Bipolar Disorder: An Illness of Excess

Copyright (c) 2007 by Kevin Thompson. Reprinted by BellaOnline

Bipolar disorder is a condition that is relatively unfamiliar, but surprisingly common.

The National Alliance on Mental Illness (at puts the number of Americans who have bipolar disorder at 10 million, comparable to the 15 million who have depression, and many more than the 2 million who have schizophrenia. Yet while most people have at least a vague notion of what depression and schizophrenia are, the same is not true for bipolar disorder.

The confusion over just what defines bipolar disorder is probably due to the complexity of the illness, which defies simple description. While all mental illnesses have their complexities, simplified descriptions of depression as "extreme sadness," and schizophrenia as "having hallucinations," do provide basic guidance about core issues of these disorders. However, bipolar disorder is not as easy to summarize.

Psychiatrists and psychologists speak of bipolar disorder as being characterized by two sets of symptoms, labeled mania and depression. Since it is the presence of mania that distinguishes bipolar disorder from ordinary depression, it is important to understand just what is meant by the term.

The symptoms of mania are commonly described as elation, irritability, increased energy, racing thoughts, racing speech, ambition, grandiosity, risk taking, impulsiveness, extravagant spending, sexual indiscretion, alcohol abuse, and insomnia without fatigue. In all cases, these symptoms are more extreme than would be justified by external circumstances.

In the simplest case, manic and depressive episodes alternate, over time scales ranging from months to (in the worst case) hours. Mania and depression can also occur simultaneously (a "mixed state"), in which case the person is depressed and "hyper" at the same time.

The list of symptoms is odd, with some (elation and irritability) contradicting each other. Mania and depression also contradict each other to some extent (elation versus sadness), while the concept of mixed states confuses the picture even more.

It may be easier to understand bipolar disorder as not so much a particular set of symptoms, as an illness characterized by excess.
Thus in short form, bipolar disorder is an illness is characterized by excess, poor judgment, and extreme variability of mood.

The conception of bipolar disorder as an illness of excess suggests that it may arise from some kind of excessive activity in the brain. If so, then treatment might logically be oriented towards dampening excessive activity back to normal levels.

Although this picture is highly simplified, it does have some merit. Some treatments for the disorder (in particular, anti-manic agents, or mood stabilizers) do act to dampen brain activity by strengthening the inhibitory mechanism mediated by the neurotransmitter gamma-aminobutyric acid (GABA). Interestingly, many of these same medications are also used to treat epilepsy and prevent seizures, which suggests that similar mechanisms underlie mania and seizures.

Mood stabilizers are usually not effective in treating the depressive episodes of bipolar disorder (although Lamictal, which is characterized as a mood stabilizer, has been found helpful in this regard). Standard antidepressants (such as Prozac and Wellbutrin) are typically prescribed for this purpose.

However, antidepressants that increase serotonin concentration (which is most of them, including Prozac) must be used with caution, and always with an accompanying mood stabilizer. The reason for this requirement is that a "serotonergic" antidepressant, taken without a mood stabilizer, can trigger or worsen mania in someone who has bipolar disorder.

In fact, anyone who experiences dramatic increases in irritability, or outright mania, from taking one of these antidepressants for depression alone, very likely has bipolar disorder.

The bad news about bipolar disorder is that it can be difficult to diagnose, and is harder to treat than depression alone (because it is a combination of mania and depression). Also, it cannot be treated by therapy alone, and can worsen over time without medical treatment.

The good news about bipolar disorder is that it can be treated successfully in most cases. So if you see yourself in this description, and you have not yet seen a psychiatrist for a diagnosis, now is the time to go.

Kevin Thompson, Ph.D. is the author of Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication. You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at

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