Manic Depression

An Overview by Lori Todd

Professor Keefer's Writing Workshop II, 1997

Lori Todd Dr. Keefer Writing Workshop II 13 May 1997

Ukraine translation at

Due to the stigmatization attached to psychological disorders, people are embarrassed and afraid to seek help. Psychological disorders are illnesses and are no different than other diseases such as cancer, diabetes, heart conditions, etc.. Psychological disorders (particularly bipolar disorder) have been proven to be treatable with medication and/or psychotherapy. With proper treatment, a person with a psychological disorder can live a manageable, functional life. Everyone some time or another experiences depression and according to Ronald Fieve, About 3% to 4% of the population experiences major depression. Manic depression occurs in 1% or 2%, and another 5% of the population suffers from one of the other forms of depression. All told, about 10% of the population is afflicted by depression in one form or another, with women about two to five times more likely than men to be affected. Manic depression, however, afflicts men and women equally (Fieve 33-34). According to Fieve's statistics, a total of 10% of our population suffers from some form of depression. It is unfortunate for those who are in that 10% range.

Think how hard it must be for a depressed individual to live day-by-day, not knowing what the next day will be like for them. My questions would be: "How does a depressed person know they are experiencing depression? How does this person know what they are feeling is "abnormal?" The symptoms of depression can become overwhelming to the point that a person may consider or commit suicide. Depression can include some or all of the following symptoms: feeling sad, empty, no interest in life, the inability to find pleasure in activities that used to be enjoyable, weight loss and gain, excessive sleeping or insomnia, feelings of hopelessness, guilt, trouble concentrating, not able to focus, can't make decisions, no energy, anxiety, thoughts of death and not wanting to live (Fieve 21). A person who suffers from depression may suffer from these symptoms on a come-and-go basis. Sometimes the symptoms may last longer than other times. The duration of the episodes may vary. Sometimes they last so long that a person doesn't and cannot get out of bed. They have absolutely no interest or ambition to do anything. A person may start to realize that these symptoms are not normal and may not seek help due to the stigma attached to mental illness.

There are different kinds of depression. There is reactive depression, which is what a person experiences when mourning someone's death. Major depression can have episodes and lasts about 2 weeks alternating with normal periods. Dysthymia depression is mild but present most of the time lasting for at least 2 years. Finally there are manic depressive disorders classified as bipolar I and bipolar II (Fieve 22). Bipolar I is a major depression alternating with periods of manic highs, which can require hospitalization. When a person is in their mania state and the elation is severe, they are diagnosed as a bipolar I patient. Bipolar II involves periods of major depression also mixed in with manic, hypomanic, or mild periods of elation. The difference between bipolar I and bipolar II is that bipolar I patients suffer from extreme feelings of elation and bipolar II patients suffer from extreme feelings of depression (Fieve 22).

According to Ronald Fieve, Hypomanic patients become overactive socially, physically, and sexually. Characteristically tireless in energy, they may be garrulous and expansive, charming, and irritable or cracking risque jokes. During a full manic episode, into which the hypomanic state sometimes grows, the increased energy is extreme. People experiencing this manic state may literally go for two or three days without sleep at all. Hypomanic people, who usually require only four or five hours of sleep, are constantly busy, talking, telephoning, faxing, planning, and implementing numerous schemes (Fieve 29). A person can experience two kinds of hypomania. They can experience either euphoria or dysphoria. Euphoria is grandiosity, feeling in love with the world, having endless energy. Dysphoria is when one is in a "high" but is destructive, paranoid, full of anxiety, panic stricken and can lead to the depressive side. (On-Line p. 12).

The "mania" mood is not your average high of happiness. It is very similar to hypomania, but the person can be hospitalized because the mania gets to an extreme where it is out of control. Mania is excessive grandiosity, reduced need for sleep, excessive talkativeness, telephoning, spending, constant flow of thoughts, inability to concentrate, increase in social activities, and poor judgment (Fieve 31-32). Individuals affected with the bipolar disorder may suffer one episode of mania and depression in their lifetime, but this is usually not the case. Over 95% of people with bipolar disorder have recurrent episodes throughout their lives. As the illness progresses, individuals tend to spend more time ill and less time well. It has been reported that 25% of the individuals have attempted suicide (Basco 2).

Baron Shopsin breaks down the classic symptoms of mania into three groups: 1) Mood, 2) Behavior and 3) Mentation and Speech. Mood symptoms can be the following: expansive or infectious, elation, euphoria, mood usually consistent with ideation, humorous, may be irritable and argumentative. Behavior symptoms include grandiose acts, need of little sleep, socially active (generally overinvolved), sexually overactive (females), ambitious (excessive planning), and increased motor activity (physical hyperactivity). Mentation and speech symptoms could be any of the following: flight of idea, pressure of speech, voluminous details (circumstantial), distractibility, humor, illusions, and grandiosity (Shopsin 58). The question to all of this is what exactly causes depression and bipolar disorder?

Francis Mondimore postulated the biochemical theory that a lack of Norepinephrine causes a person to be depressed and that their level of Acetylcholine is very high. On the other side of the spectrum, when Norepinephrine is at a very high level, their state is a manic state and their level of Acetylcholine is very low. (See Illustration #1). The medication Lithium is used to treat both the depressed state and the manic state. It does not treat the level of neurotransmitters, but rather it treats the mechanism that determines how to release these neurotransmitters. (Mondimore 1990). A similar theory claims bipolar is caused by an imbalance in the number of small amino acid molecules, called neurotransmitters, that travel between nerves across the synapses in the brain. Synapses are the spaces between two successive nerve fibers.

There are three major neurotransmitters: norepinephrine (NE), serotonin (SE), and dopamine (DA). These neurotransmitters enter the synapses. If one or more of these enter the synapses this can lead to mania, and in reverse, if one or more of these don't enter the synapses, this leads to depression (Fieve 45-46). It is believed that this disorder has a biological basis that is inherited and stress triggers the mood swings (Emery 20). Is bipolar disorder inherited? There have been many studies and according to Korff Leonhard's family study, there is an increased incidence of psychosis and suicide in the families with bipolar I or II compared to the families with unipolar. In a study conducted by Thus Perris, he studied 138 bipolar, 137 unipolar depressives, and 17 unipolar manics who had been hospitalized. There was at least one relative interviewed for each patient. He found that 11% of the bipolar relatives had bipolar illness and only 0.5% had unipolar illness. For the unipolar relatives, he found that unipolar hereditary occurred in 7% and bipolar hereditary occurred in 0.4% (Fieve, Dunner 149-50).

There are least two potential sources of evidence for the physiological basis of depression; genetic data and biochemical evidence. According to George Winokur and his colleagues, bipolar depression is due to a dominant gene of the X chromosome. The X chromosome is one of two chromosomes that, taken together, determine sex. There are 46 chromosomes in humans, or 23 pairs. Women have an XX or a similar pair of sex chromosomes; men have a dissimilar pair, XY. If a gene is dominant, it will be independent of the other gene with which it is paired. The mother always contributes an X chromosome to the offsprings, the father an X or a Y. If the father contributes an X chromosome, the child will be a girl; if a Y, the child will be a boy. Winokur separated the patients into two groups, those whose families had affective disorders and those whose families did not. For those who were in the bipolar group were at high risk of bipolar depression. He found that female relatives were much more likely to be depressed than male relatives. This would support Winokur's prediction that bipolar depression is regulated by a dominant gene on the X chromosome. In his study, it turned out that the gene that causes manic-depression in a father is an X chromosome. If the father only passes on his Y chromosome, he cannot transport bipolar to his son. Overall, he suggests that the bipolar affective disorders are sex-linked on the X chromosome and are genetically transmitted (Endler 120).

There are two theories discussed by Norman Endler in reference to biochemical factors. He believes that depression is due to low levels of norepinephrine and/or low levels of serotonin at the synaptic gap. The norepinephrine theory also suggests that mania is due to an excess of norepinephine. Both norepinephrine and serotonin are neurotransmitters. Affective disorders are physical, metabolic, and biochemical disturbances of the nervous system. These disturbances produce changes in the brain which produce changes in moods, perception, cognition, reasoning ability and behavior. Primary chemical depressions are basically different from the secondary depressions that are due to stress or caused by neurosis. Therefore, a correct and precise diagnosis is essential. From the above research, it is evident that there is some kind of genetic chemical imbalance that occurs in patients with psychological disorders. Therefore, bipolar disorder is just like any other "physical" disease. It is out of a person's control. The part that a person can control is the ability to seek treatment and get help just just like a patient who has cancer goes for chemotherapy treatment.

What kinds of pharmacotherapy treatments are there for bipolar disorder? There are three types of medications commonly used to treat bipolar: mood stabilizers, antidepressants, and antipsychotics. According to Millie Niss, mood stabilizers seem to be the primary treatment for most people since they level a person's moods. Millie claims, "Lithium is the most common mood stabilizer and is the oldest." The problem with lithium is that there are side effects which include the following: lethargy, diarrhea, nausea, frequent urination, tremor, and weight gain. Frequent blood tests are necessary so that your therapeutic blood level can be maintained. Liver, kidney, and thyroid functions can also be damaged by long-term use. The other mood stabilizers are anticonvulsants, which are used primarily to treat epilepsy. These include Depakote, Depakene, Epival, Tegretol. Lithium has done quite well with many people and Lithium plus an antidepressant has worked well too (On-Line, Bipolar Disorder FAQ). According to Mohammed Abou-Saleh, studies have reported a favorable response to lithium of those whose family history that contained bipolar illness (Abou-Saleh 120) Depending on the severity of a bipolar's condition, antidepressants alone can be the solution for some bipolar patients.

However, doctors have to be careful in prescribing these drugs. They not only can take a person from a depressed state to a normal state, but they could cause a person who is in the mania state to go into a hypermania state. This could be very dangerous because this drug helps a person go from a depressed state to a normal state, and now the patient has to be concerned with going into a hypermania state. This is just one of the difficulties. It is a very hard illness to treat. If a bipolar person is already in hypomania or mania, an antidepressant can induce their condition. To avoid this a doctor will prescribe an antidepressant plus a mood stabilizer. Antidepressants medications are the following: Prozac, Paxil, Zoloft, Luvox, Effexor, Norpramin, Sinequan, Elavil, Anafranil, Doxepin, Nardil, Parnate. Some of the side effects include: dry mouth, tremor, nausea, insomnia, drowsiness, anxiety, hypomania, sexual dysfunction (Bipolar Disorder, FAQ). It is no wonder why an affected person would refuse to take medication. There are just too many side effects and other issues that arrise. Antipsychotics are major tranquilizers and are used to calm people down. Bipolar patients are given this kind of drug when waiting for a mood stabilizer to become therapeutic. These include: Thorazine, Mellaril, Stelazine, Haldol, Risperdal, Clozaril, Trilafon. Antipsychotic side effects can include: sleepiness, slowed speech and thinking, difficulty walking or with balance, restlessness, twitching, involuntary movements, confusion, stiffness (Bipolar Disorder, FAQ).

According to Ronald Fieve, antiepileptic medications have been used such as Tegretol or Depakote in place of lithium when lithium has not been successful for certain patients (Fieve, 5). According to Gary Emery, "A drug, lithium, can control this disorder, but since there seems to be a psychological as well as a physical components to the problem, the best treatment is often a combination of lithium and psychotherapy." Drugs help the physical problems, but what about the psychological problems that exist? These too need to be addressed. This is why psychotherapy in conjunction with medication is important. Drugs have been criticized because they are only a temporary cure for the problem and people don't look at what's wrong with their life and the changes needed to ensure their mental health. Instead, they become dependent on drugs. To attempt to control the course of this illness, pharmacotherapy treatment is needed though it may not altogether eliminate recurrences of mania or depression. It does however decrease the chances, frequency, and severity of both the depression and mania states. This improves the patients psychosocial functioning (Basco 2). The major problem is that patients do not take their medications regularly.

There is a psychotherapeutic treatment called Cognitive-Behavioral Therapy (CBT) that can enhance medical management so that patients can identify symptoms in their early stages which could prevent a full relapse or a recurrence of a new episode. According to Basco, In a 12-month study of the maintenance treatment of bipolar disorder, Davenport, Ebert, Adland, and Goodwin (1977) found that patients assigned to a couples psychotherapy group had fewer instances of rehospititalization and few marital failures, as well as better social functioning and family interaction, than did patients in a lithium maintenance group or community-based after care. In addition to this 12-month study, there have been other long- and short-term group therapies combined with pharmacotherapy, that have been found to reduce the frequency, length, and severity of the episodes. The affective, cognitive, and physiological changes in depression and mania lead to behavioral responses that can create problems for patients such as stress. CBT for the maintenance phase treatment of bipolar disorder augments rather than replaces the pharmacological management of this illness. The CBT techniques provide patients with additional coping strategies when medication alone is not enough (Basco 4-8). See Illustration #2. In one particular case a woman named Ms. Galindo moods' changed from week to week, even though she was on medication. CBT is based on the notion that feelings, thoughts, and behaviors are interrelated and they influence one another. For example, when Ms. Galindo felt blue (these were her feelings), she reminisced about the past. She thought about the mistakes she had made and the people she had hurt (these were her thoughts), and she felt hopeless so she would isolate herself from work, friends, and family (this was her behavior). But with CBT, patients are taught to recognize the affective, cognitive, and behavioral patterns that make their symptoms worse. Once the pattern is recognized, CBT techniques can be used to "break the cycle" by modifying cognitive or behavioral responses. These detected symptoms detected can serve as cues to seek better medication and control feelings the patient is experiencing (Basco 9-10).

According to Emery, psychological treatment can be broken down into three types: traditional or insight, behavioral, and cognitive. Insight therapy helps you understand your problems. This could focus on your childhood experiences, and maybe it's these experiences that cause your depression. It could also be focusing on your true feelings i.e., you're depressed, but in actuality you are angry at someone else and turn the feelings inward and become depressed. Behavior therapy believes that your depression is caused by too many unpleasant experiences and the solution is to increase pleasant experiences by solving unpleasant experiences. Cognitive therapy teaches a person to identify, correct, and "reality-test" cognitive distortions. "Cognitive therapy is brief, directive, and highly structured. The person first learns how to obtain relief from the symptoms; later she learns how to identify and change the dysfunctional beliefs that led her to distort her experiences in the first place" (Emery, 22-23). It appears that psychological treatment is an essential piece of the treatment. Depending on how severe a person's condition, some people may be able to survive and live a normal fulfilling life by obtaining psychotherapy without medication.

The thing to remember is that bipolar disorders are life long, chronic medical conditions. They are not curable but are treatable and can be managed. According to Barry Campbell, "Bipolar Disorder is a lifelong, chronic medical condition. It cannot be cured, but it can in almost all cases be managed to at least some extent" (On-Line Services FAQ). The biggest problem with the disorder is that manic patients are in denial that they are ill and refuse to get professional help. They are afraid. They must accept their illness before they can help themselves. They are too concerned about how they will be perceived by our society since there is a "stigma" attached to psychological illnesses. Norman Endler, in Holiday of Darkness, gives his personal journey of his life with depression. He suffered from bipolar affective disorder. He wound up using many forms of treatment such as drugs, electroshock therapy (ECT), and psychotherapy. Although ECT is probably the most effective method of treating depression, it is not used as frequently as drugs because of sociopolitical and practical factors. ECT is the treatment of choice of many moderate depressions and for all severe ones. Clinical studies have shown that ECT is the most reliable, effective, and convenient technique for alleviating disabling and/or intense depression. ECT was basically effective because it induced a convulsion and because of the methodology used. Thereafter, it became a highly sophisticated technique and was not a horrific experience anymore. ECT is best for severe bipolar and unipolar affective disorders. After three or four treatments the depression starts lifting, and all that is necessary, as a rule, is a course of 6 to 12 treatments. Manic reactions of a bipolar illness can also be treated effectively with ECT, although lithium is preferred. Lithium is known as a prophylactic against manic-depression. It is not a traumatic nor an unpleasant treatment. It is recommended today that after ECT treatment, a patient should be placed on a drug treatment program.

Norman Endler's experience with ECT turned out to be a success. He had many fears of memory loss and was concerned it could make his condition worse. After two weeks, he had gone from feeling like an emotional cripple to feeling well. He felt like he was on top of the world. ECT did not work for him when he had his next episode of depression. After trying many different medications and ECT treatments, his doctor prescribed Lithium to him. In conclusion, his first depression was alleviated dramatically and instantaneously by ECT. His second depression took much longer to dissipate. At the time he was writing his book, he was still taking a dose of Lithium of 600 mg a day. He thought that he may have to take Lithium for the rest of his life just like a diabetic takes insulin the rest of their life. Lithium acts like a fine-tuner mechanism. It fine tunes the moods. If they are too high, it helps to lower them. If they are too low, it helps to raise them. Norman Endler said, "The prospect of having to take lithium for the rest of my life is a small price to pay for being my old cheerful, easy-going, self again." Psychotherapy may be a useful therapeutic supplement to ECT and antidepressants. Lithium plays a useful role in treating the bipolar affective disorder and can serve as a prophylactic (prevention) against recurrences. Norman Endler indicates that his illness was biochemically induced and not due to his childhood or other trauma. When he finished his book in mid-April 1981, he was symptom-free for almost three years. He felt in excellent health both emotionally and physically. He stopped taking lithium on a trial basis, but he knew that it was available to him if he needed it again. Knowing it was available was reassuring in itself.

In the movie Mad Love, the main character, Casey, suffered from bipolar disorder. The scenes displayed her doing "very wild and crazy," things such as pulling a fire alarm at school, crying on the floor in a restaurant bathroom, covering her boyfriend's (Matt) eyes while he was driving. Throughout the movie you saw her condition progress. She tried to kill herself by overdosing on pills. At the end of the movie, she held a gun in her mouth. The strange thing was that her moods would swing from being very happy to being very depressed. It was hard to detect at first that she suffered from a psychological problem, but her boyfriend finally realized it after he had witnessed her behavioral changes. At the end, he confronts her and makes her realize she has to stop fighting this and realize that she can not do this on her own and she must seek professional help. She needed to take medicine, which had to be monitored.

Kay Redfield Jamison suffered from bipolar disorder. She tried for the longest time to avoid seeking help, and do it on her own. After fighting her sickness without treatment for many long years, she finally gave in. Dr. Kay Redfield Jamison experienced manic-depression firsthand. While she was pursuing her career in academic medicine, she found herself succumbing to the exhilarating highs and horrific depressions. Her disorder launched into spending sprees, epidisodes of violence, and an attempted suicide. She finally sought help and went on Lithium. Lithium had side effects that didn't agree with her. She suffered from nausea, vomiting, inability to read, comprehend, and remember what she read. She suffered blurred vision. It impaired her concentration, attention span, and affected her memory. As soon as she felt stable again, she lowered her lithium level. There were also times she stopped taking the medicine because she wanted to be able to handle whatever difficultities that came her way without having to rely upon medication. But she realized she had to stay on Lithium because no matter what struggles she had had, it was painfully clear that without it she would have been in a state hospital or dead. The first time Kay lowered her intake of Lithium the effect was dramatic. She felt as though she had been living in a cloud. " A few days after lowering my does, I was walking in Hyde Park, along the side of the Serpentine, when I realized that my steps were literally bouncier than they had been and that I was taking in sights and sounds that previously had been filtered through thick layeers of gause. The quacking of the ducks was more insistent, clearer, and more intesnse; the bumps on the sidewalk were far more noticeable; I felt more energetic and alive. Most significant, I could once again read without effort. It was, in short, remarkable." The problem with lowering her dosage of Lithium was that she still experienced the manias of high-flying exuberance and cascading of ideas. Thereafter, came the black tiredness in which she would be reminded that she had a horrific disease, one that could destroy her. She realized that the extremes in her moods were clearly due to the lower dosage of Lithium she was taking. She was finally convinced that a certain intellectual steadiness was essential and desireable. She feels it is definitely worth taking 300 miligrms of lithium a day. While she was going through the whole ordeal of her illness, she was deeply skeptical that anyone who did not have the illness could truly understand it or understand exactly how hard it was to live with the disorder.

Depending on the degree in which a bipolar patient is affected with the disorder, does he/she have to be treated with both Lithium and/or other medications (such as anti-depressants)? In addition, does he/she need to see a psychotherapist in order to function in our society? Or can a person maintain a normal functional life by only receiving one without the other? A person should not first start taking medication without being evaluated by a psychiatrist. There is a vast majority of people who can overcome their depression without drugs. But if they have a biological imbalance in conjunction with psychological problems they need both medication and psychotherapy. Depending on the severity of the person's condition (and each person's situation will differ), medication may be necessary, so a person can at least function on a daily basis and so that a therapist can evaluate them. If a person is in a stage where they are too depressed or too manic can be very difficult for the therapist to assess their condition. A lot of times a psychiatrist prescribes medication so that a patient can be brought to a therapeutic level. Even if people are being treated for depression, they are still uncomfortable sharing this information with their family, employers or acquaintances due to the risk of how they will be treated and perceived after people are aware of their illness.

In medieval times, it was explained in terms of religious and demonic explanation. During the Middle Ages, depressives were called witches. Psychiatric interpretations and treatment of depression begun effectively in 1793 by Philippe Pinel, a French physician. The next major advance in depression was introduced by Freud in 1900. Freud believed that depression was related to some childhood trauma, combined with a predisposed personality. According to Freudian theory, depression is a function of guilt and hostility turned toward the self. He believed that an organic and/or biochemical basis would be found. Unfortunately depression and bipolar disorders are not socially acceptable; therefore, there is a stigma attached to these disorders which makes people feel too embarrassed to get help. Throughout history the mentally ill have been tortured, scorned, and laughed at. Why were mental patients treated so harshly?

There was, and still is, ignorance about the nature of mental illness. Although progress is being made toward educating people to the physical cause, it was and still is believed to be a "mental" problem. According to Norman Endler, "we fear the unknown and reject the deviant. Studies in social psychology have shown that the deviant is treated like an outcast". By making the public aware of the nature and treatment, a lot of misery and suffering can be alleviated and people can lead more productive lives. The government and our society need to be more responsive and provide funding so that the needs of depressives can be adequately met. There shouldn't be a stigma attached to being a manic depressive. It is part of a medical condition. Bipolar disorder and other mood disorders have been proven to be biological chemical imbalances. This is an illness. It is an illness just like cancer, diabetes, heart conditions, blood diseases, Parkinson's disease, etc. The point is that mood disorders are medical problems that must be treated with medication and any other medical treatments deemed necessary such as psychotherapy.

Unfortunately, the term mental illness has come to have all kinds of negative connotations. Some of the myths are that people with mental illnesses are dangerous, and that mental illness is incurable and that these people should be institutionalized. Ignorance has led to a societal stigma. People need to be educated. Psychological disorders needed to be recognized as illnesses just like other illnesses. Insurance companies need to be forced to treat mental illnesses just as they treat all other illnesses. Currently, they discriminate against people who need treatment by not providing coverage or by limiting the coverage that they reluctantly provide. The government needs to take an active role in educating the public that depression and mood disorders are illnesses. These illnesses are biological problems that have been proven to be treatable. If the government gets involved and addresses this problem, more people can get treatment and alleviate themselves from the misery that they may be living in. They should not be embarrassed. A mood disorder is an illness and with the proper treatment, it can be managed so that a person can live a normal-functioning life. Knowing that our government and society are supporting psychological disorders by educating them, this will help affected people realize this is not something to be embarrassed about and rather it is a treatable disease.

Seeking treatment has enormous benefits to affected individuals and all of society. The negative attitudes toward mental illnesses needs to be changed. Depression is a common pervasive illness affecting all social classes and it has been proven to be treatable. There is no question that it is a difficult illness to treat due to the stigma and side effects of the medications. But the bottom line is that a person shouldn't be afraid or discouraged to seek help because they are ashamed of their illness or that they are concerned about how society will perceive them. It is a difficult task to convince someone to seek help and it is difficult for an individual to admit that they need held. There are certainly a lot of elements going against a person with this disease. A great deal of heartbreak can be avoided by helping an individual detect the illness and seek treatment. If he/she then refuses to get help, is is a personal misfortune. However, if we as a society refuse to provide adequate means for treatment, then it is a tragedy on us all.

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Interview Questions:

1) Is there anyone you know who has bipolar disorder? If yes, who? What is the relation?

2) Do or did you have to deal w/ this person on a daily basis?

3) How did you realize this person had the disorder?

4) Can you give me specific behaviors of this person? Please describe as many as possible and how often they would go into the manic, mania, and "normal" state.

5) Did this person's behavior affect you or anyone else?

6) How? and How did you cope with it?

7) Did this person seek professional help? If so why? What made him go? What kind of help did he seek?

8) What was this person's diagnosis and what treatment was prescribed?

9) Did he take Lithium? (If not what did he take?)

10) How did it work? Were there side effects? Give specific information.

11) How did you treat this person once you learned about their illness?

12) Did you accept it and did you support the person?

13) Do you blame this person for having this illness? Do you think this person chose to be the way he/she is?

14) What would you do if you were in his shoes?

15) Did people (family, friends, children, co-workers) treat him differently once they learned that this person had psychological problems. Was he treated like an outcast?

16) Did he accept his illness?

17) Is he stabilized now? What is his current treatments?

18) If he is not stabilized, is it because there is not a treatment that works or is it that he is not consistent with his medication and therapy?

19) What is your overall opinion about this disorder?

20) Do you think the stigma it has today will ever change? If so, how can this evolution get speeded up?

21) Other Comments: Lori Todd 3 70670008.CTA 11:08 PM 05/12/97\3