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Bipolar disorder is often called by its older name, manic-depressive illness, because people with the illness can have both manic (high) and depressive (low) episodes. The current term, bipolar, refers to the two poles of the illness, up and down.

Everyone has ups and downs. Most of us feel somewhat blue or delighted or irritated depending on daily circumstances. In bipolar disorder, however, moods are very different from normal mood. Although, to the untrained eye, the presence of mania may not be obvious, it is usually clear that something is wrong -- for example, the person may be unusually extravagant or nasty, or may be sleeping very little.

Mood disorders are grouped by type of mood (whether low or elevated) and by severity. The hallmark of bipolar disorder is the manic episode, a period of extreme elation or irritability. During such periods, an individual will likely have a decreased need for sleep and may have an expansive or grandiose sense of self. Thinking and talking may speed up, with speech sometimes called "pressured."

A person can become very active, but in a scattered and unproductive way, sometimes with painful or embarrassing consequences. Examples are spending more money than is wise or getting involved in sexual adventures that are later regretted. What sometimes distinguishes mania is that a person makes these choices without giving any thought to the repercussions.

Of course, it would not be bipolar illness without two poles.

The vast majority of people with bipolar disorder do become depressed at some point. Along with a distinct low mood, there may be a change in weight or appetite (up or down), disturbed sleep, low energy, poor concentration, feelings of guilt, a lack of interest in usually pleasurable things, and thoughts of death or suicide.

Sometimes both manic and depressive symptoms overlap or alternate rapidly. In that case, it is called a mixed episode. It may be difficult to tell whether depression or mania is the predominant mood.

Some people with bipolar disorder develop psychotic symptoms. The term psychosis refers to a problem in making judgments about reality. Examples of psychotic symptoms are delusions (false beliefs) and hallucinations (false perceptions). Typically, during a manic episode, delusions are grandiose (if the mood is elevated) or paranoid or suspicious (if the mood is irritable).

In bipolar disorder, both manic and depressive episodes are quite likely to recur, especially if the person does not seek treatment.

Bipolar disorder occurs in approximately one percent of the general population. Unlike other depressive disorders, where women are more frequently diagnosed, the incidence of bipolar disorder is about equal in men and women.

The most important risk of bipolar disorder is the risk of suicide. Also, there is a high incidence of alcohol and substance abuse and, during manic periods, people may run into trouble with the law. The poor judgment and irrationally exuberant behavior seen during a manic episode can ruin lives, either through self-destructive spending or through embarrassing dealings or hurtful relationships.

If you suspect that you or a loved one has bipolar disorder, seek an evaluation with a psychiatrist. It is often difficult to overcome the reluctance to get a consultation, but treatment can make a dramatic and helpful difference.

In bipolar disorder, the first line of medication treatment includes drugs called mood stabilizers, which are different from antidepressants. Also, if psychosis is part of the illness, drugs called antipsychotics may be prescribed. Psychotherapy is important, too, because it will help a person come to terms with the illness and the problems caused by the illness.


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