Navigation:

"Depression and manic depression are treatable medical illnesses. They are not character weaknesses. You can't develop these disorders from listening to too much Puccini or reading too much Poe. You won't catch depression from doorknobs or from the guy sitting next to you on the bus. And you can't make yourself feel better by trying to "snap out of it" or "lighten up."

"There is no room for shame . . . or blame . . . or misinformation."

--from the National Depressive and Manic Depressive Association web page

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life, although it can begin at any time. Sometimes its symptoms are subtle enough that it is often not recognized as an illness, although it has a profound impact on a person and their daily interactions, nonetheless.  Other times, the manic and depressive symptoms are quite pronounced, often requiring hospitalization.

It's estimated that as many as 2/3 of the people in the United States who are experiencing some form of bipolar illness are undiagnosed, misdiagnosed, or being poorly treated for this illness.  Some of this is due to a hesitation to seek proper treatment because of the stigmas which still surround mental illness in our society.  Some problems are associated with a mental health care system (particularly within the context of managed care) which has a long way to go before it will achieve parity with the system in place for physical illnesses.  Of course, the performance of mental health professionals can also vary widely.

Manic depressive illness can also be misdiagnosed as "uni-polar" depression -- depression without mania.  The treatment recommended for bipolar illness is significantly different than that for unipolar depression.  For example, anti-depressants which may produce relief for the depressive part of the bipolar cycle might send someone into an uncontrolled mania in the absence of a correct bipolar diagnosis and appropriate treatment program.

As a consequence, people experiencing "bi-polar" moodswings may suffer needlessly for years or even decades. People with bipolar illness need not settle for inadequate and inappropriate treatment.  Medical science is making new strides each day in the treatment of this illness.  With proper support and advocacy, most people can find the right diagnosis and a program of treatment that works for them.

Indeed, a multitude of effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. (These complications can include marital and other relationship problems, job loss, alcohol and drug abuse, and suicide.)

Some relevant facts:

• At least 2 million Americans suffer from manic-depressive illness. For those afflicted with the illness, it can be extremely distressing and disruptive, especially if it goes untreated.
• Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
• Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.
• Bipolar disorder tends to run in families and is believed to be inherited in many cases.
• Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. It can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.
• The risk of suicide is one more important reason for persons with bipolar illness to seek proper treatment.  The statistics are sobering. The mortality rate is higher than many forms of heart disease or cancer.  Historically, as many as 1 in 5 people with bipolar disorder have committed suicide.  This is a rate approximately 30 times greater than that of the general population.  While these statistics are intimidating, they do not represent destiny.  With new understandings and new developments in the treatment of this illness, a person receiving proper support and treatment has every reason to trust that they can not only survive this illness, but thrive in their daily lives.

RECOGNITION

Bipolar disorder involves cycles of mania and depression.

Signs and symptoms of mania include discrete periods of:

• Increased energy, activity, restlessness, racing thoughts, and rapid talking
• Excessive "high" or euphoric feelings
• Extreme irritability and distractibility
• Decreased need for sleep
• Unrealistic beliefs in one's abilities and powers
• Uncharacteristically poor judgment
• A sustained 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

Signs and symptoms of depression include discrete periods of:

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, a feeling of fatigue or of being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleep disturbances
• Loss of appetite and weight, or weight gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical disease
• Thoughts of death or suicide; suicide attempts

Various types of bipolar illness exist along a spectrum of severity, although the labels attached to these different manifestations of the illness may have little practical value at any given time.  Bipolar I is generally defined as occurring when a person has experienced at least one major manic episode (one which likely required hospitalization) at some point during their lifetime, in addition to severe depression.  Bipolar II is generally characterized by moodswings that diverge into a more moderate mania, or hypomania, in addition to depression, which can also be quite severe.  Cyclothymia is characterized by significant, but somewhat less extreme, moodswings.

In general, it may also be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania (as manifested in Bipolar I).

Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (Bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single "mixed" bipolar state.

Finally, a person with bipolar disorder doesn't generally have an episode of depression, then an episode of mania, in equal amounts. Although it is true that "what goes up, must come down," the cycles are often unpredictable and of varying length.

Many people cycle only once every few years. Rapid cyclers go through four or more episodes of mania and depression per year. Ultra-rapid cyclers have episodes shorter than a week. Ultradian cyclers have distinct and dramatic moods shifts within a 24-hour period.

Descriptions provided by patients themselves offer valuable insights into the various mood states associated with bipolar disorder:

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.

Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which can include destruction of personal relationships, loss of employment, and, in extreme cases, suicide.

Manic-depressive illness is often not recognized by the patient, relatives, friends, or even physicians.

• An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior.
• Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.
• In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.
• If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.

TREATMENT

Most people with manic depressive illness can be helped with treatment.

• Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.
• One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
• Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate (also known as depakote) have been found useful, especially in cases that have proven more resistant to treatment. Often these medications are combined with lithium for maximum effect.
• Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.
• Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
• Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania.
• The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia.
• Adequate and regular sleep is an important factor in preventing moodswings, particularly in terms of the prevention of manic episodes.
• Moderate exercise has proven to be an invaluable tool in warding off depression, and increasing overall stability of mood.
• Thyroid augmentation may also be of value.
• For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.  However, there is a risk that some antidepressants may push a patient out of depression beyond a normal range of mood into mania.  Some antidepressants are better than others for the treatment of bipolar illness in this respect, it has been found.  Given these risks, close collaboration with a trusted psychiatrist in battling depression is imperative.
• Some medications may sometimes produce a range of undesirable side effects, especially in the early stages of treatment.  This is also reason for ongoing contact with a trusted doctor who is willing to work with the patient in arriving at a treatment program that gets at the underlying illness with a minimum of accompanying discomfort caused by such side effects.
• Electroconvulsive therapy (ECT) is sometimes believed to be helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.  It should be noted that -- due in large part to past abuses of this type of therapy -- this is a treatment which remains controversial in many circles.  Memory loss and other side effects can result from ECT.  However, many psychiatrists argue that ECT is a humane treatment of last resort in cases of debilitating depression where a patient has been unresponsive to other forms of treatment.  Regardless, a person contemplating ECT (and their family) must make an informed decision based on a realistic assessment of the perceived risks and benefits.
• There is no such thing as a "magic pill."  Rarely will medication alone be enough to help someone with bipolar disorder recover from the disruption caused by the illness on the path to resuming their lives.  As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
• Many people with bipolar illness also benefit greatly from peer-to-peer support, gaining insights and inspiration from other people with similar challenges and experiences.
• Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.
• Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.  A natural reaction when someone feels better is to stop taking their medication, however, for the person with bipolar illness, this can have disastrous consequences. Living with bipolar illness requires a period of adjustment as one adapts to the notion of needing medication and good self-care strategies in place for the long-term.   However, for the vast majority of people with this illness, proper treatment will result in a significant increase in the quality of that person's life.

Getting Help

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease.

Other mental health professionals, such as psychologists and psychiatric social workers, can assist in providing the patient and his or her family with additional approaches to treatment.

Help can be found at:

• University- or medical school-affiliated programs
• Hospital departments of psychiatry
• Private psychiatric offices and clinics
• Health maintenance organizations
• Offices of family physicians, internists, and pediatricians

People With Manic-Depressive Illness Often Need Help To Get Help.

• Often people with bipolar disorder do not recognize how impaired they are or blame their problems on some cause other than mental illness.
• People with bipolar disorder need strong encouragement from family and friends to seek treatment. Family physicians can play an important role for such referral.
• If this does not work, loved ones must take the patient for proper mental health evaluation and treatment.
• If the person is in the midst of a severe episode, he or she may have to be committed to a hospital for his or her own protection and for much needed treatment.
• Anyone who is considering suicide needs immediate attention, preferably from a mental health professional or a physician; school counselors and members of the clergy can also assist in detecting suicidal tendencies and/or making a referral for more definitive assessment or treatment. With appropriate help and treatment, it is possible to overcome suicidal tendencies.
• It is important for patients to understand that bipolar disorder will not go away, and that continued compliance with treatment is needed to keep the disease under control.
• Ongoing encouragement and support are needed after the person obtains treatment, because it may take a while to discover what therapeutic regimen is best for that particular patient.
• Many people receiving treatment also benefit from joining mutual support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), the National Mental Health Association and other support and advocacy groups.
• Families and friends of people with bipolar disorder can also benefit from mutual support groups such as those sponsored by NDMDA and NAMI.
• Some people also benefit from their involvement in consumer mental health groups which exist in part to battle the stereotypes, stigmas and discriminatory effects associated with having a mental illness.  Consumer groups may be geared toward political work, social support, or both.
• In most states, legal advocacy groups exist for people with mental illnesses seeking redress from institutions or mental health care providers that may have abused or disserved them.
• While no generalization -- negative or positive -- will necessarily hold true for a given individual, there is evidence to suggest that people with bipolar disorders are found in disproportionate numbers among those who make significant creative contributions to our society. Some people have also noted an increased empathy and sensitivity that have resulted from their encounters with the extremes of human emotion. Discovering who you are at the core, in the midst of the emotional turmoil caused by this disease, is not an easy road.  Part of the challenge of living with bipolar disorder is to identify a treatment program which allows one to remain unencumbered by the illness's excesses, while retaining the "gifts" this illness brings.
• As is evidenced by this site, and the wealth of information listed on our links page, much help is now also available for people with bipolar illness through the various media of the Internet.  Regardless of where a person finds it, one truth rings universally true -- a person with bipolar illness (and that person's loved ones) need not go through this experience alone.  Information and support are there for you once you begin to take steps to find them.

Sources: Adapted from The National Institute of Mental Health: Bipolar Disorder web site with additional source material from Joy Ikelman's Cybersite: Bipolar Disorder Pages and The National Depressive and Manic Depressive Association web page  

 It is estimated that over 17.4 million adults in the U.S. suffer from a depressive or manic depressive disorder each year--that's one out of every seven people. If you are not affected now, chances are that at some point in your life, you yourself or someone you know will become affected.

Empowerment, information and support can make that road a much easier one.  Don't try to do it alone.  Decreasing the isolation is the first step.  At the Harbor of Refuge, we understand your struggle.  A listening ear and sympathetic heart will always be found here.