Bipolar Disorder: Perspectives on Diagnosis and Treatment

Glenn Brynes, Ph.D., M.D.

Mood, like the weather, is always changing. For most people, the emotional climate remains within predictable limits—not too high and not too low. For a person with bipolar disorder the barometer of life will at times seem to fall from a temperate normal mood, to the bleak chill of depression. It can also shoot up to the bright heights of hypomania or beyond to the brilliant blaze of mania.

Bipolar Disorder, as its name suggests, is a condition characterized by periods of high mood in addition to the low moods that occur in the more common “unipolar” depression. Studies show that 1.5% of the population will have at least one hypomanic or manic episode in their adult lives.

When a person is hypomanic, they may feel unusually good and competent, or simply irritable. Their thoughts race and consequently their speech is often pressured; they may be distractible and flit from topic to topic. They apply their heightened energy to multiple projects. Sleep seems less necessary. There is a drive for pleasurable activities with uncharacteristic disregard for risk. Friends and relatives who know the person recognize that they are behaving differently—out of character. If the symptoms are so severe that they cause marked impairment in work or social functioning, then the condition is called mania.

Depression, the other pole of Bipolar Disorder, may also vary in severity from a relative decrease in enjoyment and interest, to a complete and painful lack of pleasure in anything. Often there are disturbances in concentration, sleep, appetite and energy as well as paralysis of decision making. Guilt and low self-esteem are common.

Without treatment, bipolar disorder can be devastating. People with this condition divorce 2-3 times more commonly and show decline in occupational functioning twice as commonly as the average population. Proper treatment can lower the elevated suicide mortality rate in this group.

Fortunately, there are a number of good treatments available for Bipolar Disorder. The first step in treatment is appropriate evaluation and diagnosis. Usually medication can help control the mood swings. It is essential to develop a trusting relationship between the psychiatrist and patient, especially since many patients initially don’t recognize or don’t want to recognize the danger of an elevated mood. If a strong alliance is present, medication can often be started sooner—before a crisis develops—and prevent a full-blown mood swing. It is often a turning point in treatment when the patient accepts the need to monitor their own mood and to ask for help early on.

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