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Old September 16th, 2005, 04:52 AM  
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What Is Bipolar Disorder?

Bipolar disorder, previously known as manic depression, is a serious, double-edged mental illness. In contrast to the sustained bleakness of generalized depression (technically described as unipolar disorder), bipolar disorder is characterized by cyclical swings between elation and despair. The pattern of the mood alternations varies widely among sufferers. In some people, years of normal functioning can separate manic and depressive episodes. In others, the episodes cycle frequently, three or four times a year, with respites between. For some people, depression and mania cycle continuously and sometimes rapidly. There are also people who experience mixed episodes, in which mania and depression occur together or alternate rapidly within a brief period of time. And for a rare few, an episode of bipolar disorder may occur only once in a lifetime. (If it occurs twice, it is usually followed by other episodes.) Generally, the depressive phase lasts longer than the manic phase, and it also tends to be more frequent; the cycle can be erratic.

Bipolar disorder is known to afflict about 1% of the U.S. population, although its frequency may be much higher because almost 75% of cases go untreated. Men and women are equally susceptible. Much evidence suggests that the illness has a genetic basis, but its origins are still uncertain. The symptoms result from chemical imbalances in the brain, and they lie beyond voluntary control. The disorder is not only life-disrupting but can also be dangerous: About 20% of people with bipolar disorder commit suicide, usually when they are passing from one phase to another and feel disoriented. Some 11% of sufferers take this drastic action in the first decade after diagnosis.

Fortunately, great strides have recently been made in treating this illness; in most cases, the symptoms can be controlled effectively by medication and other therapies.

The disorder occurs in two main forms, known as bipolar I and bipolar II; they may have separate genetic origins. In bipolar I, both phases of the illness are apt to be very pronounced. In bipolar II, mania is often mild (it is termed hypomania), and the depression can be either mild or severe. Bipolar II is more difficult to diagnose and is often mistaken for generalized depression. It has fewer and shorter periods of remission than bipolar I, tends to run in families, and is somewhat less responsive to treatment. It may be the more common form of bipolar disorder.

The illness is sometimes linked to seasonal affective disorder, with depression occurring in late fall or winter, giving way to remission in the spring, and progressing to mania or hypomania in the summer.

About one case of bipolar disorder in five begins in late childhood or adolescence; adolescents are more likely than adults to have physical and psychotic symptoms, such as hallucinations and delusions, and they are more apt to be misdiagnosed. Usually, however, the illness strikes young adults between the ages of 25 and 35. The first episode in males is likely to be manic; the first episode in females, depressive -- and frequently, a woman will experience several episodes of depression before a manic episode occurs. As patients grow older, recurrences of either bipolar I or bipolar II tend to come more frequently and last longer.

Bipolar disorder is thought to result from chemical imbalances in the brain, caused by a defective gene or genes. Among the brain chemicals possibly involved are serotonin and norepinephrine, but the chemical interaction in bipolar disorder is complex and not yet completely understood. The likelihood that genes play a role is supported by the fact that usually there is some family history of mood swings, depressive illness, or suicide.


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