Bipolar disorder affects mood and thinking

June 20, 2005|by Dr. Matthew Wagner

"My moods are so up and down, doctor. I think I'm bipolar."

In this column, I will describe what bipolar disorder is, how to diagnose it, and what can be done about it.

Bipolar disorder was until recently called manic-depressive illness, which is a more descriptive term for what the condition is like. This is a disorder of mood, thinking and behavior.

For many years, bipolar disorder was easy to recognize and diagnose, based on episodes of extreme euphoria and irritability. These episodes - called manias - are quite out of character for the person with the illness.


Peoople in manic conditions become hyperactive and grandiose, believing, for example, they can accomplish superhuman tasks. They have racing thoughts, engage in reckless behavior, display poor judgment and don't need sleep. Often, they are unable to appreciate how abnormal their behavior is.

Such episodes can go on for weeks and cause trouble due to disregard for others, excessive spending, substance abuse and dangerous behavior.

Hospitalization might be necessary to safeguard the person until the manic symptoms subside. Under the current terminology, this pattern of manic episodes is called bipolar I disorder.

In recent years, doctors and researchers have recognized that some people experience distinct periods of elevated or irritable mood with some of the symptoms of mania, but overall less severe and disabling. This is called hypomania, which might be thought of as "halfway to mania."

These periods might be briefer, lasting days. They often are less obvious to the casual observer and harder for professionals to identify with confidence. This condition is called bipolar II. A number of celebrities have revealed recently that they have this condition, which has increased interest in the general public.

However, hypomanic states can be difficult to distinguish from normal "up" moods or from the irritability that can go with stress, fatigue or other causes. That is why I think this diagnosis should be made with caution and only after a period of working with a mental health professional. As there is no biological test for bipolar disorder, the diagnosis is made on the basis of history, clinical signs and symptoms.

There is evidence of genetic influences, at least for bipolar I disorder. Scientists are getting closer to identifying several genes that might cause this illness in some families.

People with bipolar I and persons with bipolar II experience similar episodes of severe depression and the "down" side of manic-depressive illness. This kind of depression is different from the blues that all of us get at times. People with clinical depression feel low, sad and often hopeless for weeks at a time. His sleep and appetite are disturbed. He loses energy and concentration. He becomes withdrawn and cannot experience pleasure in life. In severe forms, delusional or suicidal thinking might occur.

The depressive side of bipolar disorder can be just as disabling and is often more painful than the manic side.

Fortunately, there is effective treatment for bipolar disorder. The goal of treatment is to prevent episodes of both mania and depression. This illness can reappear even after years of stability, so treatment is usually long-term.

Education and support are important. People with bipolar can help themselves avoid relapses by avoiding substance abuse, managing stress, maintaining consistent sleep-wake schedules and consistently taking their medications.

Medication is almost always necessary. Some medicines help treat and prevent mania and others work for depression. Only one medication, lithium, has been consistently shown to prevent both mania and depression. However, lithium can have a number of side effects and long-term problems.

A full discussion of all the medications used for bipolar disorder is beyond the scope of this article. Patients should consult with specialist physicians to figure out which medication or combination of medications is right for them.

A number of useful books have been written for patients and families. I recommend "An Unquiet Mind" by Kay Redfield Jamison. She is a psychologist at Johns Hopkins who has bipolar disorder and has written about her experience.

Dr. Matthew Wagner is a staff psychiatrist at Behavioral Health Services of Washington County Health System.

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