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Manic Depression

A depressive disorder is a group of symptoms that are experienced as a sad mood which goes beyond the normal experience of sadness or grief. The sadness of clinical depression is marked by a greater degree of intensity and a longer duration than is normal for a sad mood.

Mental depression is not only a condition of the mind. The symptoms of depression are characterized not only by negative thoughts, moods, and behaviors, but also by specific changes in the body. Symptoms can include: irregular eating habits, sleeping, uncontrollable crying spells, and decreased libido. Thought to be “only in your mind” at one time, there are actually nervous system changes in the brain and neurochemical imbalances that cause many physical changes that result in depression. Certain people with a depressive disorder, especially bipolar depression, formally called manic depression, appear to have inherited a certain predisposition to this condition.

Manic depressive refers to mood swings from overly high or manic to overly low or sad/depressed. The correct clinical term for manic depression is bipolar disorder. The term bipolar refers to an individual’s mood alternating between opposite poles of mania and depression. Like unipolar depression, bipolar disorder is also a brain disorder that causes changes in an individual’s mood and ability to function. Bipolar disorder affects both men and women equally. The onset can occur at any age however, it usually begins in late adolescence. It tends to run in families and appears to have a genetic link and.

The definitions given below are from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (American Psychiatric Association, 1400 K Street NW, Suite 1101, Washington, DC 20005-2403 USA).

Bipolar I Disorder

The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar II Disorder

Criteria for Major Depressive Episode

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Criteria for Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week. During the period of mood disturbance, three (or more) of the following symptoms have persisted and have been present to a significant degree:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

Criteria for Mixed Episode

  • The criteria are met both for a Manic Episode and for a Major Depressive Episode nearly every day during at least a 1-week period
  • The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others or there are psychotic features
  • The symptoms are not due to the direct physiological effects of a substance or a general medical condition

Criteria for Hypomanic Episode

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences


Continuous treatment is recommended as manic depression has a recurrent pattern. Consistent sleep times and adequate sleep is of primary importance. Many individuals with bipolar disorder sleep three to four hours a night or forgo sleep altogether when they are in manic state which makes the condition worse. Psychiatrists generally prescribe medications mood stabilizers such as lithium or antidepressants to balance the highs and lows of the disease. Psychotherapy is also important and compliments medical interventions.

Bipolar disorder will not get better without medical treatment. A physical exam is recommended with any mental disorder or condition and with bipolar disorder the thyroid function should especially be examined by a doctor. People with bipolar disorder often have abnormal thyroid function. Thyroid levels affect mood and energy levels therefore they need to be monitored carefully.

Relapse prevention and education is vital. Understanding the illness and learning to spot relapses into depression well before they happen is vital to successful treatment. This applies to the individual who suffers from the depressive disorder as well as family members and significant others who often seek treatment. There is no cure for bipolar disorder but with proper therapy individuals with this disease can lead more stable and productive lives.

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