Talk:Bipolar disorder/Archive 5

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Archive 5
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Contents

On the balance of the article, POV, etc.

Although I am quite tempted to jump in on the above discussion, I will withhold for now. On another note, I noticed that a short time ago that one editor deleted the entire introduction. While I agree that the previous introduction was too long, I also believe the article needs an introduction of some sort (maybe on the order of two or three paragraphs plus the note on usage). Also, some of the content from the old introduction probably could/should have been moved into the main section of the article, but I don't think this was done. Anyone else agree and/or want to give some attention to this? -- Ithacagorges 06:38, 15 August 2005 (UTC)

No need to jump in, Ithacagorges, for you've made your position more than clear. Let me sum up for you: anything that mainstream psychiatry comes up with is honest and scientific. And anyone who disagrees is a member of a campaign with an agenda of dishonesty and exaggeration. Got it. Nothing POV about where you're coming from.

-- EFS

The fact that someone makes edits to try to bring balance to an article does not warrant your sarcastic accusations. I don't know about Ithacagorges, but my edits have simply been an attempt to improve the quality of the article. As you read the article on mental health law that I wrote and gave you a link to earlier, you'll see that I am by no means a blind apologist for current psychiatric practice. I just want to avoid this article degenerating into a useless mass of revert wars and POV-pushing, and perhaps even become a half-decent article on bipolar disorder. --ascorbic 22:34, 15 August 2005 (UTC)

The accusations were entirely accurate. My frustration (and resultant sarcasm) is due to my perception of what some posters mean by the term "balance." It really does appear to me that anything "mainstream" is called NPOV and anything outside the mainstream, no matter how true or how well cited, is called POV. It's very frustrating. Like I said, I was impressed with your article and am surprised that you're not more adamant about getting the facts out there on Wikipedia. Why is it that anything not palatable is called NPOV? Because it is mainstream psychiatry that is horribly skewed, and completely POV. I haven't even begun to address what's wrong with psychiatry in general and the bipolar diagnosis in particular. I haven't talked much about bipolar disorder being caused by antidepressants, although that's a huge problem and is certainly how I developed it. I haven't discussed the huge role that nutrition (or, more accurately, poor nutrition) plays in bipolar disorder. I also haven't discussed how many of us manage our mood swings effectively without medication. I just cannot believe psychiatrists are given so much power when their work is so consistently poor. The documented error rate on psychiatric diagnosis is around 50%. Lives have been destroyed by psychiatric treatment based on this kind of shoddy science. I've been as restrained as I can. -- EFS

As I said: it's not enough for it to be true or well cited. You cannot simply present the conclusion that one side of the argument is right or wrong. The article should not be about making a conclusion or convincing people either way. It should be about presenting the facts and letting the reader decide. It is a fact that critics say such and such or the APA says something else, and that's ok to say. You cannot, however, make a conclusion that one or the other is "true". That is not a fact: that is an opinion. It may be a correct opinion, but others would dispute that. Where in the article do you find it skewed towards "mainstream psychiatry"? As I read it, it presents the mainstream opinions as just that: the mainstream medical opinion. It likewise presents the criticisms as that: the opinions of a minority. It does not conclude which is correct. You may be surprised that I don't appear to you to be adamant in getting the facts out there. I will take that as a compliment. I am adamant in having the article represent the facts and the balance of opinion. This is not the place, and I am not the person to decide for readers what is the truth. That would constitute original research anyway, which is not allowed. I would be equally active in maintaining NPOV if there were an editor as active as yourself who wanted to remove all of the criticisms, or dismiss them as false. I do hope that if you make the changes you mention, you do so in a manner that reflects the balance of opinion, and doesn't use inflammatory language. Editing the article in order to say "what's wrong with psychiatry in general and bipolar diagnosis in particular" would be a VERY BAD idea. However, it's ok to report in a neutral tone on the views of those who share your belief. This article is also not the place for general criticisms of psychiatry: keep that to psychiatry and anti-psychiatry. From what I understand, you are active in the anti-psychiatry movement. This means you should be doubly careful to ensure that your bias doesn't enter into your edits. --ascorbic 08:31, 16 August 2005 (UTC)

I really do appreciate your comments, Ascorbic, and I think I should direct my energies elsewhere (huge sigh of relief all around!). I just wanted to say, though, that much of this article (and the ones on electroshock and schizophrenia) actually do put forward one point of view as fact. And that point of view is just not supported by the evidence -- there is NO evidence for the chemical balance theory and thus it is unethical to teach people that there is something diseased about their brains, especially when that teaching leads to discrimination and human rights violations.

What if we had a Wikipedia-friendly NPOV article about racism? You know, some people feel that Races X and Y are inferior. Of course, someone would jump in and rage and say the whole notion of racism is bunk! Do you know what I mean? And when I make edits that ARE neutral (here and in the other articles I mentioned) they get re-edited in very offensive ways. As I'm sure you're aware, the anti-psychiatry movement is significant, certainly enough to make psychiatrists start to pull up their socks. For example, at least one state in the USA has now partially opted out of the Texas Medication Algorithm Project in that they will require parental consent before screening. This is a HUGE victory and is entirely due to the work of organizations that I'm involved in. So when someone edits my "critics of psychiatry" to "some rather vocal former psych patients," yes, I am offended, very offended. I had a great cite on the electroshock page to a practicing doctor who did a very credible analysis of other studies. Well, that link was deleted right out without explanation. I'm not suggesting for a minute that you do this but I'm trying to get you to see how frustrating is to read this bumpf. Anyway, like I said, you've done brilliant work here, with me. -- EFS

  • To echo and add to absorbic’s comments, this is an article on a medical, mental health, and psychological topic. As such, the article should have somewhat of an emphasis on the prevailing mainstream medical, psychological and scientific view. My position on this was sarcastically mocked above but I stand by it as appropriate. That said, there is certainly a place for the views and assertions of critics in this article (and at present many are given). However: a) they should be stated as the claims/beliefs/opinions of a minority of critics, the anti-psychiatry movement, and the Scientologists, not as absolute fact; b) they should not use inflammatory, sarcastic, or outrageous language; and c) if they make claims that are widely disputed or considered inaccurate or misleading by the mainstream community, such should be noted. The tenor of a certain vocal editor’s recent contributions are generally not in this spirit. In addition, as absorbic points out, this article is not the place for general criticisms of psychiatry; that belongs on the psychiatry and anti-psychaitry article. Likewise, criticisms and claims about ECT generally belong on the ECT article. Finally I will note that if someone tries to start a topic on the talk page about a subject completely unrelated to one’s particular criticisms or beliefs about a subject, it is not necessary or courteous to juggernaut said section(s) as a further pedestal for your views. (FYI, you may be surprised to learn that I have certainly had far cry from a 100% positive experience with the mental health/psychiatric community, that I added a section on criticisms of psychiatry on that article, and I have also made some contributions that certainly do not put the drug industry in very good light.) -- Ithacagorges 10:06 16 August 2005 (UTC)

You've outdone yourself again, Ithacagorges! The scientologists are but a subset of the anti-psychiatry movement and it is so typical of you and mainstream psychiatry to attempt to smear us by referring to us as scientologists. That's not NPOV, man! We don't have mere "claims, beliefs, opinions" when psychiatry has "evidence." Your POV is dripping right off the page! Do you get the distinction? We have equally, actually more, compelling evidence for the environmental/social causes of mental illness and by extension the case for treating mental illness with psychotherapy and risk avoidance. Re your comments on electroshock, yes, that section has been moved but at one time it was embedded right in the bipolar article so I don't understand your complaint. Yes, I would be flabbergasted to learn that you have been badly treated by the mental health industry because you seem to be all for it here. -- EFS

EFS, I'm glad you appreciate my efforts here. I don't feel you;re being fair to Ithacagorges. The quote in question said "the anti-psychiatry movement, and the Scientologists", which is perfectly true: both the anti-psychiatry movement and Scientologists oppose psychiatric practice. The use of "and" not "including" does not to me read like referring to you as scientologists. Can you try to calm down a little: some of your recent comments (though not those directed towards me) have been quite aggressive. ---ascorbic 22:57, 16 August 2005 (UTC)

Start with a personal attack. Take a couple points I made, distort them significantly, then hammer on them as much as possible. And/or maybe take a couple things I actually didn’t say at all, and do as above. Use ample sarcasm and exaggerated language. Ignore most of what I said, particularly when inconvenient or counter to the intended point.

This is how I would briefly characterize EFS’s responses to my recent comments on this talk page. Quite interstingly, I would say this is analogous to many of EFS’s contributions regarding psychiatry (e.g. replace "on my comments" with "on current psychiatric or mental health practice"), and frankly is an approach used in a lot of anti-psychiatry and related literature and information. This is one of the primary qualms I have with both EFS’s contributions and the anti-psychiatry movement in general.

I think my statement was unambiguous in that I did not call EFS (or critics or members of the anti-psychiatry movement generally) a Scientologist. If EFS had checked my record, as I alluded to, she would have would seen my contributions have not been universally praising of mainstream psychiatry. I would be the first to admit that many patients’ experiences with psychiatry are not entirely positive, and some even find the downfalls worse than the benefits. On the other hand, in my experience and I would assert in general, only a very small number patients/former patients take on the views of or join the anti-psychiatry movement, or claim of intentional injury, "oppression" or "assault".

I apologize if this is somewhat aggressive and sarcastic myself. More on the balance of the article later. --Ithacagorges 00:06 August 17, 2005 (UTC), minor revisions 03:00 August 17, 2005 (UTC)

But the scientologists are just a subset of the anti-psychiatry movement. They are very prominent because many of their members are, as I'm sure you know, Hollywood celebrities. However, they are not better or MORE anti-psychiatry in any respect. IMO, saying "anti-psychiatry activists and scientologists" is an intentional slur against the anti-psychiatrists. Otherwise, why don't you mention "anti-psychiatry activists and libertarians"? As for personal attacks, Ithacagorges, weren't you the one who said "90%" of my posts were misleading, exaggerated, non-scientific, etc.? I've asked you some time ago to back up your claim and am still waiting. Many patients' experience has been "not entirely positive"? You crack me up. May I ask what you do for a living? FYI, MANY survivors find psychiatry causes more harm than good. You are correct that statistically only a small number of former patients oppose psychiatry. At least part of the reason for that is that some former patients were killed outright by psychiatry and many others live a kind of living death: an endless despairing cycle of trips to the psych ward, interspersed with appointments with shrinks they loathe and fear, "assisted" housing, asinine day programs, all this on the basis of a theory which has no credible evidence. -- EFS

Ascorbic, I would like the same standards to be applied to both sides. That is manifestly not the case at present. -- EFS

We try. You can help. If you look at Ithacagorges' last edit, it's actually balancing my edits to the now-defunct ECT section to reflect more of your POV. Ironic, considering your recent comments. --ascorbic 22:57, 16 August 2005 (UTC)

You are right! That is much more balanced and, dare I say, even approaching NPOV. Thank you for restoring the link to Dr. Peter Breggin's paper. Any idea who killed it in the first place? -- EFS

This is Ithacagorges FIRST reference to my edits: "I agree that 90%+ of 24.108.4.85's edits have been POV with no place in this article; they promote the so-called "anti-psychiatry" agenda, and typically make misleading, inaccurate, exaggerated, and/or non-scientific claims." The funny part is that he says "I agree" but the previous editor hadn't made an analogous claim. If "aggression" is being accused here, I would suggest that Ithacagorges set the tone of this discussion. Once again, I ask for specific examples of where I make "misleading, inaccurate, exaggerated, non-scientific" claims. -- EFS

Introduction

Let's try this again. I noticed that a short time ago that one editor deleted the entire introduction. While I agree that the previous introduction was too long, I also believe the article needs an introduction of some sort (maybe on the order of two or three paragraphs plus the note on usage). Also, some of the content from the old introduction probably could/should have been moved into the main section of the article, but I don't think this was done. Anyone else agree and/or want to give some attention to this? -- Ithacagorges 22:56, 15 August 2005 (UTC)

I agree. While the old introduction was not great, and had quite a bit that should have been in the body of the article, the article does need at least something as an intro. -- ascorbic 23:06, 15 August 2005 (UTC)

I think before such changes are made (and I agree that they are required) we should try to figure out how this topic can be presented without being an advertisement for mainstream psychiatry. I am just appalled at some of what is in this article so far. You're swallowing Big Pharma's line -- that the only way to "manage" this "disease" is by taking medication.I don't think it's unreasonable to give a fair piece of this article to something other than Big Pharma driven narrative. -- EFS

PLEASE give me an example of where I have introduced something misleading and/or exaggerated. -- EFS

Neurological basis.

I was hoping to find some kind of summary or indeed collection of the neurological bases of bipolar disorder here. Maybe someone with an appropriate understanding of the field could add to this article?

At this time, there is no compelling scientific evidence of a neurological origin for bipolar disorder (or any other mental illness). -- Francesca Allan of MindFreedomBC

Genetic Component

The current entry has this:

Bipolar disorder is considered to be a result of complex interactions between genes and environment. The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Therefore, the genetic component makes up about 70% of the risk for the disorder. Relatives of persons with bipolar disorder also have an increased incidence of having unipolar depression.

However, since twins are brought up in the same environment, a monozygotic concordance rate does not give you a percentage of the risk of the disorder. Sometimes studies of adoptees are done--twins who were seperated at birth. At very least, there needs to be a nuanced comparison between monozygotic twins and non-twins. There is also the issue that "70% of the risk for the disorder" is so vague as to be effectively meaningless. Risk for whom? Someone who doesn't have "the gene" is at 30% at risk? No, that's muddled. I'm not trying to be pedantic or lash at people for hard work--thanks for doing what you've done. Just trying to justify my removal of the sentence in bold. Cheers--Pigkeeper.

"Complex interactions between genes and environment" pretty much demonstrates how little psychiatry knows as most if not all diseases are a complex interaction of genes and environment. The truth is that as of this moment there is no objective diagnostic test for any mental illness. If, by some miracle, they actually did find some biochemical or other marker, then bipolar, schizophrenia and depression would no longer be dealt with by psychiatry but would be true brain diseases and treated by neurologists. That is unlikely to happen.
Also I found the following unsigned paragraph above: "It's often the case that someone with BP disorder who is not being medicated will appear normal between distrbances and to be fully functional and independent. It's rather uncommon for people with schizophrenia who have undergone several episodes to be fully functional and independent without medication." This is completely untrue. First of all, it's not a matter of "appearing" normal -- between episodes a bipolar IS normal and fully functional. Second, it's not at all uncommon for schizophrenics to go into remission, even 2 or 3 year decades into their illness. Chronic disability is caused by psychotropic drugs, not the alleged disorders. -- Francesca Allan of MindFreedomBC

Mixed States ; "Bipolar" vs. "Manic Depression"; Manic depression includes unipolar?!

Number one: The page could use more information on mixed states. If/When I get a chance, I'll add it. No time at present or for coming weeks.

Number two: People are disparaging the term 'manic depression', but I know I am not the only one out here who prefers the term to bipolar disorder. It is precisely because of mixed states that I say this.[1]

Manic Depression is, in my view, a better term for the condition, the reason being that there really aren't two poles. It is possible to be manic and depressed at the same time, believe it or not. These so-called "mixed states" are can be the most troubling--I know they are for me. Many people have a somewhat romantic notion of manias, but when you're your mind is hyperactive but you're unhappy, it really sucks. The best word that comes to mind to describe this is "aggitation". It is hard to deal with people in relationships when they are being this way. It's also when people feel crap enough to kill themselves, but have the energy to pull it off.

Number three: From the introduction:

"the term manic depression is also now used (by a relatively small number of mental health professionals) to refer to the entire clinical spectrum of mood disorders that includes both bipolar disorder and unipolar depression."

COULD SOMEONE GIVE A CITATION FOR THIS PLEASE? I THINK THIS IS WRONG. I've never heard anyone say that unipolar depression is a form of manic depression! I'd respectfully admit I was wrong if you have any sources. But at any rate, I think it's such a minority that it's misleading to put it in the introduction. However, bipolar spectrum disorders is another thing... Bipolar I, bipolar II, cyclothymia, etc...

Cheers, Pigkeeper, Oct 17, 2005

I've never heard this either and I agree with you that it's probably in error. One other point is that when bipolar disorder is caused by antidepressants (i.e. a depressed person takes antidepressants and becomes manic for the first time) some psychiatrists refer to this as "latent bipolar disorder" becoming evident. This is an obscene interpretation of a fairly obvious cause and effect relationship. -- Francesca Allan of MindFreedomBC


Feb 2005 Journal of Affective Disorders had a entire issue devoted to the *theory* of Hagop Akiskal MD of the University of California at San Diego about Bipolar and Unipolar Despression being on the same spectrum. Journal of Affective Disorders: http://www.sciencedirect.com/science?_ob=IssueURL&_tockey=%23TOC%234930%232005%23999159997%23568410%23FLA%23&_auth=y&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=40fc023079b068243a79a0dad8579d7e And a layman's description is here: http://www.mcmanweb.com/mood_spectrum.htm Curlywhirly 03:52, 16 December 2005 (UTC)

Chaos

This article is presently a bit chaotic. I've done some cleaning up, but there are still two sections about creativity and bipolar disorder etc etc.

I feel the article still lacks the basics, but contains the latest research that has made the popular press. That is immensely confusing for the reader. There's a lot of work to do here. On the Medical WikiProject, we stick to a fixed format: signs and symptoms, diagnosis, mechanisms of disease, treatment etc, see here. This may be less suited for this article, but may be worth trying. JFW | T@lk 23:18, 15 November 2005 (UTC)

Link vandal

Anonymous user 24.199.113.69 keeps adding a link to http://bipolartreatment.com in multiple sections of several articles, including Medicine where it is inappropriate - what can be done to prevent him or her from repeating this over and over again? unsigned comment 19:26, 23 November 2005 by Anarchist42

Same from other anonymous IP addresses. Getting quite aggressive with the linkspamming. CarbonCopy 19:44, 23 November 2005 (UTC)

France

I heard that the country with the lowest rates of bipolar disorder is france. What is the cause of that. I May have heard something about natural salts? any help would be apreciated. ---Bohouse 20:50, 1 December 2005 (UTC)bohouse

Natural salts high in lithium? JFW | T@lk 23:11, 1 December 2005 (UTC)

The answer is lithium carbonate. --165.236.228.81 03:12, 9 December 2005 (UTC)

clean this sh*t up!

Man this article is riddled w/poor writing. I don't have time to work w/it now but we need more quality information (better no info than false/poorly supported info!) I changed some things under the "creativity" section; there has been TONS of research on BP & creativity links, so it shouldn't be hard to cite. I added two articles, but i don't know how to put them under the reference section. anyone else w/access to a university library database could fix this for me... --Katwmn6 00:39, 5 December 2005 (UTC)

I'm sorry it's not in the best of states now. Feel free to remove whatever sounds illogical or cannot be backed up with a CITE. This is an important condition, and there is little reliable information online. Wikipedia should have a good article on it. JFW | T@lk 15:33, 5 December 2005 (UTC)

Please add a section on how Bipolar and Schizophrenic parents affect children's self esteem and safety.

I'm sure many people who have these mental problems will want to know how to protect their children from their outbursts, and how to explain their out-of-control behaviors to their children. I have seen some children who were told that their parent's behavior is "normal", who then LEARNED to copy the behaviors and attitudes, which created many problems for the children. (karenjoyce_bell).

Their outbursts? Which outbursts would those be? Francesca Allan of MindFreedomBC 15:35, 5 December 2005 (UTC)

People with borderline personality have outbursts of anger etc, where people with schizophrenia have relapses of psychotic episodes and people with bipolar have episodes of mania or depression.

As opposed to the general population which never gets angry, high or depressed. Francesca Allan of MindFreedomBC 18:19, 11 December 2005 (UTC)
"Mental problems?" You remind me of a teacher I once heard say that bipolar patients should never be so "selfish" as to raise children. misanthrope 17:48, 23 December 2005 (UTC)

Hypomania

in the section "Domains of bipolar disorder," there is a brief mention of Hypomania, but there isn't really a description of its features beyond its characterization as "mania-lite." Honestly, after reading this article (and knowing a few BPs) I'm curious as to what hypomania is, and the article didn't really do it for me. Can anyone expand this section? Shaggorama 05:28, 14 December 2005 (UTC)

A terrible mess

This article, whilst containing some good writing and verifiable information, has been bloated by drivel and has become a structureless mess. It needs substantial editing and trimming of redundant material. And yes, I have made a small start on doing so. -- The Anome 17:54, 17 December 2005 (UTC)

I too have made a start at bringing things into a more coherent article. Please forgive me and point me in the right direction if I don't follow wiki-ettiquette, as this is my first time working on the project. Here are my proposed changes for the first paragraphs (combined into one):

Bipolar disorder, also sometimes called manic-depressive disorder, is a mood disorder in which a person experiences episodes of mania and depression without other environmental or medical etiologies. Other causes of manic or depressive symptoms such as hyperthyroid or sleep deprivation negate the diagnosis of Bipolar Disorder. These mood "cycles" which can vary in speed can effect the victim's levels of motivation, energy, cognition and overall functioning, and can be disabling as they have extreme shifts in mood between depression and manic euphoria or irritability. The DSM lists two main types of bipolar disorder (recognized clinically as Bipolar I and Bipolar II), the former of which features more marked mania. Some people with Bipolar also experience psychotic symptoms along with the mood disturbance. Treatment of disabling bipolar disorder is with mood stabilizers, prominently lithium salts and/or some anticonvulsants and/or anti-psychotic medications.

Looking forward to input from others,

Curlywhirly 23:03, 18 December 2005 (UTC)


This sounds very good. JFW | T@lk 23:30, 18 December 2005 (UTC)

Here are my proposed edits for the second section on Epidemiology:

The lifetime prevalence rate of Bipolar Disorder I and II is between .6 and 2% of the population. Bipolar I disorder is gender-neutral, affecting both women and men equally, although Bipolar II is found more frequently in women. There appears to be no difference in frequency among races. Often the disorder starts with a depressive phase, and mania or hypomania then follows. For many years it was believed that Bipolar was a disorder that emerged in late adolescence and young adulthood, but recent research has shown that even young children can suffer from Bipolar symptoms. In the vast majority of cases the symptoms are present for the rest of the persons life, although there are some occasional reports of single manic episodes and then full recovery with no reoccurrence. It should be noted that manic symptoms that are caused by other medications or diseases or disorders rule out the diagnosis of Bipolar Disorder, and this is possibly the root cause of some of the full recovery case reports.

Bipolar Disorder can be co-morbid with a number of other disorders and problems, including panic disorder, social phobia and substance abuse/dependence, somatization disorder, personality disorders, suicidality and delinquency and possible associations with Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Tourettes syndrome, impulse control and eating disorders, ADHD, Oppositional Defiant Disorder and conduct disorder.

I have 2 references for my edits:

Co morbids and prevalence rates, etc http://www.wpic.pitt.edu/STANLEY/3rdbipconf/Sessions/sess2main.htm

BP in children http://www.nimh.nih.gov/scientificmeetings/pediatric.cfm

Would the proper style be to add these to the References section or should I cite them as part of the article itself? Curlywhirly 23:38, 21 December 2005 (UTC)


I would like to suggest merging the Multiple co-occurring explanations & Etiology categories. There is much over lap of information and it becomes quite confusing to me. I am still working on providing adequate references for statements made... I'd post those before making the changes listed here. Here are my proposed changes:

A diagnosis of bipolar disorder means the diagnosis of clinical depression and at least one major manic episode... Quite frequently, a patient will be diagnosed with clinical depression, modified to bipolar after the onset of mania. The causes of a manic episode may also be indeterminable, leaving the diagnosis of chronic bipolar disorder in doubt. See manic episode or depressive episode. A person can have symptoms of mania without having bipolar disorder, or without being depressed.

Multiple factors may be involved in developing Bipolar Disorder. Stressful events or major life transitions, a family history/ genetic predisposition to psychiatric diagnoses including bipolar disorder, clinical depression, or schizophrenia (This increases a family member's likelihood of having psychiatric symptoms by 10% or more), past or present drug use (may complicate diagnoses if present and may lead to misdiagnoses), sleep deprivation can also cause a manic like state. Drug use, both legal and illegal may also contribute to the development of Bipolar Disorder. According to the "kindling" theory [1], persons who are genetically prone toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, the mood episode itself is sufficient to trigger reoccurring difficulties. Conversely, Bipolar disorder may be caused by a combination of biological and psychological factors. In some cases the onset of this disorder can be linked to stressful life events. Periods of depression, mania, or "mixed" states of manic (euphoric) and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life. It is possible to see single occurrences of depression and mania which do recur.

Drugs and Bipolar: Adderall and other drugs and amphetamines (including meth) have been cited as producing mania, even after the drug is not in the bloodstream. For such a patient, the euphoria of the Adderall might not wear off as quickly as it may for others. They may exhibit manic symptoms while on the drug. Some medications have depression as a side effect. Conversely, often a manic patient will, if untreated, be misdiagnosed by laypersons and even medical professionals as being "high" on meth in a state of "meth psychosis," which also includes the co-occurrence of a string of sleepless nights found in a true, or full blown 'mania.' At this point, without medical intervention, the manic state and sleeplessness can combine to form a vicious cycle which only proper intervention, can end. According to their prescribing information published by the manufacturers antidepressant medications can also possible trigger manic or psychotic episodes which may or may not resolve when the medication is resolved.

Three sections I was unable to merge successfully. If anyone else would like to try that would be great, otherwise I can try to find appropriate places for them elsewhere in the article. Looking forward to input.

1)Rarely does the disease first manifest in a manic or hypomanic episode: generally these occur after years, even more than a decade of clinical depression. 2)Often emergency room hospital personnel will view any manic behavior as symptomatic of drug abuse, whether or not the patient has any drugs in their system or not. Most emergency room staff have little or no training, which could contribute to the high rates of suicide among bipolar patients who seek help and are denied medicinal intervention. 3)Conversely, it is also possible for the the onset of the depressive aspect of bipolar to first appear in the late teens with no "kindling" or outside stressors. Such patients are often diagnosed with clinical depression until the first manic episode occurs, usually in the mid-to late twenties. In these patients, the biological factor seems to be prevalent, although co-occurring substance use or 'self-medication' can cause a misdiagnosis or further complications.

Curlywhirly 17:31, 27 December 2005 (UTC)