Bipolar disorder (manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression). Cycles may be predominantly manic or depressive with normal mood between cycles. Mood swings may follow each other very closely, within hours or days, or may be separated by months to years. These “highs” and “lows” may vary in intensity and severity.
When someone is in a manic “high,” he may be overactive, overtalkative, and have a great deal of energy. He will switch quickly from one topic to another, as if he cannot get his thoughts out fast enough; his attention span is often short, and he can easily be distracted. Sometimes, the “high” person is irritable or angry and has false or inflated ideas about his position or importance in the world. He may be very elated, full of grand schemes which might range from business deals to romantic sprees. Often, he shows poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state.
Depression will show in a “low” mood, lack of energy, changes in eating and sleeping patterns, feelings of hopelessness, helplessness, sadness, worthlessness, and guilt, and sometimes thoughts of suicide.
The medication used most often to combat a manic “high” is lithium. It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions, so that it is used not just for acute manic attacks or flareups of the illness, but also as an ongoing treatment of bipolar disorder.
Lithium will diminish severe manic symptoms in about five to 14 days, but it may be anywhere from days to several months until the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Likewise, antidepressants may be needed in addition to lithium during the depressive phase of bipolar disorder.
Someone may have one episode of bipolar disorder and never have another, or be free of illness for several years. However, for those who have more than one episode, continuing (maintenance) treatment on lithium is usually given serious consideration.