"My husband didn’t know if he was going to come home to Cruella Deville or Dolly Levi from Hello Dolly.” That’s how Jane Pauley, broadcast journalist and former co-host of the TV morning show Today, described her battle with bi-polar disease in a interview on Healthy Minds, produced by New York Public Radio. “Who knows what provokes it, but it was like a swarm of bees that wants a target,” she says.

Being diagnosed with bipolar disease was a shock, recalls Pauley, but getting a diagnosis and subsequent treatment, however, allowed her to regain some normalcy in her life again.

Bipolar disease is a serious mental illness that is associated with extreme mood swings from mania to depression. “It is one of the most serious illnesses we deal with because of the disruptive nature of the disease,” says Sharon Hammer, M.D., psychiatrist at the University of Nebraska Medical Center (UNMC). “It is more serous than depression or schizophrenia because it can lead to risky behaviors, such as drug and alcohol abuse, damaged relationships, and suicide. And because of the impulsive nature of the disease, there is often no time to intervene.”

The average onset of bipolar disease tends to occur in older teenagers and young adults ages 20 to 25 years old. “Many women may start to experience symptoms of depression in their teenage years followed by their first manic episode in college,” says Hammer. “This is a very risky time because the college years are often mixed with stress, sleep deprivation, and alcohol use, which are all triggers for episodes.”

“It is one of the most serious illnesses we deal with because of the disruptive nature of the disease." - Sharon Hammer, M.D., psychiatrist at UNMC

Women with bipolar disease typically spend about 80 percent of the time in depression and 20 percent in mania. Episodes of mania are characterized by abnormal elevated moods that include irritability, being easily agitated, impulsivity, racing thoughts, and insomnia.

Many women tend to be in denial and don’t start taking it seriously until they have children, notes Hammer. Even then, it is often misdiagnosed as depression or anxiety due to the extended depressive states associated with the condition, and the fact that women are twice as likely to have depression than men. In fact, bipolar disease is the most under-diagnosed mental illness and the most challenging to diagnose, notes Hammer.

Misdiagnosis can create more problems because medications used for depression and anxiety are different than those used to treat bipolar disease and can make the condition worse.

In addition, untreated bipolar disease tends to gain momentum and become more malignant with time, says P.J. Malin, M.D., a psychiatrist with Alegent Creighton Clinic and an associate professor of psychiatry at Creighton University School of Medicine. “It can be very disruptive to other parts of your life. Approximately 60 percent of people with bipolar disease will develop substance abuse problems, and it carries a 15 to 20 percent suicide rate.

“Early treatment of the disease can help prevent the disease from getting more aggressive. Untreated bipolar disease, on the other hand, lowers one’s life expectancy by 10 years.”

If you are being treated for depression and are not responding to depression medications or you are experiencing negative or an unusual response, it is important to communicate this with your provider, adds Malin.

“Early treatment of the disease can help prevent the disease from getting more aggressive." - P.J. Malin, M.D., psychiatrist with Alegent Creighton Clinic

You can also do your own test by taking the Mood Disorders Questionnaire (MDQ) online, which provides fairly accurate results and can help you and your clinician determine whether you are bipolar, notes Hammer.

Environmental factors and heredity appear to be the major risk factors for bipolar disease, says Malin. “There are different theories as to how the environment plays a role, but they include: obstetric complications, intra-utero viral infections, use of hallucinogenic drugs, and traumatic life events, such as the death of family or friends or abuse.”

Treatment typically involves a combination of medications and counseling that may be necessary over a person’s lifetime. “Counseling is huge for long-term success and stabilization,” says Robin Houser, a counselor for Nebraska Methodist Hospital’s employee assistance program, Bestcare EAP. “Bipolar disease is a lifetime problem, and counseling can help people learn coping techniques and avoid unhealthy thinking and unhealthy patterns of behavior. A lot of people think that once they have become stabilized that they don’t need medications or counseling anymore, but that’s when we’ll start seeing imbalances and manic episodes occur again.”

Women with bipolar disease are very sensitive to stress, lack of sleep, and environmental and seasonal changes, all of which can trigger an episode, notes Hammer. Practicing healthy lifestyle habits like getting regular exercise, adequate sleep, managing stress, and light therapy during the winter months can help keep the disease stabilized.

 “Counseling is huge for long-term success and stabilization.” - Robin Houser, counselor for Nebraska Methodist Hospital

Postpartum is also a common time to experience recurrences, probably because of sleep deprivation, says Hammer. There are medications that are safe to use during pregnancy, which are important to take to prevent a relapse. If a woman stops her medications during pregnancy, it can take up to six months to get the symptoms under control again, says Hammer.

“Newer medications as a whole have fewer side effects,” she says, “but it’s important that you are matched with the medication that works best for you and has the fewest side effects.

“Patients who are being followed and treated by a trained health care professional can function vey well and live a normal life.”