My wife’s behavior has changed drastically in the last year. Sometimes she tries to avoid our children, isn’t interested in being intimate with me, and just wants to stay home, preferably alone. Other times she insists on making social plans, can’t get enough of the kids or me, and works frantically on all sorts of projects. Her medical doctor says it’s strictly severe depression, but I think the high energy levels are above normal. Could she be bipolar? Is it the same as manic depression? What about medication for these disorders?

Many health care professionals consider Bipolar Disorder the same as Manic Depressive Disorder; however, there are several subtypes that vary in the frequency and intensity of symptoms. Bipolar Disorder is characterized by moods shifting between emotional highs (Mania) and lows (Depression). These shifts are called "episodes." Signs of mania include, but are not limited to poor judgment, recklessness, extreme irritability, or feelings of euphoria. Rapid speech and increased physical activity may also be present. For individuals who cycle rapidly, a manic episode can physically and emotionally wear them down to a point that they begin to develop severe depression. This depressive episode causes persistent feelings of sadness, anxiety and loss of interest in pleasurable activities. Difficulty concentrating is also common. In severe cases, some individuals are plagued with hopelessness and recurring thoughts of suicide.

Treatment for this disorder can be very effective when assessed quickly and accurately. There are several medications that have proven to be very successful in treating Bipolar Disorder without harsh side effects. Psychotherapy, or "talk" therapy, combined with the right medication has a very positive impact on achieving emotional stability for millions who suffer from this disorder. Research indicates there is a very strong genetic transmission factor to consider. Learning about the subtleties of this disorder helps family members develop effective self-care habits to maintain overall family stability. With understanding, patience and a strong emotional support network, family members can contribute much to the overall management of Bipolar Disorder.

Edward F. Allen MSW, LCSW
St. Louis, MO
314-780-7410

Yes, your wife could have Bipolar Disorder. Manic depressive illness and Bipolar Disorder are the same illness, although there are clinical distinctions between Type I and Type II. Persons with Bipolar II often have more problems with the depressive phase of the illness. The depressive phase symptoms can include periods of depressed or irritable mood along with disturbances in sleep, energy, appetite, concentration or memory. Thoughts of death and/or suicidal thinking can be part of the episode. The manic phase symptoms can include lack of sleep, increased activity such as in the rate of speech, sex drive, spending, impulsive behavior and an elevated sense of self.

Severe mania is almost always a psychiatric emergency and nearly always requires hospitalization to maintain the safety of the patient and those around him/her. The place to begin is with a comprehensive psychiatric evaluation with a competent psychiatrist. It is also important that your wife have a complete physical examination with her family doctor to determine any possible medical causes of these symptoms. It’s important to understand that individuals can have widely varying courses to their illness. Some patients may have one or two episodes with extended well periods in between. Others may have more chronic difficulty. It is critical that every effort be made to obtain an accurate assessment and diagnosis before embarking on a medication or treatment plan. A good psychiatrist will not only be able to prescribe medications but will also develop a rapport with the patient.

Stacey L. Smith, MD
St. Louis, MO
314-361-8566

Want to see other Open Mind columns?  Click here for archive index.