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About 1 in 100 people in the US has bipolar affective disorder, also known as manic depression. In
this disorder, episodes of elation and abnormally high activity levels tend to alternate with episodes of
low mood and abnormally low energy levels (depression). More than half of all people with bipolar
affective disorder have repeated episodes. Trigger factor for manic and depressive episodes are not
generally known, although they are sometimes brought on in response to a major life-event, such as
a marital breakup or bereavement. Bipolar affective disorder usually develops in the early 20s and
can run in families, but exactly how it is inherited is not known.

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Symptoms of mania and depression tend to alternate, each episodes of symptoms lasting an
unpredictable length of time. Between periods of mania and depression, mood and behavior are
usually normal. However, a panic phase may occasionally be followed immediately by depression.
Sometimes, either depression or mania predominates to the extent that there is little evidence of a
pattern of changing moods. Occasionally, symptoms of mania and depression are present during the
same period.
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Speech may be difficult to follow because the person tends to speak rapidly and change topic
frequently. At times, he or she may be aggressive or violent and may neglect diet and personal
hygiene.

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While severely depressed, an affected person may not care whether he or she lives or dies. About 1
in 10 people with bipolar disorder eventually attempts suicide.

In more severe cases of bipolar disorder, delusions of power during manic episodes may be made
worse by hallucinations. When manic, the person may hear voices that are not there praising his or
her qualities. In his or her depressive phase, these imaginary voices may describe a personal
inadequacies and failures. In such cases, the disorder may resemble schizophrenia.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous
range. At one end is severe depression, above which is moderate depression and then mild low
mood, which many people call ³the blues´ when it is short-lived but is termed ³dysthymia´ when it is
chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate
mania), and then severe mania.

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In some people, however, symptoms of mania and depression may occur together in what is called a
 bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, and
significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad,
hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness²for instance, alcohol or drug
abuse, poor school or work performance, or strained interpersonal relationships. Such problems in
fact may be signs of an underlying mood disorder.

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During a manic phase, people usually lack insight into their condition and may not know that they are
ill. Often a relative or friend observes erratic behavior in a person close to him or her and seeks
professional advice. A diagnosis of bipolar affective disorder is based on the full range of the personal
symptoms, and treatment will depend on whether the person is in a manic or a depressive phase. For
the depressive phase, antidepressants are prescribed, but their affects have to be monitored to
ensure that they do not precipitate a manic phase. During the first days or weeks of a manic phase,
symptoms may be controlled by antipsychotic drugs.

Some people may need to be admitted to the secure environment of a hospital for assessment and
treatment during a manic phase or a severe depressive phase. They may feel creative and energetic
when manic and may be reluctant to accept long-term medication because it makes them feel.

Most people make a good recovery from manic-depressive episodes, but recurrences are common.
For this reason, initial treatments for depression and mania may be gradually replaced with lithium, a
drug that has to be taken continuously to prevent relapse. If lithium is not fully effective, other types of
drugs, including certain anticonvulsant drugs, may be given. In severe cases in which the drugs have
no effect, electroconvulsive therapy may be used to relieve symptoms by including a brief seizure in
the brain under general anesthesia.

Once symptoms are under control, the person will need regular follow-ups to check for signs of mood
changes. A form of psychotherapy can help the person come to terms with the disorder and reduce
stress factors in his or her life that may contrib