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Bipolar Disorder

A condition (traditionally called manic depression) in which a person alternates between the two emotional extremes of depression and mania (an elated, euphoric mood).

Bipolar disorder is classified among affective disorders in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders . The National Institute of Mental Health (NIMH) estimates that about one in one hundred people will develop the disorder, which affects some two million Americans. While this condition occurs equally in both males and females and in every ethnic and racial groups, it is more common among well-educated, middle- and upper-income persons. Those suffering from untreated bipolar disorder will generally experience an average of four depression/mania episodes in a ten-year period. However, some people go through four or more mood swings a month, while others may only experience a mood swing every five years. The onset of bipolar disorder usually occurs in the teens or early twenties.

Of all types of depressive illness, bipolar disorder is the one that is most likely to have biological origins, specifically an imbalance in the brain's chemistry. Genetic factors play an important role in the disease. In one study, one-fourth of the children who had one manic-depressive parent became manic-depressive themselves, and three-fourths of those with two manic-depressive parents developed the disorder. The likelihood of bipolar disorder being shared by identical twins is also exceptionally high. Manic depression has also been associated with the "biological clock" that synchronizes body rhythms and external events.

The depressed state of a person suffering from bipolar disorder resembles major depression. It is characterized by feelings of sadness, apathy, and loss of energy. Other possible symptoms include sleep disturbances; significant changes in appetite or weight; languid movements; feelings of worthlessness or inappropriate guilt; lack of concentration; and preoccupation with death or suicide. When they shift to a manic state, people with bipolar disorder become elated and overly talkative, speaking loudly and rapidly and abruptly switching from one topic to another. Plunging into many work, social, or academic activities at once, they are in constant motion and are hyperactive. They also demonstrate grandiosity— an exaggerated sense of their own powers, which leads them to believe they can do things beyond the power of ordinary persons. Other common symptoms include excessive and/or promiscuous sexual behavior and out-of-control shopping sprees in which large amounts of money are spent on unnecessary items. People in a manic phase typically become irritable or angry when others try to tone down their ideas or behavior, or when they have difficulty carrying out all the activities they have begun. Mania may also be accompanied by delusions and hallucinations.

Mania creates enormous turmoil in the lives of its victims, many of whom turn to drugs or alcohol as a way of coping with the anxiety generated by their condition—61 percent of persons with bipolar disorder have substance abuse or dependency problems. In addition, 15 percent of those who fail to receive adequate treatment for bipolar disorder commit suicide. The disease may be misdiagnosed as schizophrenia, unipolar depression, a personality disorder, or drug or alcohol dependence. Individuals commonly suffer from it for as long as seven to ten years without being diagnosed or treated.

However, effective treatment is available. Lithium, which stabilizes the brain chemicals involved in mood swings, is used to treat both the mania and depression of bipolar disorder. This drug, which is taken by millions of people throughout the world, halts symptoms of mania in 70 percent of those who take it, usually working within one to three weeks—sometimes within hours. Antipsychotic drugs or benzodiazepines (tranquilizers) may initially be needed to treat cases of full-blown mania until lithium can take effect. Persons taking lithium must have their blood levels, as well as kidney and thyroid functions, monitored regularly, as there is a relatively narrow gap between toxic and therapeutic levels of the drug. Since lithium also has the ability to prevent future manic episodes, it is recommended as maintenance therapy even after manic-depressive symptoms subside. Some persons resist remaining on medication, however, either because they fear of becoming dependent on the drug or because they are reluctant to give up the "highs" or alleged creativity of the manic state. However, psychiatrists have reported instances in which lithium was not as effective after being discontinued as it had been initially.

Many great artists, writers, musicians, and other people prominent in both creative and other fields have suffered from bipolar disorder, including composers Robert Schumann and Gustav Mahler, painter Vincent van Gogh, writers Virginia Woolf and Sylvia Plath, and actresses Patty Duke and Kristy McNichol. The NIMH reports that 38 percent of all Pulitzer Prize-winning poets have had the symptoms of bipolar disorder.

Further Reading

Duke, Patty. Call Me Anna. New York: Bantam, 1987.

Jamison, Kay. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. New York: Free Press, 1993.

Additional topics

Psychology EncyclopediaDiseases, Disorders & Mental Conditions