The severe mood fluctuations of bipolar or manic-depressive disorders have been around since the 16-century and affect little more than 2% of the population in both sexes, all races, and all parts of the world (Harmon 3). Researchers think that the cause is genetic, but it is still unknown. The one fact of which we are painfully aware of is that bipolar disorder severely undermines its' victims ability to obtain and maintain social and occupational success. Because the symptoms of bipolar disorder are so debilitation, it is crucial that we search for possible treatments and cures. The characteristics of bipolar disorder are significant shifts in mood that go from manic episodes to deep depressive episodes in a up and down trip that seemingly never ends.

There are actually three types of bipolar disorder. In bipolar III disorder there is a family history of mania or hypomania in addition to the client experiencing depressive episodes. This category is not highly used but is worth noting. Bipolar II disorder is marked by hypo manic episodes that have not required hospitalization.

Bipolar I disorder is the full-blown illness and is defined by the presence of manic episodes which require treatment, and usually hospitalization (Winner 44). Bipolar disorder can strike at any age but most commonly strikes at age 18 in bipolar I; for bipolar II disorder, the age is 22 (Durand and Barlow 189). It has also been found that children can be seen with bipolar disorder early on. This is not very prevalent, and is only one in every 200 cases.

This is thought to occur because many children with manic depression might Dyson 2 have been misdiagnosed or just thought of as hyperactive and disruptive. The early symptoms of childhood bipolar disorder, , irritability, and hyperactivity are also the signs of attention deficit hyperactivity disorder (ADHD) (Harvard Mental Health Letter, March 1997). It is mainly for this reason that many cases might be misdiagnosed as ADHD and the prevalence of bipolar disorder in children could be much higher. A person suffering from bipolar disorder alternates from manic states to those of depression. These emotional states can alternate cyclically or one mood may dominate over the other.

It is also possible for the two to be mixed or combined with each other. When the sufferer is in a manic phase of the disorder they may exhibit many unusual behaviors that are not normally present in their everyday life. Elation is probably the most obvious component, and it is often misplaced and without any real reason for being in this mood. Manic episodes bring with them extreme self-confidence and energy to meet people and engage in all sorts of activities and adventures.

It is not uncommon to be unable to understand what a person in a manic state is saying because they are talking loud and fast, and can jump from one subject to the next without any provocation or knowing why. Irritability and lack of attention span are also trademarks of this state. In its most extreme, mania can also bring about violence and rage from the individual. During this period the sufferer often enrolls themselves in many activities or responsibilities that they cannot fulfill after the mania subsides, lending to further problems even after the episode has subsided (Encyclopedia Britannica, 23: 847).

The depressive state is the darker side of this disorder. There are two types of the depressive state, the agitated state and the retarded state. In the agitated state one may have sustained tension, over-activity, despair and possibly have apprehensive delusions. For the retarded state the stage becomes darker still as their activity is slowed and can almost become Dyson 3 catatonic. The patient is dejected and sad, and beats himself down with self-degrading talk. Suicide is most likely to happen in the depressive side of bipolar disorder and the patient must be closely watched for suicidal tendencies.

Estimates of suicide in bipolar disorder range from 9% to as high as 60%, with an average of 19% (Nathan, 205) It is often impossible to predict the number of episodes that a person with bipolar disorder can expect to have over the course of a year and is often dependent on each individual case. There is a problem when one experiences too many episodes in one year, it is called rapid-cycling pattern. "An individual with bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to be experiencing a rapid cycling pattern." (Durand and Barlow 192) This group of manic-depressives makes up about 20% of the total number of that are afflicted with bipolar disorder (Harmon 32). In most cases, rapid cycling tends to increase in frequency as time passes and can reach severe states in which there may be no break between manic and depressive stated at all. Over the years many different medications to treat bipolar have been introduced, but lithium carbonate has been the primary treatment of bipolar disorder since its introduction in the 1960's. Its main function is to stabilize cycling characteristics of bipolar disorder.

However, there were drawbacks to using lithium. Some people being treated for bipolar disorder were not able to tolerate the side effects of lithium. Lithium has been linked to causing kidney and thyroid problems. Many people have found the adverse side effects of the medication too difficult to endure, interfering with their jobs and daily living (Burns 103).

For years, Lithium has been the standard treatment for bipolar disorder. By chance, scientists found other effective anti manic drugs are the anti convulsant medications Tegretol and Depakote, which have been used to treat temporal lobe epilepsy (Harvard Mental Health Letter, Dyson 4 June 1997). In 1995, Depakote was approved by the FDA for the treatment of bipolar disorder and is slowing becoming the most widely prescribed drug for the use on mania. Depakote hasn't totally replaced lithium; however, it is being used on patients that were not previously treatable with lithium. Compared with lithium, Depakote doesn't have all the bad side effects when properly administered. Patients taking Depakote find their thinking is clearer and don't seems to have the kidney and thyroid problems (Burns 104-106).

The antipsychotic drug Clozaril also has been used to stabilize the moods of bipolar disorders, especially those that have not responded to lithium and the. One major side effect of Clozaril is that is suppresses the production of white blood cells on about 1% of patients (Harvard Mental Health Letter, June 1997). Because of this side effect, doctors have to be extremely careful when prescribing. One of the major problems when treating clients with pharmaceutical agents, however, is that during manic stages the euphoria they experience is so enjoyable that they discontinue their medication during the low stages of depression in an attempt to bring that "high" back again. Also when one goes off of the medication given to them the disorder may actually get worse. They can cause more episodes to occur and with each episode the risk of future episodes increases, as does the chance that lithium treatments will prove ineffective (Robbins 78).

A more radical treatment is electro convulsive therapy (ECT). Many people have heard about the horror stories of ECT and see it as an archaic tool that does little but torture the patient. This, however, seems to be a competent technique for treating bipolar disorder. Electro con- therapy was the main form of treatment for both mania and severe depression before the introduction of lithium. "In one study, all of 28 manic patients responded to ECT, while only 18 of 28 similar patients responded to the antipsychotic drug chlorpromazine. In another study, ECT was given for eight weeks to 17 patients who had not responded to lithium, and all of them Dyson 5 recovered" (Harvard Mental Health Letter, June 1997).

Electro convulsive therapy is very effective with patients suffering from rapid cycling between mania and depression and those that require restraint or if they are delirious. There is no study in which ECT has proved less effective than lithium or antipsychotics. A new alternative method of treating bipolar disorder may be as simple as altering one's diet. Studies have shown that consuming fish oil may reduce the symptoms of bipolar disorder. It is well accepted that fish like Salmon and Mackerel have been known to reduce heart disease, but now studies are showing that they may also reduce the symptoms of bipolar disorder. Oily fish are packed with fats called omega-3 fatty acids.

One study at Mclean Hospital in Belmont, Massachusetts found that one group of patients taking fish oil pills along with their regular medications showed fewer symptoms than patients taking only their regular medications (Finkelman 201) ). While researchers aren't sure of how omega-3 fatty acids helps alleviate symptoms of bipolar disorder, they are hopeful that in the future the fatty acids will provide an alternative low cost, natural mood-stabilizing drug. It seems that everything that goes wrong with the human body is somehow linked backed to our genes. Bipolar disorder is no different. In the not so distant future, we may have another way treating bipolar disorder.

Researchers are currently hunting for mood-disorder genes that lead to manic depression. If the genes were found, they would help scientists design better drugs to control bipolar disorder. With every great finding there is always a controversy lurking in the background. One such controversy has already arisen for mood-gene testing. If the exact gene or genes are found, they mat lead to test being done on fetuses. People may elect to abort the pregnancy rather than giving birth to a baby that has a higher risk or having bipolar disorder.

On the positive side, new drugs made possible by mood-gene research may be effective enough to Dyson 6 render the disease harmless, so the issue of abortion would be eliminated (Finkelman 176). Bipolar disorder is a very difficult disorder to live with; it affects one's life in many differing ways and can be extremely debilitating. Those diagnosed with manic-depressive psychosis cannot look forward to a quick recovery; this is a disorder that is often chronic like diabetes. To live with the disorder one must be diligent in their treatments; they must take their medication, have a collaborative relationship with the therapist in the psychosocial therapy sessions, involve one's family, and possibly even join a support group. The number of people with bipolar disorder is growing everyday. Many people live with bipolar disorder everyday and have no idea they have it because they are in denial or have been wrongly diagnosed by a physician.

I have only touched on some of the way that bipolar disorder can be treated. There are many other ways, some better, and some worse. With the information we know have bipolar and the knowledge that we will learn in the future, hopefully someday the disease we know as bipolar disorder will cease to exist. Works Cited Burns, David. Feeling Good: The New Mood Therapy. New York: Avon Books, 1980 Durand and Barlow.

Abnormal Psychology. New York: Brooks/Cole Publishing Company, 1997. Encyclopedia Britannica 1994 Vol. 23 Pg. 847. Finkelman, Anita Ward.

Psychology Today. Gaithersburg, Md. : Aspen Publishers, 1997. Harmon, Daniel E. The Tortured Mind: The Many Faces of Manic Depression.

Philadelphia: Chelsea House Publishers, 1998 Nathan, Peter E. Treating Mental Disorders: A Guide to What Works. New York: Oxford University Press, 1999." What is the role of ECT in the treatment of mania?" Harvard Mental Health Letter. June 1997. Will ner, Paul.

Depression: A Psychobiological Synthesis. New York: Wiley, 1985.