Bipolar Disorder: An Illness of Excess
|Copyright (c) 2007 by Kevin Thompson.
||Reprinted by BellaOnline
Bipolar disorder is a condition that is relatively unfamiliar, but
The National Alliance on Mental Illness (at www.nami.org
) puts the
number of Americans who have bipolar disorder at 10 million, comparable
to the 15 million who have depression, and many more than the 2 million
who have schizophrenia. Yet while most people have at least a vague
notion of what depression and schizophrenia are, the same is not true
for bipolar disorder.
The confusion over just what defines bipolar disorder is probably due
to the complexity of the illness, which defies simple description.
While all mental illnesses have their complexities, simplified
descriptions of depression as "extreme sadness," and schizophrenia as
"having hallucinations," do provide basic guidance about core issues of
these disorders. However, bipolar disorder is not as easy to summarize.
Psychiatrists and psychologists speak of bipolar disorder as being
characterized by two sets of symptoms, labeled mania and depression.
Since it is the presence of mania that distinguishes bipolar disorder
from ordinary depression, it is important to understand just what is
meant by the term.
The symptoms of mania are commonly described as elation, irritability,
increased energy, racing thoughts, racing speech, ambition,
grandiosity, risk taking, impulsiveness, extravagant spending, sexual
indiscretion, alcohol abuse, and insomnia without fatigue. In all
cases, these symptoms are more extreme than would be justified by
In the simplest case, manic and depressive episodes alternate, over
time scales ranging from months to (in the worst case) hours. Mania and
depression can also occur simultaneously (a "mixed state"), in which
case the person is depressed and "hyper" at the same time.
The list of symptoms is odd, with some (elation and irritability)
contradicting each other. Mania and depression also contradict each
other to some extent (elation versus sadness), while the concept of
mixed states confuses the picture even more.
It may be easier to understand bipolar disorder as not so much a
particular set of symptoms, as an illness characterized by excess.
- Feelings and behaviors range far outside the bounds of
- Mood runs from elation to depression, and energy from
hyperactivity to lethargy.
Thus in short form, bipolar disorder is an illness is characterized by
excess, poor judgment, and extreme variability of mood.
The conception of bipolar disorder as an illness of excess suggests
that it may arise from some kind of excessive activity in the brain. If
so, then treatment might logically be oriented towards dampening
excessive activity back to normal levels.
Although this picture is highly simplified, it does have some merit.
Some treatments for the disorder (in particular, anti-manic agents, or
mood stabilizers) do act to dampen brain activity by strengthening the
inhibitory mechanism mediated by the neurotransmitter
gamma-aminobutyric acid (GABA). Interestingly, many of these same
medications are also used to treat epilepsy and prevent seizures, which
suggests that similar mechanisms underlie mania and seizures.
Mood stabilizers are usually not effective in treating the depressive
episodes of bipolar disorder (although Lamictal, which is characterized
as a mood stabilizer, has been found helpful in this regard). Standard
antidepressants (such as Prozac and Wellbutrin) are typically
prescribed for this purpose.
However, antidepressants that increase serotonin concentration (which
is most of them, including Prozac) must be used with caution, and
always with an accompanying mood stabilizer. The reason for this
requirement is that a "serotonergic" antidepressant, taken without a
mood stabilizer, can trigger or worsen mania in someone who has bipolar
In fact, anyone who experiences dramatic increases in irritability, or
outright mania, from taking one of these antidepressants for depression
alone, very likely has bipolar disorder.
The bad news about bipolar disorder is that it can be difficult to
diagnose, and is harder to treat than depression alone (because it is a
combination of mania and depression). Also, it cannot be treated by
therapy alone, and can worsen over time without medical treatment.
The good news about bipolar disorder is that it can be treated
successfully in most cases. So if you see yourself in this description,
and you have not yet seen a psychiatrist for a diagnosis, now is the
time to go.
Kevin Thompson, Ph.D. is the author of Medicines for Mental Health: The
Ultimate Guide to Psychiatric Medication
You can find information about treatments for depression, bipolar
disorder, schizophrenia, and sexual problems on his Web site at