Mania, the up side of bipolar disorder, is as destructive as the ensuing depression.

Mania, the up side of bipolar disorder, is as destructive as the ensuing depression.(HUBER-STARKE/RADIUS/MASTERFILE)

Bipolar disorder, sometimes called manic depression, affects nearly six million American adults, or about 2.5% of the adult population, according to the National Institute of Mental Health. Some patients who eventually get diagnosed spend years, even decades, cycling through institutions and switching therapists before they get the correct treatment.

Mary, a mental health advocate who lives in western Massachusetts, is one of these people. She had episodes of mild depression starting when she was in her late teens.

When these came on, a quick call to her primary care physician got her a prescription for Prozac. Each time she took antidepressants, the medications kicked her into a slightly manic state during which she was often pretty effective in her many roles at work, home, and community. "I survived that way for 20 years," she says.

Then in 2002, her world crumbled when her son, who had been diagnosed with bipolar disease at age 7, spent more than four months in a hospital while awaiting transfer to a residential mental health facility. Mary became suicidally depressed. This time her doctors reached the conclusion that she, too, had bipolar disorder.

[ pagebreak ]The term bipolar means "two poles," like the Arctic and Antarctica, and that image describes this disease pretty well. People with bipolar experience periods of depression interspersed with periods of mania, when their thoughts race and they behave impulsively and often irrationally.

"Bipolar disorder gets you to commit acts of excess that nobody outside of Congress can get away with," says Steven D. Hollon, PhD, professor of psychology at Vanderbilt University in Nashville.

Mania can feel like creativity
Kathleen Brannon, 49, of Herndon, Va., had spent time in a state mental hospital for depression but was reluctant to agree that she was bipolar. "I'd have some periods of intense creativity where I would write for 20 hours," she says. "I hadn't thought of it as mania, I just thought I was driven to write."

Antidepressants can be ineffective or even damaging in people with bipolar disorder. In particular, antidepressants given to a person with bipolar disorder can trigger a manic episode unless the person is also taking a mood-stabilizing drug.

"When antidepressants don't work, ask your doctor if you have bipolar disorder," says Michael E. Thase, MD, professor of psychiatry at the University of Pennsylvania, in Philadelphia.

Dr. Thase adds that unusual reactions to antidepressants may also signal bipolar disorder. "If you start taking an antidepressant and have racing thoughts, a much stronger sex drive, or insomnia that has developed or worsened during antidepressant therapy, get help from your doctor. These are not symptoms of depression," he says. Instead of signaling recovery from depression, such symptoms may signal a manic episode that was triggered by an antidepressant.