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Ms. D sits on the edge of the bed, her gown askew.  Her face is painted in brightly colored makeup that verges on the garish.  Her husband, dressed neatly in slacks and a polo shirt, stands nervously at the side of the bed.  He speaks quietly: “We just got back from a trip to Europe and––” but she cuts him off midsentence.  She talks rapidly, with little connecting one sentence to the next.  She jumps from complimenting my shoes, to her conversation with the queen – “We are best friends, you know” – to her plans to become attorney general – “I am a brilliant lawyer.  Brilliant.”  She tells me about her plans for a new company, stringing together a series of ideas that make little sense. Later, in a quiet conversation with her husband – outside her room, as it is nearly impossible to speak without her cutting us off – I learn that she is indeed a successful lawyer, also a mother of two teenagers, but not a friend of the queen.  She is, however, bipolar, and while most who travel can suffer the effects of jet lag, for her the impact has been far more serious as it has tipped off a manic episode.  “I haven’t seen her like this for years,” her husband says, clearly concerned.  “She deals with depression every few years, but her psychiatrist tweaks her meds, and then things are pretty much back to normal.  Most of the time, I don’t even think about the fact that she’s bipolar.” 

Bipolar disorder, also called manic-depressive illness, is a serious mental illness that affects about 1 percent to 3 percent of the population.  Bipolar disorder is characterized by discrete mood episodes – specifically, manic, hypomanic and depressive episodes.  Currently, we divide bipolar disorder into two types: Bipolar I and Bipolar II.  Bipolar I is characterized by at least one full manic episode while Bipolar II has at least one hypomanic episode and at least one depressive episode but no episodes of full mania, which differ from hypomania by their duration and intensity. 

During a manic episode, people typically need little sleep and are filled with energy.  They can have grand ideas and an inflated sense of self-esteem.  They may also engage in risky and impulsive behaviors that they would not do normally, like gambling, going on spending sprees, and being sexually promiscuous.  If left untreated, these episodes last for at least a week for a full manic episode (at least four days for hypomania) and severely impact their ability to function.  To complicate things, there can also be “mixed” episodes that have features of both depression and mania.  Bipolar can be difficult to diagnose and one study showed that 1 in 3 patients wait at least 10 years before receiving a correct diagnosis; in over half the cases, the first episode is depression, making it easy for a patient to be misdiagnosed.

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