What Is Bipolar Disorder? By M. Glaser, MD

The definition of bipolar disorder has
expanded over the last few decades. It used
to refer to periods of mania sometimes
followed by depression. These phases would
occur in cycles with phases of normalcy in
between. Due to the cycles of mania and
depression, the original name for bipolar
disorder is manic-depression. The two
opposite points in mood high and low. Thus
from that came bipolar disorder, or "two

In the last few years, bipolar has taken on to
mean more than that described above. The
above description is now informally referred
to as classic bipolar disorder. For some
reason it seams, psychiatrists do not see as
much of that as they used to. We now see
more of mixed episodes.

The two phases of bipolar disorder are mania
and depression. A third possible phase is a
mixture of the two called a Mixed episode.
Mania means a mood that is expansive, lots
of energy. A person typically does not need
to sleep. They can stay up all, or most of the
night for days or weeks and not feel tired the
next day. In classic mania, a person feels
fantastic! They feel like a superhero. They
experience flight of ideas, racing thoughts
and speach. They are overly excited. The
period of time one must experience these
symptoms is contreversial. Some doctors
require this period to last for a few hours
while others require days or weeks. Classic
mania required days of consistent euphoria.
Usually people with mania have too much
energy to organize their thoughts. Thus,
with the exception of cleaning the house,
they are unable to complete complex, goal
oriented tasks.

Periods of rage often occur in bipolar
disorder, but getting angry or rageful by
itself is not enough to meet the criteria for
bipolar disorder. Mood swings often occur in
bipolar disorder but by itself, it is not
sufficient to be diagnosed as bipolar. Mood
swings refer to a mood that changes quickly
and is much greater in intensity of
expression than most people would feel over
a similar stressor. The mood can swing from
normal to rage or from intense happyness to

An individual can experience a mixed
episode. This means a person has both extra
energy but instead of feeling terrificly
wonderful, they feel depressed at the same
time. Another potential symptom is
psychotic features. In bipolar disorder as
well as in major depression, a person can
experience hallucinations during times of
mania or depression but no hallucinations
when their mood is well and stable.

Most people who have bipolar disorder seek
treatment initially for depression and
anxiety. So all individuals who are being
evaluated for depression and anxiety should
also be screened for bipolar.

Another condition that has similar symptoms
to bipolar disorder is ADHD (attention deficit
hyperactivity disorder or ADD). Early signs of
mania and depression are inattention and
hyperactivity. However, stimulants are the
treatment for ADHD but can worsen Bipolar.
Thus, all ADHD patients should be screened
for bipolar disorder as well. A negative
reaction to ADHD medications or
antidepressant medications can be a sign
that it is instead bipolar disorder. Mitchell
Glaser, MD.

What Causes Bipolar Disorder?

Bipolar disorder is highly genetic. Twin
studies show that identical twins
(monozygotic) have a rate of both twins
getting the disorder of 70%-90%. While
nonidentical (fraternal) same sex twins
(dizogotic) have a rate of 16%-35%. What
could explain this. First, genes are very
important. Second, environment plays a
role. If you get the right genes and the right
environment, you get bipolar illness.
Environmental conditions that help cause or
worsen bipolar disorder are stress, traumas,
and drug/alcohol use or exposure.

What Can I Do To Prevent or Help Treat
Bipolar Disorder?

If you already have the condition, you must
take medication for years, and possibly your
entire life. I know that is a real pain in the
behind, but it is fact. Second, DO NOT DRINK
or using drugs is the surest way to mess up
your future and prognosis. Using drugs and
drinking in excess is bad for every one, but
for people with bipolar disorder, it will cause
them to lose their mind and go insane
permanently. Naturally, this does not often
happen right away (although sometimes it
does). It usually takes a few years, but that
is the nature of addiction. It will cause the
bipolar brain to lose brain cells at a much
faster rate than a brain without bipolar
disorder. Drugs and alcohol will also induce
the brain to have a manic or depressed
episode which leads to further brain cell loss.

To learn about the effects of bipolar disorder
on the brain, read my section on bipolar
disorder treatment.
Mitchell Glaser, MD. Child, Adolescent, Adult


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