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The manic highs and depressive lows of bipolar disorder can be devastating, but treatment ormal y, how happy or sad we trously in debt if they spin out of con- or delusions, or require hospitalization. feel is connected to events in trol. Mania can also lead to sexual Hypo mania may, though, have negative our lives—achievements and indiscretions and hasty, ill-advised consequences if the confidence leads to rejections, love found and loved ones marriages as well as the breakup of excess spending or promiscuity. lost. But in people with mood disorders, established ones. own often unrelated to circumstance. Depressive side of the coin
Mood has been described as our emo- Because mania is the hallmark of bi- gale, Virginia Woolf) may have had bi- tional temperature. With mood dis- polar disorder, the depressive episodes polar disorder, judging by their periods orders, we lose the ability to regulate sometimes get overlooked. But in real- of great productivity and crushing de- ity, people with bipolar disorder spend pression. A new biography of Beethoven Bipolar disorder, once known as much more time depressed than manic. argues that he was bi polar: suicidal at manic-depressive il ness, is a mood dis- Years of depression may go by between times but writing several symphonies order. People with the condition cycle manic episodes. simultaneously at others. If these people The depression experienced by did have bipolar dis order, they might just as the name suggests—at opposite people with bipolar disorder is similar have had a milder form, called bipolar ends of a spectrum. The “up” part of the in many ways to any other significant II, in which depression alternates with cycle is called mania. Untreated, mania depression. People struggle with poor productive hypo mania instead of the can last months, even years. In its self-esteem, concentration, and making depression-mania pattern of bipolar I milder form, it can be pleasant. People decisions. But some research suggests (see graph on next page). feel wonderful—exuberant, energetic, that the depression of bipolar disorder optimistic. They’re charming, outgoing, is distinctive. Bipolar depression may Worst of both
and talkative. They believe their think- lead to excessive sleep and overeating, The depressive and manic aspects of ing is sharper and more creative—and whereas in regular depression, insom- bipolar disorder sometimes overlap so nia tends to be the problem. Bipolar de- people are tense, restless, and despon- But manic episodes tend to cre- pression may come on more abruptly dent at the same time. This combina- scendo. Self-confidence changes into than normal depression, and a study tion goes by several names: mixed state, grandiosity as people imagine they published last year found that fears mixed affective state, dysphoric mania. have special talents and can achieve were more common. Although the manic phase of bi- mixed state, Jamison recounts periods ble thinking accelerates into racing, polar disorder is more likely to result of total despair with terrible agitation jumbled thoughts. Some people lose in emergency hospitalization, the de- that seem to describe the condition. touch with reality and hallucinate or pressive phase may be more dangerous. She says her mind would race from one Bipolar disorder increases suicide risk, gory image to the next, rather than be Mania is sometimes depicted as a and it’s estimated that more than 70% of filled with exhilarating ideas.
happy state of mind, but full-fledged the suicides stemming from the disease episodes can be miserable. People often occur during a depressive episode. A difficult, controversial diagnosis
Bipolar disorder is difficult to diagnose. The mania that people like
Mania also unleashes reckless behav- Instead of mania, a person with bi- up the symptoms. Mania is sometimes ior; a shopping spree is the classic exam- polar disorder may experience a milder mistaken for schizophrenia and the ple. In An Unquiet Mind, psychologist form called hypomania (hypo is Greek mixed state for a personality disorder. Kay Redfield Jamison’s memoir of her for under). People sometimes enjoy— The depressive phase often starts years struggles with bipolar disorder, Jami- indeed, cherish—these episodes. before any mania, so bipolar disorder son writes about purchasing 12 snake- They’re like the beginning stages of is often diagnosed as major depression bite kits in a mania-fueled moment of mania, a “high” of quick and inven- until a manic episode occurs—perhaps tive thinking, bursts of energy, lots of an unavoidable problem until we know Such sprees may seem harmlessly ambition. And, by definition, hypo- more about the disease. And for those odd, but they can land people disas- mania doesn’t include hallucinations with longstanding depression, hypo- 4 | Harvard Health Letter November 2007
mania may be welcomed as a reprieve risk. Doctors sometimes have difficul- been adequately tested as treatment for from the blues rather than an abnormal ty finding a dose that balances safety bipolar depression. They’ve also been mood shift worth bringing to the atten- and comfort with effectiveness. Many known to trigger mania and send some people tolerate lithium wel , but others patients into rapid cycling between Experts used to think the bipolar are bothered by side effects that include mania and depression. A Harvard child was rare. Now many believe that nausea and diarrhea, weight gain, con- study published earlier this year in symptoms often begin to surface early centration and memory problems, and the New England Journal of Medicine in life and, therefore, as many as one low thyroid levels. in every 200 children is affected by the Anticonvulsants. These medica- (Paxil) and bupropion (Wel butrin)—in
disease. Just 10 years ago, the preva- tions were developed to treat seizures, combination with drugs that stabilize Beyond drugs
Adapted from Bipolar Disorder, A Guide for Patients and Families, Second edition (2006), by Dr. Francis Mark Mondimore. Reprinted with permission of the Johns Hopkins University Press.
disorder from attention deficit hyper- but doctors noticed they had mood- time. Patients respond differently to activity dis order (ADHD) in children stabilizing effects. This group includes given medications—and in some cases, is difficult. ADHD has symptoms— valproate (Depakene, Depakote), car- they don’t respond to any. People with impulsiveness, lack of concentration— bamazepine (Epitol, Equetro, Tegretol) bipolar disorder often stop taking their that are similar to some aspects of and lamotrigine (Lamictal). Whether medications or seeing their therapists. mania. About a third of children diag- they’re as effective as lithium is debat- The active involvement of family and nosed with ADHD are eventual y iden- able, but they’re seen as an attractive friends can help keep them on track, alternative to lithium because for some although the shifts from dark depres- A menu of treatments
Antipsychotics. Once limited to again—tend to erode the very support
Medications don’t cure bipolar disorder treatment of psychotic symptoms, the that bipolar patients need.
but can control the symptoms. Drugs antipsychotics are now prescribed for are often taken in combination, and treatment of both the manic and de- tic. People with bipolar disorder can more than 80% of patients take two or pressive phases of bipolar disorder. Psy- lead extraordinarily productive and chiatrists tend to prescribe the newer creative (if trying) lives. Many patients Lithium. This drug has been used for “atypical” antipsychotics, but many anti- today respond to medication. By rein-
about half a century and in some ways psychotics can control symptoms.
Antidepressants. Anti depressants can help ensure that those who possess
for bipolar disorder, particularly for have been a vexing issue in the treat- “unquiet” bipolar minds aren’t quite calming mania and reducing suicide ment of bipolar disorder. They haven’t so troubled. November 2007 Harvard Health Letter | 5

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