Bipolar disorder is a recurrent illness that involves long-term, drastic changes in mood. A person with bipolar disorder experiences alternating highs (mania) and lows (depression). A manic period can be brief, lasting from three to 14 days, or longer, lasting up to several weeks. The depressive periods may also last from days to weeks or even six to nine months. The periods of mania and depression range from person to person many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder.

The “highs” or manic episodes are characterized by extreme happiness, hyperactivity, little need for sleep and racing thoughts, which may lead to rapid speech. Symptoms of the “lows” or depressive periods include extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder has three years of normal mood between episodes of mania or depression.

Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from functioning normally. The emotions, thoughts and behavior of a person with bipolar disorder are beyond his control friends, co-workers and family must intervene to protect his interests. This makes the condition exhausting not only for the sufferer, but for those in contact with him as well.

Bipolar disorder can create many difficulties. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending and risky sexual behavior.

During severe manic or depressed episodes, people with bipolar disorder may have symptoms that overwhelm their ability to deal with reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a “natural high”) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect every aspect of a person’s life.

Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness and/or episodes is particularly important. Patients who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.

Who gets bipolar disorder?

Bipolar disorder strikes about two million people in the United States. Both men and women are affected at the same rate. Differing rates of bipolar disorder have not been reported for different races. Although race was once considered a factor for developing bipolar disorder, it did not seem to have an effect when other factors such as socioeconomic status and age were taken into account. Lower socioeconomic status may be slightly linked to a higher rate of bipolar disorder. Bipolar disorder is more common in those who have a sibling or parent with the illness and in families having several generations affected with mood disorders.

The estimated average age for the onset of bipolar disorder is during the early 20s, although the illness may begin as early as when a child enters elementary school. In fact, the illness appears before age 20 in about one in five manic individuals.

Younger patients first may suffer cyclothymia. Although people with cyclothymia display less intense symptoms, nearly half of them will progress to having a full manic episode. Younger patients who have full manic episodes are called juvenile bipolar patients.