Depression or bipolar is worse

Manic-depressive: life between extremes

The manic-depressive illness moves between two poles: on the one hand uninhibited euphoria, on the other hand deep gloom. Experts call the disease bipolar disorder. Both extremes of mood occur in phases. In between there are often periods when the mood is normal.

In the tense relationship between mania and depression, it is difficult for sufferers to lead a regular life. If left untreated, the mood episodes usually become more and more pronounced and affect partnership, family and professional life to the utmost. If the bipolar disorder is recognized, however, it is now easily treatable.

The many faces of bipolar disorder

Bipolar disorder manifests itself differently in every person with the disease. The mood episodes can, for example, build up slowly or occur suddenly. They can last two weeks or half a year. Some sufferers go through several depressive phases in succession until a manic episode sets in. Mixed states, in which features of depression and (hypo-) mania occur at the same time, are also possible.

Typical characteristics of mania

  • Elevated or irritable mood
  • Decreased need for sleep
  • Restlessness, a thousand ideas at the same time
  • Urge to talk and racing thoughts
  • Absent-mindedness, easily distracted
  • Overconfidence, megalomania
  • Increased libido
  • Uncontrolled consumption of alcohol
  • Uncontrolled spending of money
  • Risky, uninhibited behavior

Typical characteristics of depression

  • Melancholy, depression
  • Listlessness
  • Indifference and loss of interest
  • Feeling of not feeling anything anymore
  • Feeling of worthlessness
  • Feelings of guilt
  • sleep disorders
  • Disorders of thinking and concentration
  • Various physical complaints
  • Recurring thoughts of death

So-called hypomania is a weakened form of mania. Hypomanic people are full of energy and creativity, but appear nervous, absent-minded, and overwrought.

A severe depressive or manic episode is sometimes accompanied by psychotic symptoms. These can be frightening, as those affected then suffer from delusions, feel persecuted and sometimes hallucinate.

Causes and Triggers

Bipolar disorder is not a classic hereditary disease, but it does have a genetic predisposition. This means that family members of the sick are more susceptible. However, they do not necessarily develop into bipolar disorder. Environmental factors are also involved, and only a complex interplay between genes and the environment can trigger bipolar disorder.

The illness is often preceded by a stressful life event such as the death of a loved one. But also enormous stress, drugs or a physical illness are possible triggers.

Diagnosing bipolar disorder

In many cases, it can take several years for the correct diagnosis and treatment to occur. On the one hand, this is due to the fact that sufferers feel completely healthy in manic periods and see no need to see a doctor. On the other hand, outsiders easily confuse bipolar disorder with other illnesses, for example unipolar, i.e. simple depression without mania or borderline personality disorder.

If you contact a doctor in a depressed state, it is very important to tell him about any manic or hypomanic phases you may have already experienced. If you suspect bipolar disorder, you should be examined immediately by a specialist in psychiatry and psychotherapy, for example.

Differences between bipolar disorder and borderline personality disorder

Some characteristics of bipolar disorder and borderline personality disorder may be very similar, for example, euphoric moods or moody states with suicidal thoughts. However, borderline people continuously suffer from emotional instability and the main focus is on inadequate control of their own emotions (impulse control): their mood can change in a matter of minutes. People with bipolar disorder usually experience prolonged manic or depressive phases, between which there are also periods of normal or balanced mood.

Treat the disease and learn to live with it

Bipolar disorders are now easily treatable. Doctors generally differentiate between acute and preventive treatment. However, the most important prerequisite for a good prognosis is to accept the diagnosis and learn to live with it in the long term.

Acute treatment

The aim of acute therapy is to use mood-stabilizing medication to alleviate an acute manic or depressive episode. In severe cases, the sick person is sometimes admitted to a clinic for his own protection until his mood has stabilized. In addition to administering medication, supportive psychiatric discussions help to cope with the diagnosis and to plan rehabilitation.

Preventive therapy (phase prophylaxis)

The preventive therapy aims to stabilize the mood in the long term and to prevent a relapse into a depressive or manic episode. An important component is the individually tailored medication intake. Lithium is often prescribed because its anti-manic effect has been well documented. Which drugs are useful, however, depends on the individual case.

In addition, long-term psychotherapeutic treatment is useful, in which the sick are supported in (re) leading a normal everyday life.

Relatives can do that

Relatives often give the impetus for treatment: They reflect to the person concerned that their behavior is harmful to themselves and those around them and urge them to see a doctor. For an optimal diagnosis, it makes sense if the relatives are present during the examination to describe their impressions. Because the diagnosis is based on a detailed conversation in which the doctor asks about the current complaints, problems and previous illnesses as well as the life and family history.

Family and friends are often faced with a difficult situation and do not know how to deal with the disease. Feelings such as anger and overwork can affect the relationship with the sick person. It is therefore important not to neglect your own needs, to create space for yourself or to seek contact with other relatives in self-help groups.

Tips for Dealing With Bipolar Disorder:

  • Accept bipolar disorder as a medical condition.
  • Motivate the person affected to see a doctor and consistently take advantage of the treatment. Especially during the manic episode, it is important to convince him that he needs help. If necessary, get support yourself.
  • Help him find out about the disease.
  • Do not overwhelm the patient in the depressive episode. Due to the typical lack of drive, he is not able to carry out simple activities himself, especially in the acute phase of the illness.
  • Always take comments from your relatives that they no longer want to live seriously and inform the doctor treating you about them immediately.
  • If the sick person has important decisions to make, he should not do this alone. In both depressive and manic episodes, the affected person's perception of reality can be significantly distorted. It may also make sense to set up support for financial decisions. It is best to discuss this together with the person concerned and the treating doctor.

In many regions there are self-help groups for people with bipolar disorder and their relatives. Those affected particularly benefit from initiatives such as "TRIALOG", an exchange of experiences between patients, relatives and therapists that is organized by self-help groups.

Current regional contact addresses can be found on the website of the German Society for Bipolar Disorders: