Many of us love to ride roller coasters. The unexpected drop or sudden flip only adds to the excitement of the experience.

Now imagine that your emotional life was the roller coaster. Suddenly, you are on top of your game, filled with boundless energy and ideas. Who needs more than a few hours of sleep? Why not get that new car you've wanted, even if the bank account is a bit anemic? Just as dramatically, your mood drops off a cliff and you can barely get out of bed. You feel worthless and unsure if there is any reason to continue living.

Comparing life with a bipolar or manic depressive illness to a roller-coaster ride only begins to suggest the emotional devastation that this major mental illness can cause. The American Psychiatric Association defines bipolar disorder as "a brain disorder that causes shifts in a person's mood, energy and ability to function." Its "Let's Talk" fact sheet, available online, acknowledges that this disorder "can result in damaged relationships, difficulty in working or going to school, and even suicide."

Bipolar Disorder Awareness Day was yesterday, making it a good time to explore this fascinating yet challenging disease and learn how modern treatments can help people lead much less chaotic lives.

Bipolar disorder is also known as bipolar affective disorder, the word affective highlighting the role of mood or affect in the disease. There are two sub-types. Bipolar type I is the classic manic-depressive illness and is diagnosed in people who have had at least one manic episode in addition to one or more depressive episodes. The symptoms of the manic phase, also referred to as hypomania, include elevated mood, hyperactivity, reckless behavior, poor temper control and delusions of grandeur. In Bipolar type II, the manic-like symptoms are similar but usually less intense and dramatic. The symptoms can last for weeks and even months.

The depressed phase of both types I and II must be taken quite seriously, since it is often severe and may end in suicide if not promptly treated. Symptoms include persistent sadness, fatigue, inability to sleep, loss of appetite, withdrawal from friends and activities and persistent thoughts of death.

Adding to the complexity of this illness is that alcoholism or other forms of substance abuse can often complicate a diagnosis. In medical school, the first patient I saw with frank mania had been admitted several times for alcohol detoxification. It was only after his latest admission, in which he was suffering from the delusion of being a deity, that the final connection to, and correct diagnosis of, bipolar disease was made.

What causes this illness? Both genetic and environmental elements appear to be involved. A relative of someone with bipolar illness is 10 times more likely to develop either bipolar or depressive disorders than someone with no family history. In addition, environmental triggers such as severe stress, substance abuse problems and family dysfunction are thought to have some role in precipitating the illness in vulnerable people.

Fortunately, effective treatment for bipolar disease is available. The primary treatment is medications known as mood stabilizers, which reduce the intensity and likelihood of future manic episodes while reducing the risk of depressive episodes. While beneficial, these medications have potentially serious side effects and should be monitored closely by an experienced psychiatrist.

Living with this disorder or having a family member with it can be quite a challenge. I strongly encourage patients with bipolar illness to have ongoing psychotherapy with a psychiatrist, psychologist or other appropriate medical professional. This will provide support, allow for psychological work on stressors, provide an additional objective observer of the patient's mood stability, and help the patient deal with the very real temptation to stop their medication when normal mood returns. I also encourage spouses and families to have their own support network. National mental health groups have local chapters, which can be a valuable resource.

The positive news is that people with this complex illness can enjoy a good life through appropriate ongoing treatment from a medical professional.

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David F. McMahon, M.D., FAPA, is a board-certified psychiatrist on the medical staff of Beverly and Addison Gilbert hospitals and the medical director for geriatric psychiatry at the Center for Healthy Aging at the Beverly Hospital Hunt Center.