Many people, children and adults alike, love to go to amusement parks and ride on roller-coasters and other fast rides. These rides can scare the living daylights out of some, as they go through their bolting ups and downs, and even sometimes turning the rider upside down as they whip along their way. Riders describe an exhilarating adrenalin rush that is combined with accompanying anxiety, panic, and all-out fear as they go through the experience. Once the ride is over and one’s adrenalin lift comes back to normal, equilibrium sets back in, the highs and lows of this experience subside and a sense of control returns.For people suffering from bipolar disorder, once called manic-depressive disease, the emotional roller-coaster ride never ceases. Instead, it can cause havoc to those afflicted with the disorder as well as those around them. New research suggests that between 4 and 6 percent of the population have bipolar disorder. Sufferers experience changes in mood, from highs characterized by endless emotional energy to bouts of severe depression that can lead to suicidal thoughts and behavior. Some individuals even experience both of these intense opposites simultaneously, a situation referred to as “mixed states.”Mental health experts have identified two primar y subtypes of bipolar disorder. In Type I, a person with the disease has moods that swing from extreme mania, where they may experience a flight of ideas (that is, mind-racing), paranoia and/or psychosis, to severe depression. Type II is diagnosed when a person’s emotional state vacillates between depression and a more low-grade type of mania, called hypomania, where the individual has not yet lost his or her grip on reality.The writer is a marital, child and adult psychotherapist practicing in Jerusalem, Tel Aviv and Ra’anana. [email protected]Usually bipolar persons enjoy the highs, which make them feel ver y creative, powerful, and productive. During episodes of mania, their sexual energy is also enhanced and their appetite for sexual encounters can seem superhuman. Oftentimes, manic bipolar individuals are irritable with others. In addition they may have trouble getting to sleep. They just cannot shut off their racing minds and anxiety is often a common additional feature. It is not surprising that 60% of bipolar individuals have coexisting drug and alcohol addictions, and it is well known in the psychiatric field that they use these substances to self-medicate both symptoms of mania and depression, or to enhance the manic experience, particularly those aspects which make the individual feel good.Jerry, A middle aged man in his 40s, had his own catering business. He was quite talented and creative in his work. He seemed to have endless energy, taking on such an incredible amount of work that most of his friends could not imagine how he was able to do it all. One day, he did not show up for work because he had taken an overdose of sleeping pills, clearly intending to kill himself. Jerr y’s mood had suddenly crashed. Luckily, a friend knocked on his door searching for him and managed to get him to the hospital. Today, he is taking lithium and keeping a close eye on his behavior and emotions.Another variant of this disease is what some psychiatrists have called the ‘soft side’ of bipolar illness. In these cases, mania is rarely present or even nonexistent, but the individual nevertheless has moods that cycle up and down. The depression may at times be mild and other times far worse, and this shift in depression may even change rapidly many times in the same day. Psychiatrists call this bipolar depression and it is easily overlooked and misdiagnosed as clinical depression. The focus is not on the polarity, from depression to mania, but on shifting depression.Ellen, a 16-year-old girl, had a histor y of cutting her arms either with her sharp fingernails or with a kitchen knife. The cuts were never intended to actually sever a vein, although this could have happened by accident. Instead, she was tr ying to get herself to feel something. After a lot of time spent in psychotherapy and a few trials on anti-depressant medication prescribed by other doctors she was taken to before I saw her, I obser ved that her cutting was triggered by cyclical depression. She was always somewhat depressed, but at times her depression would crash down to a lower point and it was only then that she would cut herself. The antidepressants that were prescribed could certainly bring her mood up, but were useless against the undetected and untreated cyclical disturbance that would trigger more cutting behavior. After it was discovered that she had bipolar depression, a psychiatrist colleague once again prescribed an antidepressant drug but this time added a mood stabilizer. Ellen’s cutting behavior completely disappeared and never returned. The good news is that there is excellent treatment for people like Jerr y and Ellen; but first they must be properly diagnosed. Unfortunately, studies consistently reveal that on average it takes around 10 years for someone with bipolar disorder to receive the correct diagnosis.