Wednesday, 17 December 2014

Meeting With Mania

I was probably about 24 years of age when I first came into contact with mania. I walked into the admissions unit and there, surrounded by nurses, was a young athletically-built man holding court. He was a little flushed in the face, but then he was rattling off jokes like there was no tomorrow and making everyone laugh. I didn’t take very much notice. Staff constantly came and went so I guessed he was a student and I set about my work for the day.

A few days later I was back on the unit. This same young man was now on a program of modified narcosis (we’re in the early 1970s at this point). He’d effectively been put to sleep because his mood had escalated to a point where it had rapidly tipped into a full episode of mania. What did this mean? I was told he’d become locked into a frantic cycle of speech and action. He hadn’t stopped running about, talking, singing, doing acrobatics and exercising. He hadn’t slept, eaten or drunk fluids and was effectively burning up.

I met this young man a few days later. He was trembling and still salivating from the effects of medication. His speech was slurred, yet even after days and nights of enforced sleep his speech was pressured and he remained agitated. He was disorientated and concerned about what was happening to him. In between asking questions, and barely able to focus on the answers, he continued to crack jokes. This continued for roughly two more weeks. He was then discharged but was readmitted a few weeks later for more treatment.

In describing this I know I haven’t done it justice. Unless and until you come face to face with mania, even when subdued, it’s hard to convey the sense of how the person becomes victim to their situation. Since then I’ve seen many more examples. Some tragic, some less so, but in all cases the effect on the person and those around them was disruptive, to put it mildly.

Some people have a capacity for energy that must seem odd if you don’t share it. To be mildly hypomanic is a boon for certain roles. In the ambitious world of business, research, journalism, medicine and other high energy jobs a certain type of person does well if they can meet demands with energy.

So, what am I suggesting here, it’s good to be a bit high? Well, perhaps it is, but it does rather depend on context. At one end of the spectrum there is little doubt that mild hypomania can fuel creativity. The person feels good, achieves a lot, socializes easily, is persuasive, infectiously optimistic, funny and can be highly effective in what they set out to do. Then, as we progress along the mood continuum, comes mania. It isn’t inevitable that hypomania will tip into mania but the danger exists. With this we see the need to talk, but often incoherently. Thinking becomes disconnected and there is an inability to finish anything that was started. Confidence becomes arrogance and self-esteem becomes inflated. Plans become more grandiose and impractical. Sleep becomes an indulgence. Friends and relatives are woken by telephone calls in the early hours. Very often it is the unsocial acts, such as playing loud music, that brings the person to the attention of police and subsequently enforced treatment.


When someone feels so good it’s hard for them to take on board the reasoning that they are actually ill. Perhaps this is one reason why people with hypomania or mania are so reluctant to take medication, the antithesis of everything bright, cheerful and pleasant. But, in the way that no two people are alike, no two experiences of mania may be the same. Some people have a profound dislike of the sense they are not in control. Their experience of mania may be one of agitation and anxiety, far removed from the high’s experienced by others. Over time, and in seeing the possible effects of mania on relationships, employment and personal finances, there is the possibility the person may want to give medication a try.

Sleep and Depression

The association between sleep disturbances and depression is quite well known but research is revealing a number of other implications. Insomnia used to be thought of as a symptom of depression but growing evidence suggests it may actually precede depression and increases our risk of other health problems including obesity, heart disease and diabetes.

Most sleep disturbances fall into one of three categories. Sleep continuity problems involve difficulties in falling to sleep or staying awake and waking up early. This is the most common form of sleep disturbance and will be familiar to approximately 80 percent of people with depression.  The second form of sleep disturbance relates to decreased slow-wave sleep, sometime called delta sleep and the third type relates to altered patterns in the nature and timing of Rapid Eye Movement (REM) sleep. Antidepressant drugs nearly always suppress REM sleep and this has resulted in some claims that suppressing REM is itself a critical factor in reducing depression.

In children and adolescents REM sleep does not match that of adults, but this may be due to the fact that the younger brain is still developing. However, studies of insomnia in children do seem to show an increased likelihood of depression as they become young adults (Angst, 2008). Sleep problems in children have also been linked with increased risk of anxiety and aggression in later life (Gregory, 2008).

So, sleep pattern problems indicate risks for the future but sleep disorders can also be brought on by other conditions. Children with migraine are much more likely to experience sleep disorders and sleep apnea (sleep disordered breathing) than children without migraine. According to Martina Vendrame, MD, the study author, 50 percent of children with tension headache grind their teeth at night. Moreover, sleep disordered breathing is frequently found in children with non-specific headaches or who are overweight.

Insomnia is a common problem for older people. Wilfred R Pigeon, Ph.D, assistant professor of psychiatry at the University of Rochester Medical Center in Rochester, New York, found that patients with persistent insomnia were up to 3.5 times more likely to remain depressed compared with patients with no insomnia.

Lack of sleep is common with roughly 30 percent of adults. Skipping sleep for short periods may be fine but if you are aware of sleep disturbances in children, or yourself, its time to seek out help.

Sources:

American Academy of Sleep Medicine. "Insomnia Linked To Depression In Young Adults." ScienceDaily 3 April 2008. 22 April 2008 <http://www.sciencedaily.com­ /releases/2008/04/080401081937.htm>.

American Academy of Sleep Medicine. "Insomnia May Perpetuate Depression In Some Elderly Patients." ScienceDaily 4 April 2008. 22 April 2008 <http://www.sciencedaily.com­ /releases/2008/04/080401081930.htm>.

JAMA and Archives Journals. "Child Sleep Problems Linked To Later Behavioral Difficulties, Study Shows." ScienceDaily 10 April 2008. 22 April 2008 <http://www.sciencedaily.com­ /releases/2008/04/080407160745.htm>.