“Pam” was at her wit’s end when she called me late last March.  Her 45-year-old husband, “John,” was having another manic depressive episode, and wouldn’t consider her advice.  

Pam said she was tired of taking care of her husband because John wouldn’t take his medication for bipolar disorder.  He spent most of his days driving around or visiting coffee shops and bars.  She worked full-time to pay for their two children’s college educations.

Usually John returned home around dusk, glib and obstinate.  “It’s still winter,” he said.  “I deserve ‘down’ time before starting spring planting and hard work.”  

Pam couldn’t reason with John.  She worried he wasn’t taking care of their hog finishing unit properly.   When she checked it, often the feeders were empty.

She worried even more that John would do something foolish—like drive his vehicle while inebriated or make an unnecessary purchase such as he did last year when he bought a new truck even though his previous one was only a year old.  They didn’t have the money to pay for the new vehicle and Pam had to cash in a retirement account to pay for it.  

What is bipolar disorder?  Bipolar disorder, also called manic depression, is a mental illness with a strong genetic inclination, although its severity varies from person to person and some carriers of the genetic proclivity never develop the disorder.  

The National Institute of Mental Health indicates that children with a parent or sibling who has bipolar disorder are up to six times more likely to develop the illness than children who do not have a family history of bipolar disorder.

It’s almost always a lifelong condition, caused by chemical imbalances in the brain that produce extreme mood swings.  Persons with the disorder may experience either manic or depressed phases, maybe both.  Serious symptoms usually first appear in early adulthood, but children and adolescents may develop the illness.

Bipolar disorder symptoms are different than normal “ups” and “downs.”  They can result in damaged relationships, poor school or work performance and even suicide.  Each mood episode is accompanied by extraordinary changes in energy, activity, sleep and behavior.

A diagnosis of bipolar disorder, according to diagnostic manuals, requires five or more symptoms of depression or mania.  Depression symptoms include the following: unusually sad mood (or irritable mood in children) that lasts more than a week, loss of interest in activities once enjoyed, strong feelings of worthlessness or guilt, changes in eating habits that result in significant recent weight gain or loss, difficulty sleeping or excessive sleep, loss of energy to carry out usual activities, more than usual complaints about pain, physical agitation or psychomotor retardation, difficulty concentrating and recurring thoughts of suicide and death.

Symptoms of mania include the following: overly silly or grandiose mood, inflated self-esteem, decreased need for sleep (feels rested after only 3-4 hours of sleep), more talkative than usual or pressure to keep on talking, feelings that perceptions are unusually intense, flight of ideas and easily drawn to unimportant stimuli, increase in talking and thinking about sex and behaving in risky ways such as pursuing unwise purchases or relationships.

Treatments of bipolar disorder usually entail medications that modify brain activities, called mood stabilizers, along with counseling about the disorder and its effects.  Family members or other loved ones often are involved in counseling as a support team.

In John’s case, as in many cases involving a severely bipolar individual, others are needed to detect the emergence of bipolar episodes, to ensure maintenance of a medication regimen and to protect the individual from mistakes.  

Pam had to take charge of the checkbook and overall family finances during John’s episodes of mania.  She and others helped pursue his periodic hospitalizations when he was depressed or manic, refused to take medication and was a danger to himself or others.

Mood stabilizing medications, such as lithium, anticonvulsants such as valproic acid, or atypical antipsychotics such as risperidone almost always are needed to control bipolar disorder.  The medications must be carefully regulated to prevent poisoning and to reduce side effects while still sufficient to control symptoms.

Most persons who take mood stabilizing medications don’t like the intended effects because they “slow” the bipolar person down and reduce the exuberance that accompanies a manic episode.  John purposefully avoided taking medications because he enjoyed his boundless energy and enhanced sense of power while manic.

Behavior management greatly assists control over bipolar disorder during both depressed and manic episodes.  Psychotropic medications may rectify the chemical imbalances in the brain but medications don’t guide the person’s behavioral choices.  Persons with the disorder can learn to recognize and curtail their abnormal mood tendencies and to respect and respond to the feedback given them by persons who have their best interests at heart.  

Next week’s column will elaborate on behavioral approaches to managing bipolar disorder and I’ll describe John’s outcome as well.  Stay tuned.


by Mike Rosmann, Ph.D.

Dr. Rosmann resides on his farm near Harlan, Iowa.  He can be contacted at www.agbehavioralhealth.com.