With or without therapy, episodes of major depression usually end, and people temporarily or permanently return to their previous behavior patterns. However, some people rebound to, or sometimes start with, the opposite emotional extreme—the hyperactive, overly talkative, wildly optimistic state of mania. If depression is living in slow motion, mania is fast forward. Alternating between depression and mania signals bipolar disorder.

Adolescent mood swings, from rage to bubbly, can, when prolonged, lead to a bipolar diagnosis. Between 1994 and 2003, diagnoses of bipolar disorder swelled. U.S. National Center for Health Statistics annual physician surveys revealed an astonishing 40-fold increase in bipolar disorder diagnoses in those 19 and under—from an estimated 20,000 to 800,000 (Carey, 2007; Flora & Bobby, 2008; Moreno et al., 2007). Americans are twice as likely as people of other countries to have ever had a diagnosis of bipolar disorder (Merikangas et al., 2011). The new popularity of the diagnosis, given in two-thirds of the cases to boys, has profited companies whose drugs are prescribed to lessen mood swings. Under the new DSM-5 classifications, the number of child and adolescent bipolar diagnoses will likely decline, because some individuals with emotional volatility will be diagnosed with disruptive mood dysregulation disorder (Miller, 2010).

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During the manic phase, people with bipolar disorder typically have little need for sleep. They show fewer sexual inhibitions. Their positive emotions persist abnormally (Gruber, 2011; Gruber et al., 2013). Their speech is loud, flighty, and hard to interrupt. They find advice irritating. Yet they need protection from their own poor judgment, which may lead to reckless spending or unsafe sex. Thinking fast feels good, but it also increases risk taking (Chandler & Pronin, 2012; Pronin, 2013).

For some people suffering depressive disorders or bipolar disorder, symptoms may have a seasonal pattern. Depression may regularly return each fall or winter, and mania (or a reprieve from depression) may dependably arrive with spring. For many others, winter darkness simply means more blue moods. When asked “Have you cried today?” Americans have agreed more often in the winter (TABLE 51.2).

In milder forms, mania’s energy and flood of ideas fuel creativity. George Frideric Handel, who may have suffered from a mild form of bipolar disorder, composed his nearly four-hour-long Messiah (1742) during three weeks of intense, creative energy (Keynes, 1980). Robert Schumann composed 51 musical works during two years of mania (1840 and 1849) but none during 1844, when he was severely depressed (Slater & Meyer, 1959). Those who rely on precision and logic, such as architects, designers, and journalists, suffer bipolar disorder less often than do those who rely on emotional expression and vivid imagery (Ludwig, 1995). Composers, artists, poets, novelists, and entertainers seem especially prone (Jamison, 1993, 1995; Kaufman & Baer, 2002; Ludwig, 1995). Indeed, one analysis of over a million individuals showed that the only psychiatric condition linked to working in a creative profession was bipolar disorder (Kyaga et al., 2013). As one staff member said of the great leader Winston Churchill, “He’s either on the crest of the wave, or in the trough” (Ghaemi, 2011).

It is as true of emotions as of everything else: What goes up comes down. Before long, the elated mood either returns to normal or plunges into a depression. Though bipolar disorder is much less common than major depressive disorder, it is often more dysfunctional, claiming twice as many lost workdays yearly (Kessler et al., 2006). It afflicts adult men and women about equally.

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