Understanding and Dealing with Manic Depression (Bipolar Disorder)

By: Michael G. Conner, Psy.D

Revised: May 21, 2014

Bipolar disorder, also known as manic depression, is a mental illness that involves episodes of mania and depression. The person’s mood swings from excessively "high" and irritable to sad and hopeless and then back again, with periods of the person’s mixed or normal mood in between. At least 2 million Americans suffer from bipolar disorder.

Although a specific genetic link to bipolar disorder has not been determined, studies show that 80 to 90 percent of people who suffer from this illness have relatives who have some form of depression. 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.  Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. It can be confused with attention-deficit /hyperactivity disorder, so careful diagnosis is necessary. Some cases of bipolar disorder have a late onset.

Some researchers believe people may inherit a vulnerability to the illness, which can be triggered by psychological, social, health and environmental factors such as stress.  Other research suggests the illness may be caused by biochemical imbalances  which may alter a person’s moods. These imbalances may be due to irregular hormone production or recurrent excessive and deficient neurotransmitters levels.

Some cases of bipolar disorder can be extremely distressing and disruptive.  Like other serious mental illnesses, bipolar disorder is extremely distressing and difficult on spouses, family members, friends and employers. Family members of people with severe  bipolar disorder must cope with many serious behavioral problems and the lasting consequences of these behaviors. In other cases, the disorder is rather minor in terms of the influence it has. There are less intense forms if bipolar disorder that have high and lows that are not severe. In some cases, the lows are not that low or the highs are not that high. 

Bipolar disorder can become disabling, but it is also a treatable or manageable mental illness in most cases. The combination of medications and psychotherapy helps a vast majority of people with this illness return to happy fulfilling lives. 

Bipolar disorder is often difficult to recognize and diagnose. One reason is because of hypomania, which is an early sign of manic depression. Hypomania may cause a person to have a high level of energy, unrealistically expansive thoughts or ideas, tremendous creatviety and impulsive or reckless behavior. These symptoms may feel good to the person, which may lead to denial that there is a problem. In many cases, the symptoms of bipolar disorder will occur with other problems such as substance abuse, poor school performance, or trouble in the workplace.

Symptoms Of Mania

  • Increased energy, activity, restlessness, racing thoughts and rapid talking
  • Denial that anything is wrong
  • Excessive "high" or euphoric feelings
  • Extreme irritability and distractibility
  • Decreased need for sleep
  • Unrealistic beliefs in one’s ability and powers
  • Uncharacteristically poor judgment
  • A sustained period of behavior that is different from the person’s usual behavior
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol and sleeping medications
  • Provocative, intrusive, or aggressive behavior

Symptoms of Depression:

  • Persistent sad, anxious, or empty moods
  • 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, or making decisions
  • Restlessness or irritability
  • Sleep disturbances
  • Loss of appetite and weight, or weight gain

Serious and Critical Symptoms

  • Suicidal behavior, thoughts, feelings
  • Dangerous, threatening or self-harming behavior
  • Extreme neglect and lack of self-care

Most people with bipolar disorder are usually treated with medications such as Lithium which tends to manage mania. Carbamazepine and valproate are two additional medications that were originally used to control seizures.  In some cases they have been found to act as a mood-stabilizers. Benzodiazepines such as Valium, Lorazapam and Ativan are sometimes prescribed for insomnia.

If the person is in the midst of a manic episode, he or she may not recognize or appreciate the impact of their behavior.  They may not feel at risk or that they are taking any risks.  A person in the midst of a manic episode may experience an elevated sense of well being or over confidence that he or she may refuse to get help.  A person who is manic or severely depressed may need to be hospitalized for his or her own protection in order to receive treatment. Education, guidance and support from a psychotherapist is often very helpful when a manic or depressive episode resolves. A therapist can help the person to deal with personal relationships, maintain a healthy self-image and ensure that the person complies with his or her treatment. Psychotherapy can also assist the person in coping with the side-effects of the medications.

Information And Steps You Can Take

  • Seek immediate help if the person has any serious and critical symptoms.
  • Consultation with a qualified mental health professional or crisis intervention specialist is recommended if a person is in the midst of a manic or depressive episode. 
  • Anyone with symptoms of bipolar disorder should have a comprehensive medical, social and psychological evaluation.
  • Ongoing encouragement and support from friends and family are also very important. It may be helpful to join a self-help or support group to help those coping with this illness.
  • Evaluate and address any suicidal, self harming or dangerous behavior.

Copyright 1998 to 2008, Michael G. Conner