Bipolar manic depression is a disorder characterized by periods of major depression alternating with periods of elevated mood. When those periods of elation are severe, they are known as mania and the diagnosis is bipolar I. When the periods of elation are relatively mild, or hypomanic, the diagnosis is bipolar II. About 25% of the people who experience major depression also experience these periods of high, and the contrast between the two poles (hence the term “bipolar”) is dramatic. Hypomanic patients become overactive socially, physically, and sexually. Characteristically tireless in energy, they may be garrulous and expansive, charming, and irritable or angry, and they are often seductive at the office, cracking risque jokes. During a full manic episode, into which the hypomanic state sometimes grows, the increased energy is extreme. People experiencing this manic state may literally go for two or three days without sleep at all. Hypomanic people, who usually require only four or five hours of sleep, are constantly busy, talking, telephoning.

faxing, planning, and implementing numerous schemes. Hypomanic women in the home are often described as “super moms.” Everyone tends to admire hypomaniacs except when they seem to lose judgment or snap back angrily when their opinion is challenged or when they are crossed. Their minds often race, and they periodically overestimate their own abilities. Their judgment in politics, business, and the arts may be extremely sharp. Yet at other times their judgment is poor. As the hypomanic mood develops, at times coming dangerously close to a full mania, they may take irresponsible risks, drive recklessly, go on spending sprees, or participate in a multitude of sexual liaisons.

In the most severe form of the illness, manic-depressive patients become psychotic. Those who experience four or more mood swings a year are referred to as rapid cycling manic depressives.

Even though patients often use the word “high” to describe these hypomanic or manic episodes, the mood in many cases is not euphoric but irritable, paranoid, and angry, leading to confrontations and rage attacks. In its most severe form, known as psychotic mania, the manic-depressive patient may hallucinate or have grandiose religious or paranoid delusions. Because manic patients seldom perceive that they are ill, they often refuse to see psychiatrists or take any medication. However, if severe mania is left untreated, there is a risk of full psychosis and collapse brought on by physical and mental exhaustion. Hospitalization is usually required to prevent harm to themselves or others. Often, this hospitaliza-tion must be made at the request of the family, and, unfortunately, it must occasionally be legally forced when two psychiatrists deem that the patient presents a threat to him or herself or to others in the community.

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