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manic-depressive illness

Understanding bipolar I disorder

Read also about Bipolar II and the mood spectrum

Bipolar disorder, also called manic-depressive illness, is a type of depression characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy, or agitated and irritable. A growing body of research recognizes a "bipolar spectrum" with symptoms of bipolarity occurring along a continuum. Mania and hypomania often affects thinking, judgment, and social behavior. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state. See Symptoms of bipolar disorder.

Causes of depression/bipolar disorder

Because the symptoms, course of illness, and response to treatment vary so much among people with depression, doctors believe that depression may have a number of complex and interacting causes. Research suggests that vulnerability to bipolar disorder results from both genetic and environmental factors. A serious loss, difficult relationship, financial problems, or any stressful (unwelcome or even desired) change in life patterns can trigger a bipolar/depressive episode. The hormonal system that regulates the body's response to stress also is overactive in many depressed people.

Treatment for bipolar disorder

Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out mood swings. Other medications have been found to be effective in controlling mood swings, including some mood-stabilizing anticonvulsants. Most people who have bipolar disorder take more than one medication including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia. Working with a doctor to find the best possible combination of these medications is of utmost importance.

Many forms of psychotherapy can help individuals resolve their problems.

"Behavioral" therapists help patients learn how to get more satisfaction through their own actions and how to unlearn the behavioral patterns that contribute to or result from their disorder. Psychotherapy can help people with bipolar disorder, and their families, identify early warning signs and manage emotional stress, which may help prevent a bipolar episode. Some people with milder forms may do well with psychotherapy alone. Most people with bipolar disorder do best with a combination of medication and psychotherapy.

manic side

Faces of mania

Understanding the manic side of bipolar disorder

The doctor knew

He knew the minute she walked into the room that his patient was beginning a manic episode. He knew by the passionate-purple lipstick that streaked her lips. It always began this way. He’s been her doctor for 15 years and he knows what comes next. Soon, she’ll begin to think faster and talk faster. She’ll become charming and vivacious; her dates will find her irresistible. Usually quiet and modest, she’ll begin to dress provocatively and behave recklessly. The doctor will act quickly and aggressively with medications, even hospitalization, if necessary. He’s a firm believer in the common theory of “kindling:” that each unchecked manic episode leads to more frequent and more severe episodes that will be more resistant to treatment. Another patient, a business man in his 40s, rises after four hours of sleep, exercises, gulps coffee, heads for work where he just got a promotion. He’s started using cocaine; drinks his lunch. He feels invincible, that he can’t fail. He’s beginning to make dangerous business decisions. His insomnia is getting worse. He’s becoming more irritable. The doctor recognizes that he’s crossing over into mania.

Symptoms of bipolar mania vary from person to person.

A man who’s usually quiet and agreeable becomes irritable. Generally not one to speak up, he begins to dominate meetings at work and becomes increasingly competitive. He can’t stand having anyone driving slower or faster than he is and his driving becomes dangerous. He feels aimless. His doctor, who’s been treating him for bipolar disorder for many years, recognizes the signs of his mania weeks before he himself does. He doesn’t become euphoric. “He becomes like a clockwork toy that needs to be wound up again,” says the doctor. One woman becomes unusually mistrustful of her friends and suspicious of her husband as she becomes manic. One man starts sending long emails, then stops sleeping just before developing a full-blown manic episode. Recognizing early signs is crucial for treatment to be successful, says Igor Galynker, MD. “By the time a patient is not sleeping, is feeling invincible and is making bad decisions, it may be too late,” he says. “It may take six months before the person recovers completely.”

Many people living with bipolar disorder don’t recognize the signs of their mania. The change can be gradual. Others don’t want to acknowledge it because the “highs” of a manic state can, for some, be addictive, like a drug. A psychiatrist, who is trained to observe subtle changes, can often recognize the onset of mania even if they don’t see the patient often. Family members are in the best position to notice early warning signs, says Dr. Galynker, who is Director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in Manhattan. If you or someone close to you is exhibiting early signs of a manic episode, it's important to see a doctor immediatley so that treatment can be started or adjusted.