Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

What Are the Symptoms of Bipolar Disorder?
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can’t concentrate well
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, a feeling of fatigue or of being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much, or can’t sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus, even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Aperson may have a very sad, hopeless mood while at the same time feeling extremely energized. Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless.... [I am] haunt[ed]... with the total, the desperate hopelessness of it all.... Others say, “It’s only temporary, it will pass, you will get over it,” but of course they haven’t any idea of how I feel, although they are certain they do. If I can’t feel, move, think, or care, then what on earth is the point?

Hypomania: At first when I’m high, it’s tremendous... ideas are fast... like shooting stars you follow until brighter ones appear... All shyness disappears, the right words and gestures are suddenly there... uninteresting people, things become intensely interesting. Sensuality is pervasive; the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria... you can do anything...but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many... overwhelming confusion replaces clarity... you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened... everything is now against the grain... you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore,recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

• Talking about feeling suicidal or wanting to die
• Feeling hopeless, that nothing will ever change or get better
• Feeling helpless, that nothing one does makes any difference
• Feeling like a burden to family and friends
• Abusing alcohol or drugs
• Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
• Writing a suicide note
• Putting oneself in harm’s way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is: Call a doctor, emergency room, or 911 right away to get immediate help Make sure you, or the suicidal person, are not left alone Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When 4 or more episodes of illness occur within a 12-month period, a person is said to have rapidcycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below—How Is Bipolar Disorder Treated?). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time, a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorderrather, many factors act together to produce the illness.

How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, longterm preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness.This chart also can help the doctor track and treat the illness most effectively.

Medications
Medications for bipolar disorder are prescribed by psychiatrists —medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as “mood stabilizers” usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

A Long-Term Illness That Can Be Effectively Treated Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

FURTHER INFORMATION

Child & Adolescent Bipolar Foundation
1187 Wilmette Avenue, PMB #331
Wilmette, IL 60091
Phone: (847) 256-8525
Web site: www.bpkids.org

Depression and Related Affective Disorders
Association (DRADA)
2330 W. Joppa Road, Suite 100
Lutherville, MD 21093
Phone: (410) 583-2919
Web site: www.drada.org
E-mail: drada@jhmi.edu

National Alliance for the Mentally Ill (NAMI)
Colonial Place Three
2107 Wilson Blvd., 3rd Floor
Arlington, VA 22201-3042
Toll-Free: 1-800-950-NAMI (6264)
Phone: (703) 524-7600
Fax: (703) 524-9094
Web site: www.nami.org

Depression & Bipolar Support Alliance (DBSA)
730 North Franklin Street, Suite 501
Chicago, IL 60610-7224
Toll-Free: 1-800-826-3632
Phone: (312) 642-0049
Fax: (312) 642-7243
Web site: www.DBSAlliance.org

National Foundation for Depressive Illness, Inc.
(NAFDI)
P.O. Box 2257
New York, NY 10116
Toll-Free: 1-800-239-1265
Web site: www.depression.org

National Mental Health Association (NMHA)
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22314
Phone: 1-800-969-6642 or (703) 684-7722
TTY-800-433-5959
Web site: www.nmha.org