By Michael G. Rayel, MD
Nancy was doing very well until about two years ago when Phil, her boyfriend of 9 years, broke-up with her. It was a difficult moment for her especially after she learned that Phil eventually married her cousin. Since then, Nancy had deteriorated. One evening, she was involved in a motor vehicular accident because she was driving fast and recklessly in a quiet suburban neighborhood.
During interrogation, the cops noted that Nancy was talking rapidly and nobody could interrupt her. Also, she was making jokes and laughing so loud. She further indicated to them that she was on her way to meet the President and his top officials about her invention that could cure the oil crunch. She eventually ended up in the emergency room where she was diagnosed and treated for bipolar disorder after intensive evaluation.
Bipolar disorder or manic-depression is manifested by highs and lows. When a patient like Nancy is on the manic side, there is a persistent feeling of euphoria or irritability associated with lack of need for sleep, excessive energy, agitation, fast and loud speech, increase in goal-directed activities such as spending sprees and establishing businesses with no appropriate plan, and hypersexuality.
Patients with this disorder develop poor judgment and impulsivity. They become irritable and can lash out easily even if not provoked. Some patients have delusions of grandeur. When this happens, patients think that they have special powers, talents, and influence.
When not manic, patients either feel normal or depressed. Depression in bipolar disorder has the same manifestation as major depression that consists of feelings of sadness associated with neurovegetative signs and symptoms such as inability to sleep, eat, and concentrate. Energy level is also impaired. In addition, patients experience a feeling of hopelessness, worthlessness, and helplessness. Suicidal ideation may ensue.
For individuals who develop mania, does it always mean that they suffer from bipolar disorder?
Not necessarily. Mania can be caused by various medical and neurologic conditions. For instance, multiple sclerosis and stroke can present with manic symptoms. Moreover, medications and street drugs may precipitate mania. Steroids, cocaine, and amphetamine are some examples. Even some antidepressants can induce mania.
So when a person shows mania, the physician usually does intensive evaluation to rule out medical, neurologic, and medication-induced conditions before diagnosing bipolar disorder. This process is important because the treatment varies depending upon the cause. Once other conditions are ruled out, then bipolar disorder can be safely diagnosed and treated.
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