Maggie shows up in the emergency room looking for Abby. When Frank comes to tell Abby that her mother is there, Abby takes a short glimpse and says she does not know who that woman is. So, Maggie waits around in the E.R. for a while, giving the staff bagels and coffee. Kerry later informs Maggie that Abby, in actuality, has said she’s lying. Immediately after she was told the news, she goes on a rampage throughout the E.R. screaming for her daughter. When Maggie sees Abby, she tells everyone that Abby is her daughter and Abby greets her mother.
Kerry is surprised at what Abby said because she told Frank that she did not know who that woman was. After witnessing Maggie’s actions, Kerry automatically comes to the conclusion that Maggie is bipolar, and talks to Abby about it. This was a recent episode of E.R.; in real life, at least 2 million Americans suffer from what is called Manic-Depressive Illness, otherwise known as bipolar disorder. It is a mental illness involving episodes of serious mania and depression. The person’s moods usually swing from overly “high” and irritable to sad and hopeless and then back again, with periods of normal mood in between (Bellenir276).
The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes, which is specific to that individual, but predictable once the pattern is identified. Research studies suggest a strong genetic influence in bipolar disorder.
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Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as a psychological problem, because it is episodicthose. Effective treatment is available for bipolar disorder. The most significant treatment issue is non-compliance with treatment. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties.
Many individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance abuse problems. 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 (Bellenir 278).
An early sign of manic-depressive illness may be hypomania–a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings; the individual often will deny that anything is wrong. In its early stages, bipolar disorder may masquerade as a problem other than mental illness.
For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression. Psychological treatment often focuses on the life adjustment problems that develop because of the manic episodes, and in helping the individual recognize the onset of a manic episode and take corrective action.
Supportive counseling is needed, to help the individual accept that he/she has a chronic psychological problem that will have a major impact on life management. Anyone with bipolar disorder should be under the care of a psychiatrist skilled in its diagnosis and treatment, as well as a psychologist. Psychologists provide the individual and his or her family with support, education, coping skills training, they also help monitor the symptoms and encourage the individual to continue medical treatment.
The psychiatrist monitors the medication that is usually required with this disorder. Almost all people with bipolar disorder, even those with the most severe forms, can obtain substantial stabilization of their mood swings. One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes.
Often these medications are combined with lithium for maximum effect. Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later. Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania. The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia. Thyroid augmentation may also be of value. For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate. Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally. Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.
Bi polar illness has been diagnosed in children under the age of 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. There is no real cure for manic depression at present, but through the use of monitored medication programs it is possible to smooth out and reduce the frequency of highs and the lows, and in some cases episodes may be all together prevented.
A variety of medications are used to treat bi polar disorder, but even with optimal medication treatment, many people do not achieve full remission of symptoms. Without treatment, marital break-ups, job loss, alcohol and drug abuse, and suicide may result from the chronic, episodic mood swings. The treatment people have to take will be for the rest of their lives and some people do not like to bother taking their medications. I have never encountered a person with bipolar disorder, but now I know that when I am walking down the street the faces I see are not just everyday people.
By looking at a person you know that there is a story behind that face. When I watch TV I always see commercials about depression but I never thought that so many people are diagnosed, not to mention the many forms of depression. Bipolar disorder is one of the most difficult forms of depression to live a smooth life with. There are many places for people to get help; I just hope they take the opportunities.
References
- Mayo Clinic: Bipolar Disorder
- American Psychiatric Association: What Are Bipolar Disorders?
- National Institute of Mental Health: Bipolar Disorder
- Anxiety and Depression Association of America: Understanding Depression
- Psychiatry Investigation: Comorbidity of Anxiety Disorders with Bipolar Disorder or Major Depressive Disorder: A Survey Conducted in the United States
- Frontiers in Psychology: The Role of Childhood Trauma in the Neurobiology of Bipolar Disorder
