Monday, January 10, 2005
(Posted by Hopkins Technology)
WHAT IS BIPOLAR DISORDER?
Bipolar disorder, which is also known as manic-depressive illness and will be
called by both names throughout this publication--is a mental illness involving
episodes of serious mania and depression. The person's mood usually swings from
overly "high" and irritable to sad and hopeless and then back again, with
periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early adulthood and
continues throughout life. It is often not recognized as an illness, and people
who have it may suffer needlessly for years or even decades.
Effective treatments are available that greatly alleviate the suffering
caused by bipolar disorder and can usually prevent its devastating
complications. These include marital break-ups, job loss, alcohol and drug
abuse, and suicide.
Here are some facts about bipolar disorder.
Manic-Depressive Illness Has a Devastating Impact on Many People.
-- At least 2 million Americans suffer from manic-depressive illness. For
those afflicted with the illness, it is extremely distressing and disruptive.
-- 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 it is believed to be
inherited in many cases. Despite vigorous research efforts, a specific genetic
defect associated with the disease has not yet been detected.
D/ART: A National Educational Program
The National Institute of Mental Health (NIMH) has launched the
Depression/Awareness, Recognition, and Treatment (D/ART) campaign to help
-- Recognize the symptoms of depressive disorders, including bipolar
-- Obtain an accurate diagnosis
-- Obtain effective treatments
-- Encourages and trains health care professionals to recognize the signs
of bipolar disorder and utilize the most up-to-date treatment approaches
-- Organizes citizens' advocacy groups to extend the D/ART program
-- Works with business and industry to improve recognition, treatment, and
insurance coverage for depressive disorders
Bipolar Disorder Involves Cycles of Mania and Depression.
Signs and symptoms of mania include:
-- Excessive "high" or euphoric feelings
-- A sustained period of behavior that is different from usual
-- Increased energy, activity, restlessness, racing thoughts, and rapid
-- Decreased need for sleep
-- Unrealistic beliefs in one's abilities and powers
-- Extreme irritability and distractibility
-- Uncharacteristically poor judgment
-- Increased sexual drive
-- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
-- Obnoxious, provocative, or intrusive behavior
-- Denial that anything is wrong
Signs and symptoms of depression include:
-- 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
-- Thoughts of death or suicide; suicide attempts
It may 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.
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"
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
Hypomania: "At first when I'm high, it's tremendous...ideas are fast...like
shooting stars you follow 'til 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 include destruction of personal
relationships, loss of employment, and 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.
-- Also in its early stages, bipolar disorder may masquerade as some
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.
Most People With Bipolar Disorder Can Be Helped With Treatment.
-- Almost all people with bipolar disorder--even those with the most severe
forms--can obtain substantial relief from 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 anticonvulsants carbamazepine and valproate have also
been found useful, especially in more refractory bipolar episodes.
-- For depression, several types of antidepressants can be useful when
combined with lithium, carbamazepine, or valproate.
-- Electroconvulsive therapy (electroshock) is often helpful in the
treatment of severe depression and/or mixed mania that does not respond to
-- As an adjunct to medications, psychotherapy is often helpful in
providing support, education, and guidance to the patient and his or her
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 encouragement from family and friends
to seek treatment. Family physicians can play an important role for such
-- 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
-- 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 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 awhile 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), and
the National Mental Health Association.
-- Families and friends of people with bipolar disorder can also benefit
from mutual support groups such as those sponsored by NDMDA and NAMI.
FOR FURTHER INFORMATION CONTACT:
National Institute of Mental Health
Public Inquiries, Room 7C-02
5600 Fishers Lane
Rockville, MD 20857
National Depressive and Manic Depressive Association
730 Franklin Street, Suite 501
Chicago, IL 60610
(312) 642-0049; (312) 642-7243 FAX; 1-800-826-3632
National Alliance for the Mentally Ill
2101 Wilson Boulevard, Suite 302
Arlington, VA 22201
(703) 524-7600; (703) 524-9094 FAX; 1-800-950-NAMI (6264)
National Foundation for Depressive Illness
P.O. Box 2257
New York, NY 10016
(212) 268-4260; (212) 268-4434 FAX; 1-800-248-4344
National Mental Health Association
1201 Prince Street
Alexandria, VA 22314-2971
(703) 684-7722; (703) 684-5968 FAX; 1-800-969-6942
MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH
Research conducted and supported by the National Institute of Mental Health
brings hope to millions of people who suffer from mental illness and to their
families and friends. During the past 10 years, researchers have advanced our
understanding of the brain and vastly expanded the capability of mental health
professionals to diagnose, treat, and prevent mental and brain disorders.
Now, in the 1990s, which the President and Congress have declared "The Decade
of the Brain," we stand at the threshold of a new era in brain and behavioral
sciences. Through research, we will learn even more about mental disorders such
as depression, bipolar disorder, schizophrenia, panic disorder, and
obsessive-compulsive disorder. And we will be able to use this knowledge to
develop new therapies that can help more people overcome mental illness.
The National Institute of Mental Health is part of the National Institutes of
Health (NIH), the Federal Government's primary agency for biomedical and
behavioral research. NIH is a component of the U.S. Department of Health and
All material appearing in this brochure is in the public domain and may be
reproduced or copied without permission from the Institute; citation of the
source is appreciated.
This publication was written by Mary Lynn Hendrix of the Office of Scientific
Information, National Institute of Mental Health. Expert assistance was provided
by Frederick K. Goodwin, M.D., Robert M. Post, M.D., and Hagop S. Akiskal, M.D.,
NIMH staff members. Their help in assuring the accuracy of this pamphlet is
Monday, January 10, 2005