What is bipolar disorder?

Bipolar disorder is a mental illness. It used to be called manic-depressive illness. Bipolar disorder causes severe changes of mood and behavior. At times you may feel extremely happy or irritable. This is the 'high,' or manic, phase of the illness. At other times you may feel deeply depressed.

An episode of mania or depression usually lasts for months if it is not treated. Some people, however, may have both high and low episodes in a matter of days. People with bipolar disorder usually have both manic (high) and depressive (low) phases, but some people have only the manic symptoms.

About 15 of every 1000 people have bipolar disorder. It is equally common in men and women. If not treated, this illness can ruin careers and marriages. It can result in violence and suicide.

How does it occur?

Scientists are working hard to find the cause of bipolar disorder. People who have close relatives with the disorder are far more likely to have it than others. Because the illness runs in families, genes appear to be at least partly responsible. In fact, researchers have recently identified a human chromosome that may contain one or more genes that contribute to bipolar disorder.

In addition to heredity, a person's environment appears to contribute to episodes of the illness.

Special scans, such as MRI (magnetic resonance imaging) and PET (positron emission tomography), have been used to look at the brains of people with this illness. These pictures show that certain parts of the brain may not be working normally when a person is having an episode of mania or depression.

What are the symptoms?

The symptoms of a manic episode include:

• You feel you are 'on top of the world' and that anything is possible. However, you may quickly become angry or irritable.

• You are unrealistically self-confident, even to the point of believing you have special powers or abilities that other people do not have.

• Your thoughts may race uncontrollably to the point of being disorganized and muddled. Sometimes, in the milder phases of the disorder, your thinking can be very creative.

• You tend to talk rapidly and loudly, moving from topic to topic. It may be hard for others to follow what you are saying.

• You may be able to go for days with little or no sleep and not feel tired.

• Your sex drive might increase, and almost everything seems interesting and enjoyable.

• You may be far too active and act recklessly. You are in danger of doing too much. For example, you might spend all your savings and go into debt, or you might drink too much alcohol or take illegal drugs such as cocaine. You also may get very angry and get into fights.

Milder degrees of mania are called hypomania. Hypomania does not involve losing touch with reality or cause as much disruption in your life.

If not treated, the average manic phase lasts 4 weeks to 4 months.

The manic or hypomanic episode may be followed by a period of normal mood. However, the depressive part of the cycle eventually begins. During the depression:

• You feel drained of energy and motivation.

• You feel worthless, helpless, and hopeless.

• You may have crying spells and may withdraw from social contact, work, and sex.

• You may not be able to concentrate.

• You may lose your appetite, or your appetite may increase.

• You may need more sleep, although if the depression is severe you may have trouble sleeping.

How is it diagnosed?

Your doctor or therapist will ask you or someone close to you about your symptoms and determine whether you have had a manic episode. He or she will try to rule out other possible causes of your symptoms. For example, they could be the result of a medical problem, such as an overactive thyroid gland, or they might be caused by a drug you are taking.

You have probably had a manic episode if:

• You have had a really high or angry mood for a week or more.

• You have had racing thoughts and rapid speech.

• You have had the feeling that you are unstoppable.

• You have been behaving recklessly.

You may have had what is called a mixed episode, if also, during the same period:

• You have had feelings of being hopeless, helpless, worthless, or totally indifferent.

• You have had unexplained crying spells.

• You have withdrawn from activities that you used to enjoy.

• You have been unable to feel and act normally at school, work, or home.

How is it treated?

Bipolar disorder is one of the most well researched mental illnesses. Many very successful treatments have been developed.

Medications are the most important part of treatment. Lithium and Depakote are the most often used and successful drugs for this illness. Sometimes many different drugs are needed. For example, you may need antidepressants, antiseizure medications that work as mood stabilizers, and antipsychotic medication to control the symptoms.

If an episode is severe, you may need to spend some time in a hospital. Because bipolar disorder is usually a lifelong illness, you may have to take medications for the rest of your life. There is a good chance, however, that treatment will allow you to lead a very productive and happy life.

What can I do for myself?

• Make sure you take your medications, even if you are feeling well. You may be tempted to stop taking medication when you are feeling fine, but you will eventually begin to have symptoms again if you stop.

• Do not take any drug that is not legal, especially stimulants such as cocaine. Avoid drinking alcohol as well.

• Watch yourself for symptoms. Identify warning signs and tell your doctor when you feel a manic or depressive episode might be coming on. Ask a family member or close friend to also watch you for warning signs.

• Try to find out whether there are certain conflicts or problems with people that make your disorder worse. Work with your therapist or doctor to develop skills to deal with these problems.

• Make sure you get enough sleep on a regular schedule. Avoid losing sleep, such as when you travel.

• Don't take any medications from another doctor before checking with the doctor treating your bipolar disorder.

• Contact organizations such as the National Depressive and Manic-Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA) for information and support.
  • NDMDA's toll-free telephone number is 1-800-826-3632. Its website address is http://www.NDMDA.org.

  • NAMI's toll-free helpline number is 1-800-950-NAMI. NAMI's website address is http://www.NAMI.org.

  • NMHA's toll-free Information Center number is 1-800- NMHA. NMHA's website address is http://www.NMHA.org.