Bipolar Disorder

A condition (also called manic depression) characterized by extreme mood swings that alternate between depression and mania (a state of exaggerated elation and euphoria).

According to the National Institutes of Mental Health (NIMH), bipolar disorder affects an estimated 2 million Americans (roughly 1% of the population). The disease usually begins in the teens or early 20s and affects males and females equally. Children with attention deficit/hyperactivity disorder (ADHD) are at above-average risk for bipolar disorder: about one in four has or will develop it. Within a 10-year period, a person whose bipolar disorder is not treated with medication usually goes through an average of four depression/mania episodes. However, the pattern varies widely: mood swings can occur as frequently as four or more times a month, or as seldom as once every five years.

Bipolar disorder is the depressive illness considered most likely to have a biological cause, thought to be an imbalance in the brain's chemistry. The condition has also been associated with the biological clock that synchronizes one's internal body rhythms with external events. Bipolar disorder is often inherited. In one study, 25% of children with one manic-depressive parent inherited the disorder, and 75% of children with two manic-depressive parents became manic-depressive. An episode of psychotic depression in teenagers is twice as likely to be followed by a manic episode within five years if there is a family history of bipolar disorder. Also, bipolar disorder is often shared by identical twins.

The depressed cycle of a person with bipolar disorder has the characteristics of major depression. Symptoms include sadness, apathy, and lack of energy. There may also be significant changes in appetite or weight; slowed-down movements; problems with concentration; feelings of worthlessness; guilt feelings; and suicidal impulses. In the manic state, people with bipolar disorder become euphoric: their thoughts race; their speech is rapid and shifts abruptly from one topic to another; they are constantly occupied, attempting to perform many activities at once, and often have trouble sitting still or sleeping; and they also demonstrate an exaggerated sense of self-confidence, manifested by the belief that they can perform extraordinary feats beyond the ability of the average person. Also common are spending sprees, with excessive sums of money spent on frivolous items, and provocative and/or promiscuous sexual behavior. While in a manic phase, persons with bipolar disorder typically resent any criticism of their behavior, and become irritable or angry when others attempt to calm them down, or when they fail to complete all their projects. Hallucinations or delusions may also occur. A symptom of bipolar disorder especially common among teenagers is extreme mood-lability (rapid changes in mood).

Adolescents with bipolar disorder develop normally until the illness first manifests itself. Their lives are then severely disrupted by the illness. In fact, bipolar disorder is especially disruptive to adolescents, more so than to other age groups: major milestones, such as dating, may be delayed for years until the disease is under control. Schoolwork also suffers because cognitive functioning is affected and concentration impaired. Teens with manic depression are likely to abuse drugs or alcohol to alleviate the anxiety caused by the condition—roughly two-thirds of all persons with bipolar disorder have substance abuse or dependency problems. Unless it is treated, the illness gets worse with each episode and harder to control. In addition, 15% of those who fail to receive adequate treatment for bipolar disorder commit suicide. Common misdiagnoses of bipolar disorder include schizophrenia, drug or alcohol dependence, unipolar disorder, and personality disorders. It is common to suffer from bipolar disorder for as long as seven to 10 years without having the condition diagnosed and treated.

Bipolar disorder is most effectively treated by lithium, which can halt episodes of both mania and depression. This medication, which works by stabilizing the brain chemicals responsible for mood swings, is 70% effective in alleviating symptoms of mania, sometimes working within hours and usually within one to three weeks. Antipsychotic drugs or benzodiazepines (tranquilizers) may initially be needed as an emergency measure to treat full-blown mania until lithium can take effect. After manic-depressive symptoms subside, lithium should still be taken as a maintenance drug to prevent future manic episodes. To ensure against toxicity, persons taking the medication must have their blood levels, as well as kidney and thyroid functions, tested regularly. Some manic-depressives are reluctant to give up the "highs" of the manic state and resist taking lithium, or refuse to take the medication because they don't want to become dependent on it. However, discontinuing the medication is risky because lithium treatment can lose some of its effectiveness when it is resumed after being stopped.

Many well-known artists and scientists have suffered from bipolar disorder. According to the NIMH, over one-third of all Pulitzer Prize-winning poets have had symptoms of the disease. Other well-known persons affected by manic depression include painter Vincent van Gogh, writers Sylvia Plath and Virginia Woolf, composers Robert Schumann and Gustav Mahler, and Academy Award-winning actress Patty Duke. In her autobiography, Call Me Anna, Duke, who suffered from bipolar disease for many years before it was diagnosed or treated, describes her experience with the illness and her eventual triumph over it.

Bipolar Disorder

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