments applied.

What is manic depression?

Manic depression, manic-depressive psychosis or bipolar disorder. These different names have emerged in different historical contexts where different orientations and schools of thought also prevailed, although in practice they refer to the same disorder.

Specifically, in all cases, reference is being made to a mental disorder categorized within mood disorders and characterized by the presence of one or more episodes of mania and/or hypomania in alternation or in the absence of depressive episodes .

Thus, in this disorder, the mood can go from an episode of maximum exaltation and increased activity and energy to a state of deep sadness, hopelessness and passivity. Such fluctuation may be followed or separated by an asymptomatic period , and the passage from one pole to the other may occur in short periods of time.

Types of Bipolar Disorder or Manic Depression

There are two basic types of bipolar disorder. Type 1 has at least one manic or mixed episode, which may be preceded or followed by a major depressive episode. However, the latter is not essential for diagnosis. With regard to type 2 bipolar disorder, the presence of one or more major depressive episodes along with at least one hypomanic episode is required for diagnosis, but in no case is there a manic or mixed episode.

In manic episodes, an expansive mood appears, euphoric or even irritable, in which there is a high level of agitation and activity for almost the entire day for at least a week. In this state, there is usually a feeling of grandeur (which may go as far as delirium), logorrhea, flight of ideas or a feeling of losing the thread of thought, tachypsicity, distractibility, disinhibition, aggressiveness, hallucinations and a tendency to take risks and not value the consequences of one’s actions. The hypomanic symptoms are similar, but not as severe, no symptoms such as hallucinations and delusions can occur and are present for at least four days.

In depressive episodes there is a low mood and/or loss of interest and the ability to feel pleasure along with other symptoms such as hopelessness, lack of energy and passivity, alterations in eating and sleeping, fatigue or thoughts of death or suicide for at least two weeks.

Effects of symptoms

The above-mentioned symptoms, whether or not they alternate manic and depressive episodes, generate a great deal of repercussions in the subject that can alter and limit a great variety of vital elements and domains.

At the academic and work level, the existence of episodes can affect the ability to draw up and follow plans, decrease performance or generate conflictive or unproductive behaviour, as well as diminish the subject’s ability to concentrate. It is also possible that they may have difficulties in assessing aspects such as the value and use of money due to the extreme impulsiveness that may arise .

The social sphere can also be affected. In the manic phase the subject may show an uninhibited sexuality and/or be irritable and even aggressive, present delusions of grandeur and antisocial behaviour, while in the depressive phase he may lose interest in relationships .

In any case, one of the aspects with which the greatest care must be taken is the possibility of suicide. In fact, manic depression is one of the mental disorders with the highest risk of suicide.

Possible causes

Although the origin of manic depression is not entirely clear, the explanations proposed are generally based on factors of biological origin that are very similar to those of depression. The existence of imbalances in the synthesis and reuptake of neurotransmitters is proposed.

Specifically, noradrenaline levels have been observed to decrease during depressive episodes and increase in maniacs. The same is true for dopamine. As far as serotonin is concerned, it is found in lower proportions than usual in both types of episodes.

Structures such as the amygdala are altered, and hypoperfusion is also observed in different brain areas in the different types of episodes (less blood reaches the frontotemporal in mania and the left prefrontal in depression). Likewise, it has been proposed that bipolar or manic-depressive symptomatology may be related to problems in the transport of the nerve signal.

The environment also participates in its genesis, destabilizing stressful events in the biological rhythm. Furthermore, as in depression, the existence and influence of cognitive distortions that generate dysfunctional patterns is also proposed. The cognitive triad of thoughts about oneself, the world and one’s own future would oscillate between negative depressive thoughts and other expansive and glorified ones.


Treatment of manic depression or bipolar disorder requires a multidisciplinary approach. The main goal of treatment is to keep your mood stable. For this purpose , mood stabilizers are used at the pharmacological level, the main one being lithium salts. This substance has a little-known but generally highly effective mechanism of action, based on its modulation of synaptic transmission. Once the subject is stabilized, it is necessary to establish a maintenance dose that allows the prevention of new crises.

However, drug treatment can lead to unpleasant side effects . It is therefore necessary to apply strategies such as psychoeducation of the face to encourage adherence. Strategies of self-evaluation of the state and symptoms can also be taught which can warn of the arrival of a crisis and prevent it from occurring.

The work with the environment is also essential, so that the relatives of the affected person know the reason for certain attitudes and behaviours, solve relational problems and can contribute to help the affected person and know how to identify possible symptoms. The subject with manic depression can benefit from other psychological treatments used in depression, such as Beck’s cognitive therapy .

There is also interpersonal and social rhythm therapy as a treatment based on the regulation of biorhythms and personal relationships that can be helpful for subjects with this disorder.

In some particularly severe cases, and especially in cases where there are severe manic symptoms, psychotic symptoms or risk of imminent suicide, electroconvulsive therapy has been successfully applied (currently applied in a controlled manner, with sedation and monitoring).

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Belloch, Sandín and Ramos (2008). Manual of Psychopathology. McGraw-Hill. Madrid.
  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Román, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.
  • Welch, C.A. (2016). Electroconvulsive therapy. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier