No Two Are Alike

Lately I have received a number of letters from prominent individuals in the corporate world and other segments of society who desperately want information about bipolar disorder which their siblings and children seem to be suffering from.

Like most diseases, bipolar disorder comes in different shapes and sizes and at times is difficult to diagnose. It is easier to identify classic bipolar disorder, marked as it is by cyclic episodes of severe depression and full -blown mania. It is referred to as bipolar I disorder.. Here the mania is characterized by grandiose and often psychotic thinking, elated mood, superhuman energy, increased libido and reckless judgment.

Atypical bipolar disorder, classified as bipolar II disorder, is a more subtle disease, not so easily recognized and much more difficult to diagnose. It is characterized by hypomania, which is a milder form of mania.

Hypomanic people appear dramatic and lively in temperament. When they are not in a depressed phase they seem very happy, with lots of energy, need very little sleep and are generally much fun to be with.

Thus the hypomania can easily be overlooked and attributed to a cheerful disposition. Moreover, no one runs to the doctor because of too much happiness. So what is the down side to hypomania?

Well, it can seriously impair a person’s judgment because their exuberance and over-confidence can lead to decisions which are potentially catastrophic, like extravagant spending due to an inflated sense of power and ability.

Furthermore, hypomania is often an unstable state that cycles into periods of depression. And these periods of depression can be potentially fatal because 10 to 20 percent of patients commit suicide.

However, it seems more accurate to see bipolar disorder as a broad spectrum. Fifteen to twenty percent of my patients at any given time suffer from one form of bipolar disorder or another. In fact, an elderly patient recently came to me seeking treatment for anxiety and depression. She had no clue that she was suffering from bipolar II disorder.

A correct diagnosis by a clinical psychologist or psychiatrist is imperative. The disorder is treated with antidepressants in conjunction with mood stabilizers because antidepressants alone can precipitate mania even in patients without any prior history of mania.

The reason is because depression is associated with decreased activity of neurotransmitters, like serotonin and norepinephrine. The antidepressants can significantly increase the serotonin and norepinephrine, but for those vulnerable to bipolar disorder, the antidepressants can spark mania.

Psychotherapy is also prescribed to deal with not only the emotional aspects of the disorder but to ensure patients take their medication, which bipolar sufferers are notorious for not doing.