Bipolar disorder is a chronic disease affecting over 2 million Americans at some point in their lives. The American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" describes two types of bipolar disorder, type I and type II.

In type I (formerly known as manic depressive disorder), there has been at least one full manic episode. However, people with this type may also experience episodes of major depression.

In type II disorder, periods of "hypomania" involve more attenuate (less severe) manic symptoms that alternate with at least one major depressive episode. When the patients have an acute exacerbation, they may be in a manic state, depressed state, or mixed state.

Everyone feels "blue" at one time or another, or "good" at other times. People who suffer from bipolar disorder, however, have pathological mood swings from mania to depression, with a pattern of exacerbation and remission that are sometimes cyclic.

The manic phase is characterized by elevated mood, hyperactivity, over-involvement in activities, inflated self-esteem, a tendency to be easily distracted, and little need for sleep. The manic episodes may last from several days to months.

In the depressive phase, there is loss of self-esteem, withdrawal, sadness, and a risk of suicide. While in either phase, patients may abuse alcohol or other substances which worsen the symptoms.

The disorder appears between the ages of 15 and 25, and it affects men and women equally. The exact cause is unknown, but it is a disturbance of areas of the brain which regulate mood. There is a strong genetic component. The incidence is higher in relatives of people with bipolar disorder.

• Alternating episodes of mania and depression (may only have episodes of mania, if Bipolar type I)

In the manic phase the following symptoms can be seen:

• Increase in goal-directed activities (either socially or at work)
• Increased energy
• Distractibility
• Flight of ideas or subjective experience that thoughts are racing
• Inflated self-esteem or grandiosity
• Increased involvement in activities that may be pleasurable, but may have dire consequences (e.g., spending sprees)
• Decreased need for sleep (person feels rested after 3 hours of sleep)
• Patient may be more talkative than usual or may feel pressured to speak
• Easily agitated or irritated
• Lack of self-control

In hypomanic episodes, symptoms are similar, but fewer and/or less intense. Delusions, (false beliefs based on incorrect information about external reality) if present, may be congruent with mood (such as delusions of grandeur, or a sense of special powers and abilities).

In the depressive phase patients may experience:

• Persistent sadness and depressed mood
• Feelings of hopelessness, worthlessness, pessimism, and "emptiness"
• Loss of interest or pleasure in activities that were once enjoyed, including sex
• Sleep disturbances
• Psychomotor retardation or agitation
• Withdrawal
• Feelings of guilt and worthlessness
• Fatigue
• Overwhelming sluggishness
• Difficulty concentrating, remembering, or making decisions
• Loss of appetite and/or weight loss, or overeating and weight gain
• Thoughts of death or suicide

If delusions are present, they may be congruent with mood (such as delusions of worthlessness or accusing voices). In "atypical depression," patients sleep more than usual and have increased appetite.

A psychiatric history of mood swings, and observation of current behavior and mood are important in the diagnosis of this disorder. A family history of manic-depressive illness may be present. A physical examination may be performed to rule out physical causes for the symptoms or potentially drug-induced symptoms.

Hospitalization may be required during an acute phase to control the symptoms and to ensure safety of individuals. Medications to alleviate acute symptoms may include: neuroleptics (antipsychotics), antianxiety agents (such as benzodiazepines), and antidepressant agents.

Mood stabilizers, such as lithium carbonate, and anticonvulsants (including carbamazepine and valproic acid) are started as maintenance therapy to relieve symptoms and to prevent relapse.

Although medications form the basis of treatment for bipolar disorders, patients and families benefit from educational and supportive interventions that promote symptom management and adequate coping skills. As with other mental disorders, patients and families benefit from joining a support group where members share common experiences and problems.

As mentioned before, the patients and families often can be helped by joining a support group where members share common experiences and problems.

For some people, treatment with lithium or (more recently) anticonvulsant mood stabilizers have successfully prevented recurrence of symptoms. However, outcome may be different between individuals, some will experience "rapid cycling" or frequent acute episodes. In some cases, medication regimens are difficult to tolerate, reducing compliance and increasing risk of relapse.

• Noncompliance with treatment, leading to a recurrence of the illness.
• Bipolar disorder may be complicated by alcohol and drug abuse, often used as a strategy to "self-medicate" mood.

Call your health-care provider if you feel yourself accelerating your activities or speech patterns, or others comment that you are talking faster than usual. Also call if you are experiencing sleeplessness, but are still not tired. Or call if you feel an increased level energy and/or self-importance.

While there is no known prevention, awareness of risk may allow early diagnosis and treatment.