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Understanding the manic side of bipolar disorder

The doctor knew.

He knew the minute she walked into the room that his patient was beginning a manic episode. He knew by the passionate-purple lipstick that streaked her lips. It always began this way.

He’s been her doctor for 15 years and he knows what comes next.

Soon, she’ll begin to think faster and talk faster. She’ll become charming and vivacious; her dates will find her irresistible. Usually quiet and modest, she’ll begin to dress provocatively and behave recklessly.

The doctor will act quickly and aggressively with medications, even hospitalization, if necessary. He’s a firm believer in the common theory of “kindling”; that each unchecked manic episode leads to more frequent and more severe episodes that will be more resistant to treatment.

Another patient, a businessman in his 40s, rises after four hours of sleep, exercises, gulps coffee, heads for work where he just got a promotion. He’s started using cocaine; drinks his lunch. He feels invincible, that he can’t fail. He’s beginning to make dangerous business decisions. His insomnia is getting worse. He’s becoming more irritable. The doctor recognizes that he’s crossing over into mania.

Symptoms of bipolar mania vary from person to person.

A man who’s usually quiet and agreeable becomes irritable. Generally not one to speak up, he begins to dominate meetings at work and becomes increasingly competitive. He can’t stand having anyone driving slower or faster than he is and his driving becomes dangerous. He feels aimless. His doctor, who’s been treating him for bipolar disorder for many years, recognizes the signs of his mania weeks before he himself does. He doesn’t become euphoric. “He becomes like a clockwork toy that needs to be wound up again,” says the doctor.

One woman becomes unusually mistrustful of her friends and suspicious of her husband as she becomes manic. A man starts sending long emails, then stops sleeping just before developing a full-blown manic episode.
Recognizing early signs is crucial for treatment to be successful, says Igor Galynker, MD. “By the time a patient is not sleeping, is feeling invincible and is making bad decisions, it may be too late,” he says. “It may take six months before the person recovers completely.”

Many people living with bipolar disorder don’t recognize the signs of their mania. The change can be gradual. Others don’t want to acknowledge it because the “highs” of a manic state can, for some, be addictive, like a drug. A psychiatrist, who is trained to observe subtle changes, can often recognize the onset of mania even if they don’t see the patient often.

Family members are in the best position to notice early warning signs, says Dr. Galynker, who is Director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in Manhattan.

If you or someone close to you is exhibiting early signs of a manic episode, it’s important to see a doctor immediately so that treatment can be started or adjusted.

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