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Roller Coaster from Hell!!

Bipolar Affective Disorder - An Overview

Many people have heard the term "Bipolar Affective Disorder " or "Manic Depressive Illness" as it was formerly called, and are aware that it is a major mental disorder. they may also be aware that it is thought to be caused by a " chemical imbalance"and is responsive to medication. Most people know that Bipolar Affective Illness is an illness of mood or affect, cycling from states of mania to depression. It is no mistake that the last two articles in the mental health topic were written on Major Depression. Bipolar (literally, "having two poles") consists of major depression at the lower level, and mania at the upper level. This article will mostly concern the manic and hypomanic symptoms and treatment. For information on the depressive end see the Depression articles.


In 1979 I was diagnosed with Bipolar Affective Disorder. Having ridden the roller coaster for nearly twenty years I have learned first hand what it is all about. I have also continuously educated myself, been involved with other bipolars individually and in support groups and kept abreast of research and new happenings in the Bipolar field. To read my story go to the About Us section on this site…Collie’s story. Also on my site you will find the personal stories of bipolar friends who kindly took the time to write and send them to me. If you are bipolar and enjoy writing I would be pleased to hear from you. Thank you.


Bipolar Affective Disorder, first identified in the early 1900's causes a wide range of symptoms from those covered in the articles on major depression to the following symptoms of mania.

1. Changes of Mood: For a distinct period of time. Feeling happy,

optimistic, euphoric, irritable, "on top of the world" 2. Changes of

thinking: Speeding thoughts, unrealistic self confidence, difficulty in

concentration, grandiose plans and schemes,


3. Changes in Behavior: Increased activity and socialization,

immersion in plans and projects, talking rapidly and much more

than usual, excessive spending, impaired judgement, impulsive

sexual involvement.

4. Changes in Physical Self: reduced need for sleep, increased

energy and stamina, fewer health complains.

Nine out of ten bipolars experience both mania and major



The cycles of the disorder vary. The periods between episodes, depression, and mania or hyomania may become shorter or longer.

Most people with bipolar have periods of normal moods between episodes. Rapid cycling (which occurs in more women than men) consists of four or more manic or depressive episodes in a year, lasting for at least 24 hours and ending with a switch to the opposite psychological state.

Ultra rapid cycling and even ultra ultra cycling have been indentified where moods may change daily or within a day. Some bipolars cycle continuously with rarely a nornal mood achievement.

Bipolar Affective Illness can follow a seasonal path with individuals sinking into depression at certain times of the year then swinging into manic or hypomania a few months later.


Bipolar I: Always includes at least one episode of mania or mixed episode. Alternating periods of severe mania and depression often requiring hospitalization.

Bipolar II: Severe depression alternating with hypomania (milder than mania)

Biopolar III: Cyclothymia: Milder depression and hypomania


Approx one in one hundred people develop a bipolar disorder. Two million american adults are bipolar.


Bipolar disorders hve long been linked with creativity, The artistVincent Van Gogh, composers Robert Schumann and George Frederich Handl, poets Robert Lowell and Sylvia Plath, and writers Virginia Woof and Ernest Hemingway all suffered from "this brilliant madness". In all of my years of meeting with bipolars there is not one that I can think of who does not express creativity in one form or another.


Hypomania literally means "less than mania." It is a state of elevated mood that usually begins suddenly and can be quite pleasurable. It may be sustained for a short or longer period of time, or sometime will intensify rapidly day by day to the point of mania.


1. A distinct change from usual mood to one of sustained elevation,

expansion or irritability, lasting at least for four days.

In addition to a clearly different mood, three of the following (four if the

mood change is irritability only) are significantly present.

a. inflated self-esteem and grandiosity

b. decreased need for sleep (rested after 3 hours)

c. talking constantly and rapidly (and feeling the need to continue)

d. the feeling that one's "thoughts are racing." Flight of ideas.

e. distractibility

f. increase in social, work, school and sexual activity. Restlessness

and agitation.

g. excessive involvement in pleasurable activities. Possible painful

consequences from buying sprees or sexual indiscretions.

An unequivocal change in functioning that is not characteristic of th


Others can observe the changes.

Episode is not severe enough to cause significant impairment in

social or occupational functioning, does not require hospitalization

and does not include psychoses.

Episode is NOT due to effects of medication, an illicit drug, or a

medical condition.


Mania is hypomania intensified. Normal mood changes to one that is increasingly impulsive, emotional, irritable or angry. The euphoria of a person in a manic state is so intense that not even a family tragedy or terrible disaster can destroy their high, yet if their plans are frustrated, their boisterous sense of well-being may turn to irritation that quickly shifts to uncontrolled fury. Some people typically become hostile, rather than joyous; a few become paranoid and violent and may assault others, verbally or physically.

A friend of mine one time, in such a manic state, was asked to leave an establishent he was playing pool at. When he left he kicked in the plate glass door, then continued along the street doing the same thing to several other doors and windows until he was stopped. Another friend working in a video store took exception to something his boss said, and, when his boss left, he trashed the store...throwing computers to the floor. There was thousands of dollars in damage. Such is mania!!


Mania is a distinct period of an abnormally and persistently elevated,

expansive, or irritated mood, lasting at least one week or requiring


Three of the following symptoms (four if the only mood change is

increased irritability) have occurred to a significant degree.

a. inflated self-esteem/grandiosity

b. decreased need for sleep

c. pressure of speech, more talkative than usual.

d. racing thoughts, flight of ideas

e. distractibility

f. increase in goal-directed activity (social, sexual, school, work)

g. excessive activity in pleasurable activites likely to lead to painful


Marked Impairment in ability to work or engage in usual social

activites or relationships, or a need for hospitalization to prevent harm

to the person or others.

The episode is not directly due to medications, illicit drugs or a

medical condition.



Treatment is necessary. As many as fifteen percent of bipolars who receive no or inadequate treatment commit suicide. Mania can quickly be followed by depression, and the risk of suicide is especially high when individuals become aware of their manic bahavior and feel ashamed or remorseful about what they did. Mania can cause many personal and social complications: marital problems, divorce, business difficulties, lost jobs, bankruptcy, unsafe sexual encounters, illegal activities, and accidents. (Most bipolars identify with some of these.) Treatment by medication is essential. Psychotherapy plays a critical role in helping individuals to understand their illness and to rebuild their lives.


Lithium Carbonate is, and remains, the medication of choice for bipolar affective disorder. It is a mood stabilizer, used to treat both manic and depressive episodes, and as maintenance therapy to prevent recurrences of mania. Effective in about seventy percent of bipolars lithium is often the "first choice" drug.

Anti-convulsants such as depakene, tegretol, lamictal and neurontin, have proved to effectively stabilize mood. New ones are being produced all the time. Either used alone or in conjunction with lithium they can be very effective.

Anti-psychotic medications are prescribed as required for delusions, hallucinations and paranoia.

Anti-depressant medications can be used for the "depressive end" of the illness, though they must be used with caution to prevent the occurrence of mania.

Other medications are prescribed as necessary.


Psychotherapy has not proved effective in treating an acute mania, nor does it affect the long term course of bipolar disorder. It does, however, enable the bipolar to learn to cope with the emotional roller coaster of the transition of a period of mania to depression.


Individuals with severe mania or severe depression need hospitalization to avoid physical harm to themselves or others.


Bipolar affective disorder can be very frightening and isolating. An individual suddenly thrust into the world of the Mentally Ill, feels abandoned. The ability to reach out for contact with others who truly understand, the individuals who also struggle with the illness is important, and sometimes a life-saver.

Self help groups are springing up all over the country. There is support available on line and more and more is becoming available.


Bipolar illness is especially hard for friends and family members. It is baffling and troublesome to watch the transformations that take place and they are never sure of "which person" they are dealing with. Mania creates "a monster" and the manic appears to be enjoying himself while alien and alienating ways. Then they may quickly slide into a depression so disabling they may not be able to communicate at all. These behaviors are threats to personal relationships and family functioning.


Bipolar affective disorder can be a destructive and disabling disorder. Active solutions are being sought. Education is becoming widely available and the stigma of the illness is lessening as bipolars speak out in defense of themselves. The ultimate solution? A cure, of course!!! In the meantime, new treatments continue to make it easier to cope.


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