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Bipolar Disorder: Managing the Balancing Act

Bipolar disorder symptoms include dramatic shifts in mood and the ability to function. Successful bipolar disorder treatment requires a careful course of medication, psychotherapy, and discipline to stay on track--and avoid an emotional crash

The 'Learning Curve' continued...

Regardless of the downsides, the mania can be compelling. "I felt like God was talking through me at one point, and I bought lavish gifts for my girlfriend [now wife]," Bernard recounts. "It's the feeling of being high and feeling like you are the messiah." In an upcoming story on General Hospital, his character Sonny -- who also has bipolar disorder -- will traverse the manic stage of the illness.

"You feel like you are on top of the world and nothing can stop you. And then, of course, the real problem is having to deal with the crash," says Bernard.

"I understand that patients who feel elated [also] feel wonderful ... it's like being on cocaine and can be extremely attractive and very seductive," says Joseph Calabrese, MD, a professor of psychiatry at Case Western Reserve and director of the Mood Disorders Center at the University Hospitals of Cleveland, Ohio. "There is one problem," he adds. "One hundred percent of people have a depression after a high.

"There are short periods of productivity on the way up, but once the highs get more severe, they are less productive," Calabrese says. And "once you are ill, you have to be able to stay on your medication for life, since in most instances when medications are stopped, people will relapse."

"It's a human phenomenon," agrees Gary Sachs, MD, an associate professor of psychiatry at Harvard Medical School and director of the Bipolar Mood Disorder Program at Massachusetts General Hospital, both in Boston. "There is a willingness to take a treatment when you're acutely ill, but then when symptoms are no longer [obvious], it's hard to get your arms around the idea of taking a drug forever when you are not perceiving any benefit."

Just as with Bernard, "as patients experience more and more relapses, the wisdom to take medication becomes clearer," says Sachs. Some people, he adds, may get the message after three lapses -- and for others it can take 13.

James E. Rosenberg, MD, director of neuropsychiatry at the Sports Concussion Institute at Centinela Freeman Hospital in Marina del Rey, Calif., says that people with bipolar disorder think, "'I am going to finally write the great symphony or make some brilliant discovery.' But in the long term, people with untreated mania may find they no longer have family, are HIV positive from engaging in risky, thrill-seeking activities, are in jail, or are bankrupt. There are horrible consequences that affect the rest of your life."

For Molliner, the repercussions were mainly social. "I lost my identity as a 16-year-old adolescent girl. I didn't take final exams [the year] I got diagnosed because I was being treated, and everybody I went to high school with knew why, and the shame that went with that was the biggest repercussion," she says. "I felt like I didn't fit in and never would."

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