The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years are on average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes, that is specific to that individual but predictable once the pattern is identified. Research studies suggest a strong genetic influence on bipolar disorder.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without treatment.

Effective treatment is available for bipolar disorder. Without treatment, marital breakups, job loss, alcohol, and drug abuse, and suicide may result from chronic, episodic mood swings. The most significant treatment issue is noncompliance with treatment. Most individuals with bipolar disorder do not perceive their manic episodes as needing treatment, and they resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode and don’t want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Unfortunately, risk-taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance abuse problems.

A manic episode is an abnormally elevated, expansive, or irritable mood, not related to substance abuse or a medical condition, that lasts for at least a week, and includes a number of disturbances in behavior and thinking that result in significant life adjustment problems. Chronic behavior that appears somewhat similar to manic behavior is more likely ADHD or evidence of personality problems.

It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call “the blues,” then normal mood, then hypomania (a mild form of mania), and then mania.

Some people with untreated bipolar disorder have repeated depression and only an occasional episode of hypomania (bipolar II). On the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single “mixed” bipolar state.

• Extreme irritability & distractibility
• Excessive “high” or euphoric feelings
• Sustained periods of unusual, even bizarre, behavior with significant risk-taking
• Increased energy, activity, rapid talking & thinking, agitation
• Decreased sleep
• Unrealistic belief in one’s own abilities
• Poor judgment
• Increased sex drive
• Substance abuse
• Provocative or obnoxious behavior
• Denial of problem

• Persistent sad, anxious, or empty mood
• Feeling helpless, guilty, or worthless
• Hopeless or pessimistic feelings
• Loss of pleasure in usual activities
• Decreased energy
• Loss of memory or concentration
• Irritability or restlessness
• Sleep disturbances
• Loss of or increase in appetite
• Persistent thoughts of death