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
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
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.
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
- 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 is believed to be
inherited in many cases. Despite vigorous research efforts, a
specific genetic defect associated with the disease has not yet
- Recognize the symptoms of depressive disorders, including
- Obtain an accurate diagnosis
- Obtain effective treatments
Bipolar Disorder Involves Cycles of Mania and Depression.
Signs and symptoms of mania include:
- Encourages and trains health care professionals to recognize the
signs of bipolar disorder and utilize the most up-to-date
- 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
- Extreme irritability and distractibility
- Excessive "high" or euphoric feelings
- A sustained period of behavior that is different from usual
- Increased energy, activity, restlessness, racing thoughts, and
- 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
- Obnoxious, provocative, or intrusive behavior
- Denial that anything is wrong
Signs and symptoms of depression include:
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
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.
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 '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
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
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
If left untreated, bipolar disorder tends to worsen, and the
person experiences episodes of full-fledged mania and clinical
- 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
- 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
Most People With Bipolar Disorder Can Be Helped With Treatment.
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:
- Almost all people with bipolar disorder--even those with the
most severe forms--can obtain substantial relief from their mood
- 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
- 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 medications.
- As an adjunct to medications, psychotherapy is often helpful in
providing support, education, and guidance to the patient and
his or her family.
People With Manic-Depressive Illness Often Need Help To Get Help.
- 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
- Often people with bipolar disorder do not recognize how impaired
they are or blame their problems on some cause other than mental
- People with bipolar disorder need 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 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 (NIMH) brings hope to millions of people who suffer from mental
illness and to their families and friends. In many years of work with
animals as well as human subjects, researchers have advanced our
understanding of the brain and vastly expanded the capability of
mental health professionals to diagnose, treat, and prevent mental and
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, manic-depressive illness,
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 Human Services.
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 gratefully acknowledged.
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
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