The TL;DR version:
Mania and Depression are NOT opposite sides of normality. Instead, in mania is the brain signals (chemical / electrical) speed up slightly more than normal. So far so typical. The new bit is that in depression the brain signals speed up even more than in mania. The mind can’t cope with the even higher signal speed and starts shutting down, giving rise to depression symptoms.
If you are one of the persons who can’t get their depression under control, talk with your psych about using an anti-epileptic / anti-manic to see if that can help. I’m currently using carbamazepine (Tegretol, Equetro, Epitol, Carbagen, Carbatrol, Teril) and it seems to work to work for me. But I’m sure there are other anti-epileptics that can work.
The Long Version (still being expanded / edited)
For most of us the modern antidepressants don’t work so well. I’ve long thought that the medical model for what mood swings are, is inaccurate. Not wrong, mind you, just not the full picture. That’s why the meds don’t work so well – we are not quite shooting at the right target, as it were. Compare this to diabetes, where the medical model is pretty well understood, and treatment works very well.
Ok, what’s a medical model. It’s the model of what happens inside of you – the complicated chemical and electrical interactions that happen inside of you. Think about your car engine. How it works is a physics model or an energy model which describes how we get the energy out of the gasoline and put it to work in moving your car.
The depression and mania medical model describes what the brain does to get from you thinking about doing something to you actually doing it. And it’s a lot more complicated than your car engine. Lots. When you think about doing something, you don’t just go “I shall do….”. Feelings about doing it, considering the effects of the action, wondering what other people will think, etc., all get mixed into the decision of “I shall do…”. We assume things are simple because we do them effortlessly, but it’s not. The brain and how we think and how we do things is very very complicated.
I think that bipolar disorder, or mood swings, or depression, or mania, is really a fouling up of the “I shall do…” mechanism. It’s not really about sadness, or feelings. But because these things are entangled in the “I shall do…” mechanism, they also get affected. And because our feelings are visible to others or because that how we, er, feel, that’s how we describe what is going wrong.
Here’s what I think is going wrong.
Before I go further, I’d like to distinguish between your brain, which is the squishy thing in your head – and your mind, which is the part of you that makes decisions, thinks, feels; the part of you that is your consciousness, your you. I’ll need the distinction in the explanation that follow.
I think that bipolar disorder, all of it, is our brain signals increasing beyond typical. Let’s assume that for a normal person, the brain signals have a certain signal speed, which we shall call the standard speed. When the brain’s signals are working at standard speed, then your mind works just fine (well, not yours if you are here reading this blog, but normal people). There can be a bit of variation on the standard speed, but the normal person’s brain has safety mechanisms that keep the signal speed at something close to standard.
In bipolar people, the safety mechanisms for regulating the brain signals don’t work well.
In mania, the brain signals speed up a bit. Not a whole lot, just amped up a bit. Here’s where the mind / brain distinction becomes important. So, the brain is not working quite properly, but the mind, the part of you that is you that makes decisions etc., is able to compensate. The mind still works. You still function. Of course the mind is making some slightly weird interpretations of what is going on because the increase in brain signals speed is providing wrong information to the mind, skewing what it thinks is going on around it. Slightly, because we still see the world around us as normal people do.
The increase in brain signals is also skewing other things, like feelings, and judgments, and decisions that the mind is making / feeling. Which the mind can’t exactly realise because, you know, wrong signals and feedback. Ask a manic person – if they stop to reflect, they may understand intellectually what they are doing may be not quite right, – but it feels right / normal to them.
In depression, and here’s where I depart from accepted medical models, the brain signals speed up even more. At higher speeds, the mind can’t cope – it can’t compensate enough. The mind starts shutting down, piece by piece, until you’re in bed under the covers not wanting to talk to anyone. The body still works, but the mind, well, that’s barely there. You’re barely there.
What is the difference in the model mean? Well, for the first part, we aren’t bipolar. We don’t have two sides of the same coin. We have a disorder that increases through a tolerable variation (mania) to an intolerable variation (depression). And it’s based on brain signals. In many ways we are similar to epileptics – their manifestation is in the body and ours is in the brain.
The second thing is that anything that slows down the brain signals should help. I’m betting that’s why MDMA and other drugs that tend to make us laid back appear to work for depression. Because they slow or brain signal propogation. But it also means that anti-epileptic drugs may work as well for depression. As they say in the ads on TV, ask your doctor.