Dear Doctor Column, October 29, 2001

Question:

Over the past 10 years, I've had severe mood swings with behaviors that include extreme spending, reckless behavior, and deep depression with explicit suicidal thoughts. Professionally, I have excelled, but many times I can't focus on a task and other times I feel I could run a multimillion dollar company. I rarely feel rested and sleep every chance I can. There is mental illness in my family, including schizophrenia and depression. People who don't really know me think I'm grounded, smart and focused, but I'm an expert at facades. Please tell me how to take the first step for help.

Answer:

You are describing the classic symptoms of bipolar disorder (formerly known as manic-depressive illness). Recent research suggests a possible genetic link: Close relatives of people with bipolar disorder are 10 to 20 times more likely to develop either depression or bipolar illness than the general population; between 80 and 90 percent of people with bipolar disorder have relatives who suffer from some form of mental illness.

Bipolar disorder is classified as either bipolar I or bipolar II. People with bipolar I disorder experience recurring episodes of euphoria and overactivity, which alternate with periods of depression. Episodes can occur up to several times a year, becoming more frequent with age.

Bipolar I disorder causes extreme mood swings from highly excited euphoria or irritability (mania) to the darkest depths of despair and depression. Elation or depression occurs unpredictably for no apparent reason, with people often feeling they are on an emotional roller coaster. During a manic phase, an individual's self-esteem and sense of importance skyrockets - they often believe they have unlimited powers. Their thoughts race, they talk constantly, are easily distracted, require little sleep and plunge with abandon into pleasurable activities with potentially painful consequences, such as sexual indiscretions or spending sprees.

Bipolar II disorder is characterized by hypomania, which is a milder form of mania. In contrast to a manic episode, a hypomanic episode does not markedly impair occupational or social functioning or require hospitalization.

As a manic or hypomanic episode abates, a period of normal mood and behavior usually follows. But, eventually, the depressive phase of the illness sets in causing people to lose interest and pleasure in most activities. Sleeping patterns and appetite change. They complain of constant fatigue and of feelings of worthlessness and hopelessness, as they withdraw from formerly enjoyable activities, friends or work. Concentration is difficult, with frequent thoughts of death and suicide. If left untreated, this phase may last for months.

Fortunately, bipolar disorder is among the most treatable of mental illnesses. Lithium, introduced in the U.S. in the 1960s, has revolutionized treatment. More recently, other medications, including carbamazepine (Tegretol) and valproate (Depakene or Depakote), have been found useful for the treatment of bipolar disorder.

Your first step is to pick up the telephone and make an appointment with a psychiatrist or with your family doctor, who can refer you to a mental health specialist. Good luck.