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Are You Bipolar?

Though the official incidence of bipolarity in the U.S. population is estimated at 1.2 percent, a survey published in the Journal of Clinical Psychiatry in January 2003 found that 3.7 percent of the population might be bipolar in one form or another (and some doctors argue that even that figure is low). In that study, 80 percent of those who exhibited bipolar tendencies had not been diagnosed, and nearly one-third had been misdiagnosed with “unipolar” depression. Just under 10 percent of all 18-to-24-year-olds surveyed screened positive for the illness. “The incidence of bipolarity isn’t a matter of opinion,” says Myrna Weissman, professor of psychiatry and epidemiology at Columbia University. “It’s a matter of evidence.”

It’s a well-established fact about medicine that new diagnoses often appear in chicken-and-egg tandem with new drugs, and the new family of bipolar disorders may be no exception. “In some ways, what’s been happening is like what happened with Prozac, in that finally we had something to treat with that wasn’t as bad as the disorder itself,” says Terence Ketter, head of the Bipolar Disorders Clinic at Stanford University. Since lithium, the onetime wonder drug of bipolarity, has no patent protection, there’s an upside in the mood-stabilizer market. The last year has seen a spate of FDA indications of atypical antipsychotics for bipolar episodes, like Risperdal and Seroquel, as well as the marketing of a new drug, Symbyax, a combination of Prozac and the atypical antipsychotic Zyprexa, to be prescribed for bipolar depression.

The most important new drug for mild bipolarity is Lamictal, the anticonvulsant that, last summer, became the first drug since lithium approved by the FDA for the long-term treatment of bipolar disorder. “Just as lithium’s advent caused more attention to bipolar I, Lamictal’s advent will probably bring more attention to bipolar II,” says Dr. Frederick Goodwin, co-author of the definitive text Manic-Depressive Illness. “In its own way, the best patient group for Lamictal therapy is the bipolar II patient, a person with mild manias and severe depressions.” The side effects are also more tolerable than those of any bipolar drugs: little weight gain, lethargy, or nausea. “It’s the most interesting drug to come along since lithium,” says Ivan Goldberg. “Lamictal is hot shit.”

A bellwether of the expanding bipolar diagnosis is Andrew Solomon, the New Yorker writer whose book The Noonday Demon explored the history of depression and his own relationship to the illness. His psychiatrist suggested he might be bipolar II several months ago. “When I was told, I almost felt cheered up by it—Maybe now we’ll solve the mystery, I thought,” says Solomon. “It made sense: When I’m at what I think of as my best, I’m kind of manic; I think I can do anything, I rule the world, I can win the Nobel Prize.” Jessica Lynch, Miss New York, a depression advocate, and no relation to the POW, was rediagnosed as bipolar recently as well. “I thought about a time where I was spinning around the room laughing and goofing around, laughing inappropriately, I guess, and I almost stepped on my laptop computer, which was on the floor,” she says. “I just kept laughing. That up mood lasted a few days, and then it went away.”

“A doctor said to me, ‘if you don’t have problems with shopping or sex, you’re not bipolar, period,’ ” says Christine, an interior designer.

Mild bipolarity, after all, can be an illness of subtle signs. “You get to know your patient very well,” says Frank Miller, a psychiatrist with a prim office on Fifth Avenue in the Sixties, the perfect reflection of an ordered, genteel mind. He is in his late fifties, wearing a well-tailored navy suit, with round eyeglasses and a slight physique that give him the look of an elder Harry Potter. “You see that their depression gets better. You see a period of normal. And then, quite unexpectedly, whether it’s a year later or six months later, a person comes in a little more dressed up, a woman maybe in a dress that’s too short, a lipstick too widely applied, a kind of spontaneity, a spunkiness that you’ve just never seen before. It only lasts for a week, and then all of a sudden, they’re depressed. That person could easily be reconceptualized as a bipolar individual, although that is the totality of the hypomania that you’d see: four or five days, quite subtle, and not recognized by family, friends, or colleagues as evidence of anything extreme. But there it is: a third mood, so to speak.”

Miller sees bipolarity as a distinctively New York phenomenon. “It may very well be that the frenetic, kinetic lifestyle of a major urban center like New York in the 21st century could be provoking more people to manifest their bipolar vulnerability than we have seen in any preceding century,” he says. “It may very well be that the world you’re living in is not a world of 1-in-120 bipolarity. The people you know in this city are people who are coming from all over, people with energy and excitement and stamina, and it may be in this city, in the people that you find yourself knowing, with throwing in other factors—staying out late, the bar scene, marijuana, being at places where people with bipolar are likely to congregate, differentially—then maybe it’s 1-in-8 that the people one actually hangs with have bipolar risk.”

He crosses his hands in his lap. “I have a patient who works at Lotto,” he says, “and she is intrigued by how many people win the lottery.”

A third mood that is a mood of ebullience, enthusiasms, and creativity is not something that’s usually considered problematic, and certainly not something that one wants medicated away. Hypomania is heightened experience—a drug you want more of. One is fascinated by the world, and sometimes it seems that the world falls in love with you, too, turning all the lights up Sixth Avenue green, sending the subway rushing into the station a moment after you’ve swiped a MetroCard. This can seem to be your best self, the state of self-actualization that one prays to get to with self-exploration, therapy, and medication, but for many remains just out of reach.

Hypomania’s hallmarks—shopping sprees and sexual promiscuity are the classics—aren’t exactly behaviors foreign to many of us, and are in fact what’s considered by some to be fun. (“After I was diagnosed as bipolar II, I ran around to a bunch of doctors for second opinions, and one of them said to me, ‘If you don’t have problems with shopping and sex, you’re not bipolar, period,’ ” says Christine, a 33-year-old interior designer.) A friend, a best-selling author and screenwriter in his fifties who was diagnosed as mildly bipolar a few months ago—bipolar IV?—says that when he asked his doctor why he was experiencing what was understood as his first mania so late in life, the doctor suggested that his “wonderful wild years of promiscuity with guys in the seventies was an eight-year mania.” He sighs. “I mean, I don’t know. I was at Studio 54 every night for two and a half years. I went to the baths all the time, but everybody did. I saw my lawyer there every day.”