• More than 2 million Americans have manic-depressive illness. It is extremely distressing and disruptive to their lives.  
• Like any serious illness, bipolar disorder also creates problems for spouses, family members, friends, and employers.  
• Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.  
• Bipolar disorder tends to run in families, and there is strong evidence that it is inherited. However, despite ongoing research efforts, a specific genetic defect associated with the disease has not yet been identified.  
• Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. The symptoms can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.

What is a manic episode?

A manic episode is an abnormally elevated, expansive or irritable mood, not related to substance abuse or a medical condition, that lasts for at least a week, and includes a number of disturbances in behavior and thinking that results in significant life adjustment problems. Chronic behavior that appears somewhat similar to manic behavior is more likely ADHD or evidence of personality problem.

It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call “the blues,” then normal mood, then hypomania (a mild form of mania), and then mania.

Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single “mixed” bipolar state. 

Descriptions of Mood States

Here are some first-person accounts of the various mood states associated with bipolar disorder:
Depression:

   
• I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless. I am haunted with the desperate hopelessness of it all. Others say, “It’s only temporary, it will pass, you will get over it,” but of course they haven’t any idea of how I feel, although they are certain they do. If I can’t feel, move, think, or care, then what on earth is the point?

Hypomania:

   
• At first when I’m high, it’s tremendous…ideas are fast…like shooting stars you follow until brighter ones appear…all shyness disappears, the right words and gestures are suddenly there…uninteresting people, things, become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria…you can do anything…but, somewhere this changes.

Mania:

   
• The fast ideas become too fast and there are far too many…overwhelming confusion replaces clarity…you stop keeping up with it-memory goes. Infectious humor ceases to amuse. Your friends become frightened…everything is now against the grain…you are irritable, angry, frightened, uncontrollable, and trapped.

Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment, and suicide.