Mental health conditions

Manic depression

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• What sort of treatment can I get?
• What can I do to help myself?
• What can friends and relatives do?
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What sort of treatment can I get?

If you go to your GP, he or she may refer you to a psychiatrist, who will be able to discuss the various medical treatments available. If a treatment does not suit you, say so and ask for other options.

Medication – the usual treatment for manic depression is the drug lithium carbonate, which controls the condition but isn't a cure. It should be seen as the foundation for a much wider treatment that takes account of individual need. You should take certain precautions when taking lithium regularly. You will need frequent blood tests to ensure that the lithium in your blood does not reach a toxic level.

Antipsychotic drugs, such as Largactil or Haloperidol, are sometimes given to people for brief periods when mania is at its height, to control distressing symptoms. These drugs may cause some people considerable discomfort and distress. Their prolonged use may cause permanent damage to the central nervous system.

Counselling and psychotherapy

'Counselling and psychotherapy are ways of responding to a wide range of human needs and provide opportunities for those seeking help to work towards living in more satisfying and resourceful ways'

COSCA: Counselling and Psychotherapy in Scotland www.cosca.org.uk

In making the decision to undertake counselling you are entering into a relationship which will afford you a period of non-judgmental listening when you will be heard by the counsellor who will journey with you as you attempt to unpack whatever issue or problem you feel you have to discuss. You should be able to talk freely and comfortably about problems without feeling judged.

What you will receive in counselling are qualities which are often described as the 'Core Conditions' namely acceptance, genuineness and empathy. These qualities are necessary to create a safe environment for you to talk about any problems you are finding hard to resolve.

• The counsellor, in providing acceptance or unconditional positive regard, provides an environment where your feelings, experiences and values are respected. You will not be judged or criticised because of your own attitudes or beliefs
• In being afforded genuineness the counselor is demonstrating that they will be honest and open with you and will not present an outward appearance of one attitude while actually holding another
• Empathy is the ability to let the person know that you have truly heard what they are saying. It is not the same as sympathy as that is about feeling sorry for a person. You will experience the counselor as having really understood what you are putting across.

At the first meeting the counsellor will hear what you want from counselling and talk about regularity of appointments and what he or she will expect of you. You also, at this first meeting, can discuss with the counsellor what you expect form counselling. Normally you will be given one appointment per week and each session will last for one hour.

It is important for you to know that your counsellor will be bound by a Code of Practice and Ethics, normally by COSCA or The British Association of Counselling and Psychotherapy (BACP). The counsellor will also be supervised by an approved/accredited Supervisor.

Cognitive Behavioural Therapy (CBT)

CBT is a form of counselling which involves learning to overcome distorted negative thinking patterns that can lead to depression.

Therapists may use techniques which enable the depressed person to do more things that give them pleasure; helping them to solve problems in their life; and learning better social skills.

How does it work?

• People who are depressed have distorted thinking patterns. They see themselves and their situations more negatively than others. These thinking patterns make their depressed mood worse
• In CBT, distorted thinking is challenged by the therapist who teaches the person to overcome their negative thinking patterns in everyday life.

Is CBT effective?

• There are studies showing that people with mild or moderate depression recover more quickly if they are treated with CBT.
• CBT is as effective as antidepressant drugs
• Unlike antidepressant drugs, CBT works as well for adolescents as adults.
• An advantage of CBT is that it helps people learn skills that may prevent them from becoming depressed in the future.
• CBT is not suitable for severely depressed peole as they are too depressed to learn new thinking skills.
• However, once they have begun to recover with medical treatment CBT may be helpful.

The way we think can effect how we feel!

'It is not things in themselves which trouble us, but opinions we have about these things'
Epictetus

Life's experience can develop our thinking habits and belief systems The meaning we place on our experiences can influence how we feel and behave Unrealistic thinking can cause and/or maintain distressing feelings

Ten common types of thinking distortions that make coping more difficult:

1. Black and white thinking – all or nothing
2. Setting unrealistic expectations – living by fixed rules
3. Selective thinking – looking on the dark side
4. Converting positive into negatives – being a cynic
5. Overgeneralising – here we go again
6. Magnifying unpleasantness – making mountains out of molehills
7. Catastrophising – whatever can go wrong will go wrong
8. Personalising – it is all my fault
9. Mistaking feelings for facts – I feel therefore I am
10. Jumping to negative conclusions

Hospital admission – if you are particularly distressed, you may benefit from shelter and protection in an environment that is not too demanding.

At present, hospital is often the only place that provides this. It will give staff the opportunity to assess your needs and try to find the best way to help you. And, for those close to you, it may provide some relief.

Crisis services – have been developed in some areas as alternatives to hospital. Sometimes they can offer accommodation, but otherwise they offer support in your own home, with the idea of avoiding admission to hospital. Crisis services rely less on drug treatments and more on talking treatments and informal support.

ECT – Electroconvulsive therapy is a controversial treatment, which involves passing an electric current through the brain of someone who is under anaesthetic. It's given for severe depression and was regularly used to treat mania before antipsychotic drugs became available. ECT can cause short or long-term memory loss. It's much less common nowadays, although it does provide some people with relief they can't otherwise get.

Community mental health teams – often community care assessments are made by the Community Mental Health Teams. Their aim is to enable you to live independently. They can help with practical issues, such as sorting out welfare benefits and housing, and other services, such as day centres or drop-in centres. They can also arrange for a community psychiatric nurse (CPN) to visit you at home.

What can I do to help myself?

Getting support and understanding – during a manic phase you may be quite unaware that your actions are distressing or damaging to other people. Later, you may feel guilty and ashamed. It can be especially difficult if those around you seem afraid or hostile. It helps if you provide people with information about manic depression, so as to increase their understanding.

After going through a manic depressive episode you may find it difficult to trust others, and may want to cut yourself off. These feelings are to be expected after experiencing such difficulties, but it may be far more helpful to talk through your emotions and experiences with friends, family or a counsellor.

There are now many support groups, where people who have gone through similar problems can come together to support each other.

Manage your own condition

Self-management involves finding out about manic depression and developing the skills to recognise and control mood swings. It can be very difficult at first to tell whether a 'high' is really the beginning of a manic episode or whether you are just feeling more confident, creative and socially at ease. It can be a strain watching out for symptoms all the time, particularly when you are first learning about the effect manic depression might have on your life.

There are various guides to self-managing manic depression. They may feature checklists and exercises to help you recognise and control mood swings, and include practical tips for dealing with depression and mania. Self-management is by no means instant, and can take some time to use effectively. However, if you choose this method, you may find you need to rely less on professionals, and have more control over mood swings. This, in turn, can lead to greater self-confidence. Working life – it's important to take things slowly and avoid stressful situations. If you already have a job, you might want to find out if you can return on a part-time basis to start with.

What can friends and relatives do?

Seeing someone you care for going through the symptoms of manic depression can be very distressing for friends and family.

It's painful enough to be with someone who is in a deep depression, but during a manic phase they may not accept that there is anything unusual about their behaviour, and they may become hostile towards you. This can leave friends and family feeling frightened and helpless. However, you can be vital in providing support and helping them to get practical assistance.

How to cope

Try to make sure you have support in coping with your own feelings. Give yourself time away from the person you are caring for, and ask friends and relatives for help. You may find counselling is helpful. Learning as much as possible about manic depression can help you to cope better with your caring role.

Addressing difficult behaviour

If someone is hearing or seeing things that you don't, there's no point trying to argue them out of it. Nor is it helpful to pretend you see or hear them too. It's much better to say something like, 'I accept that this is how you see things, but I don't share that way of looking at it.' Try to focus on how the person is feeling at the time, to empathise with their emotions and encourage them to talk about them.

Giving practical support

Being organised can be a problem for people with this diagnosis. They may need help with practical matters (like ensuring they get enough to eat and sleep) and with their finances, particularly if they have built up debts during a manic phase.

Try to work together with your friend or relative, rather than taking over completely. Ask them what support they want and then help them establish what is available. Encourage them to manage their own condition safely. Respect their wishes regarding care as far as possible. If they are in agreement, you can go ahead and approach agencies for help.

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