Bipolar Disorder

young african american man sitting with head

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,1 or about
1 percent of the population age 18 and older in any given year,2 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.

“Manic-depression distorts moods and thoughts, incites dreadful behaviors,
destroys the basis of rational thought, and too often erodes the desire and will
to live. It is an illness that is biological in its origins, yet one that feels
psychological in the experience of it; an illness that is unique in conferring
advantage and pleasure, yet one that brings in its wake almost unendurable
suffering and, not infrequently, suicide.”

“I am fortunate that I have not died from my illness, fortunate in having
received the best medical care available, and fortunate in having the friends,
colleagues, and family that I do.”

Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p.
(Reprinted with permission from Alfred A. Knopf, a division of Random
House, Inc.)

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

A manic episode is diagnosed if elevated mood occurs with three or more of
the other symptoms most of the day, nearly every day, for 1 week or longer. If
the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a
depressive episode) include:

  • 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 five 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. A person may
have a very sad, hopeless mood while at the same time feeling extremely

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