This is a disorder characterized by a state of either elation or depression or of intermediate mixed states. It occurs in about three people in every 1000 of the population. Heredity is a factor, and it is more common in women than in men. It tends to happen to people of fairly high intelligence, and suffers usually tend to be of stocky build, usually with fresh colouring and thick hair, and are vigorously active. Episodes seem to occur more often in late spring or early summer, and usually near both equinoxes (March and September).

It usually appears in extroverted personalities and often starts without obvious cause, although indications are that there is a disturbance in the body chemistry. Severe infections have been known to precede attacks and so may a marked emotional sock.

Manic individuals are frequently infectiously gay, witty and, at times, painfully sarcastic to those about them. They have tremendous flights of ideas, often very good ones, but usually too many at one time. Elation and over-activity can vary from mild to intense agitation and total restlessness which can be fatal if untreated. Often they don't realize that anything is wrong with them (lack of insight) and their judgment is also frequently impaired.

The milder degrees of the manic state are known as hypomania, where abundant energy is present, and intolerance and lack of control are common. The more intense state is mania. Insight is totally lost and judgment is grossly disturbed. Sufferers are highly elated, and full of boundless energy. They have wild flights of grandiose ideas, increased appetites, and never stop talking. This state can merge into delirious mania in which the victim becomes exhausted and very often voiceless.

The depressive phase of the manic-depressive may be mild, acute or stuporose (helpless). In the mild phase, the skin looks dull, the face worn and old. Depression is marked, and interest in self and surroundings is lost. Apathy and hopelessness are the order of the day. In the acute phase, there is a greater slowing down, with a marked feeling of isolation. Absolute hopelessness is present and the sufferer often believes, quite falsely, that she or he has committed grievous crimes and seeks punishment. The manic-depressive often believes his bowels are stopped up; it is difficult to converse with need for survival, and good nursing care is essential. Sufferers tend not to move and are unaware of their environment.

Unfortunately some manic-depressives alternate from mania to depression without intervals of being normal. Others may be 'set' at one extreme or other; for example a sufferer may vary between manic and normal, rarely if ever becoming depressed. However, on the credit side, many manic individuals carry out masses of valuable activities, good ideas are put into effect and their infectious zest enlivens and enthuses others. Like many other depressive states, much can now be done to alleviate both phases. It should be remembered that many people have mood swings which have nothing to do with manic-depressive illness.

If the condition is mild, understanding and acceptance by the individual and those closest to him is more important than anything else. It must be realized that the different moods only last a short time and, if mood tends to be extreme in either direction, moderate sedation may be required.

At the other end of the spectrum, if over-activity is excessive or even life endangering, or if depression is profound, treatment in hospital with rest and sleep is essential. Haloperidol or chlorpromazine by mouth or by injection are usually very effective in reducing over activity. One of the many anti-depressants can be used to combat the depressive phase. Long-term management with lithium carbonate has transformed the control of this illness, but its level in the blood must be carefully controlled as the body's level of tolerance is narrow. This will be checked carefully, especially at the beginning of treatment, but the patient soon becomes quick to recognize if the level is getting too high. Treatment must continue indefinitely.