The Bipolar Brain

By Ofer Zur, Ph.D.

Bipolar is described by the DSM as a disorder, and is also known as bipolar affective disorder or manic depression. Like diabetes or heart disease, bipolar is a long-term condition that must be carefully managed throughout a person’s life. It is a disorder that brings up the question, “Is it possible to have too much of a good thing?” The experience of mania raises interesting questions about whether positive emotions, such as joy or exuberance, can be pushed to extremes where they lose their adaptive or prosocial qualities. Intriguingly, bipolar is linked with exceptional creativity during periods of good functioning. Dr. Jamison, in An Unquiet Mind, called it “an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering…”


Bipolar — Recap:
  • Bipolar, also known as manic-depressive illness, causes unusual shifts in a person’s mood, energy and ability to function.
  • People on the “high” side of bipolar may feel on top of things, productive, sociable and self-confident. Many people have described the “high” of hypomania as feeling better than at any other time in their lives, but the feelings are exaggerated. They often cannot understand why anyone would call their experience abnormal or part of a disorder.
  • There is no cure for bipolar, and the best pharmacological treatments often are not very effective because of problems with adherence and compliance.
  • Different from the normal ups and downs that everyone goes through, the symptoms of bipolar are severe. They can result in damaged relationships, poor job or school performance, and even suicide.
  • Like other mental illnesses, bipolar cannot yet be identified physiologically, for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar is made on the basis of symptoms, course of illness and history.
  • Bipolar can be treated, and people with this illness can lead full and productive lives.
  • Medications are considered mood stabilizers if they have two properties: They provide relief from acute episodes of mania or depression or prevent them from occurring; and they do not worsen depression or mania or lead to increased cycling. Lithium and Depakote have been shown to fulfill this definition. Other meds were originally developed as anticonvulsants for the control of epilepsy. Other available medications that are undergoing research as promising mood stabilizers include several new anticonvulsants and the newer, “atypical” antipsychotics.
  • More than 2 million Americans in any given year have bipolar.
  • Bipolar typically develops in late adolescence or early adulthood. More than half of adults affected with bipolar had their mood disorder begin at age 16 or younger. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated.
  • Bipolar I refers to a condition in which people have experienced one or more episodes of mania. Though an episode of depression is not necessary for a diagnosis of bipolar I, most people who have bipolar I will have episodes of both mania and depression. Bipolar II refers to a condition in which people have had at least one hypomanic episode.
  • The diagnosis in general and the rate of the disorder for children, as with ADHD, is highly debatable.
  • Signs and symptoms of mania (or a manic episode) include: increased energy, activity and restlessness; excessively high, overly good, euphoric mood; extreme irritability; racing thoughts and talking very fast, jumping from one idea to another; distractibility, can’t concentrate; little sleep needed; unrealistic beliefs in one’s abilities and powers; poor judgment; spending sprees; increased sexual drive; abuse of drugs, particularly cocaine, alcohol and sleeping medications; provocative, intrusive or aggressive behavior; denial that anything is wrong.
  • A mild to moderate level of mania is called hypomania. This may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus, even when family and friends learn to recognize the mood swings as possible bipolar, the person may deny that anything is wrong. Without proper treatment hypomania can become severe mania in some people or can switch into depression.
  • Episodes of mania and depression typically recur across the life span. Between episodes most people with bipolar are free of symptoms, but as many as one-third have some residual symptoms.
  • “Pills do not come with skills,” and psychoeducation and psychotherapy are important ways of building positive skills to improve relationships, promote academic and vocational success, and produce better coping mechanisms and quality of life.
  • Cognitive behavioral therapy helps people with bipolar learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
  • Psychoeducation involves teaching people with bipolar about the illness, its treatment and how to recognize signs of relapse so that early intervention can be sought before a full-blown episode occurs. Psychoeducation is often helpful for family members.
  • Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms.


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