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    Bipolar Disorder: Managing Mania

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    When Bipolar Mania Gets Out of Control

    For many with bipolar disorder, mania feels dangerously good.

    When Bipolar Mania Gets Out of Control continued...

    "Insight is not the middle name of mania," says Kay Redfield Jamison, PhD, professor of psychiatry at Johns Hopkins University School of Medicine and author of An Unquiet Mind and other books on bipolar disorder.

    "Most manic episodes are highly unpleasant," Jamison tells WebMD. "Even people who get euphoric can end up having terrifying experiences. Some people recognize when it becomes destructive, but certainly not everyone. That's when the family and the law come in."

    Many people begin treatment via a trip to the hospital ER -- often, against their will. "To be quite honest, if someone were experiencing only the manias -- even if they recognize things are bad -- it would be difficult to convince them they need to be on medications," Bearden says.

    While depression is difficult for anyone, it's especially traumatic if you have bipolar disorder, she tells WebMD. "It's such a dramatic change from the mania. And if the depression becomes very, very severe, people may become suicidal. That's why a lot of people come for treatment. At that point, people realize they need to be on medication for the depression -- and to take the edge off the highs as well."

    Bipolar Disorder Medications: Why Quit?

    In recent years, the medication menu for treating bipolar disorder has become quite complex. Most people with bipolar I start with lithium. Drugs used to treat other illnesses have also been pulled into treatment: antiseizure medications, antipsychotics, calcium channel blockers, and benzodiazepines.

    The medications can work very effectively in smoothing the highs and lows, helping people feel "normal," says Edith Harvey, MD, staff psychiatrist with the Hope Program at the Menninger Clinic in Houston.

    "There are a lot of people out there who are extremely functional despite their bipolar disorder -- doctors, lawyers, judges, movie stars," Harvey tells WebMD. "It's a very treatable disorder. I would have to say the majority of people who get into treatment stick with it. It's a smaller percentage that repeatedly get sick."

    What makes people quit taking medication? Very often, it's denial that the problem is a real illness. Another issue is intolerable side effects, especially lethargy and weight gain. Or the medication may not be working very well, says Harvey.

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    I can tell I'm becoming manic when: