Bipolar Disorder
By Rear Adm. Joyce Johnson, D.O., M.A.

My moods seem to go up and down. Is it possible that I have bipolar disorder?

Bipolar disorder, commonly known as manic-depressive disorder, is a fairly common mood disorder. It runs in families, and genetics might contribute to its cause. People with bipolar disorder have moods of two extremes: the excessively elevated mood of mania and its counterpart, depression. Typically, they experience one mood for a period of days or weeks, followed by the other, perhaps with weeks or months of normal moods between.
 
The manic phase is characterized by inflated self-esteem and grandiosity. People experiencing mania feel invincible; they might need little sleep, be hyperactive, and have racing thoughts and fast speech.

Mania can increase goal-directed activity, making people extremely productive at work. However, it also can cause excessively risky behavior. While manic, someone could go on a spending spree or take unwise business risks; indulge in sexual promiscuity or other unsafe behaviors; and experience sudden rage, especially if others try to intervene. The behavior of a manic person can be dangerous and unpredictable.

At the other pole is depression: feelings of sadness, worthlessness, and despair. Those suffering depression lose interest in previously pleasurable activities. They might feel tired and either sleep a lot or be unable to sleep. Their eating habits are disrupted, and they might lose or gain weight. Concentration is difficult, judgment is impaired, and they might have thoughts of death and suicide.

Bipolar disorder is diagnosed by a patient’s behavior and history. It usually can be treated successfully with daily medication; in acute situations, hospitalization might be necessary.

The basic challenge with medication management is compliance: Patients require ongoing daily medication, often for years, but many complain that life is dull when they are on medication. During the manic phase, patients can enjoy the euphoria and have a hard time seeing the need for medication. Psychotherapy and family involvement can have a positive impact on medication compliance and overall prognosis.

People with bipolar disorder can be friendly, happy, successful, and effective at work, especially if they are hypomanic (i.e., mildly manic). When their disease is controlled, they can be leaders in their communities. The challenge for them is to stay on medication to prevent the extreme moods that can be so destructive to their family and personal lives.