When Bipolar Masquerades as a Happy Face

At 45, my patient Bruce was at the pinnacle of his career, with a lucrative law practice. Then his life was cruelly turned upside down by two medical events, a crushing first episode of major depression and a series of strokes from untreated hypertension.

For many years, Bruce struggled with severe depression and high blood pressure without much headway. Then something strange happened.

He suddenly pulled out of the depression and dove into his work. Not only that, but he felt the surge of energy and self-confidence that he used to have. No hurdle seemed too high or problem unsolvable, he recently recalled.

No one questioned his renewed energy and vigor, because he had always been vivacious. Nor did his combative behavior and ever increasing volume of provocative e-mail messages to friends and colleagues raise a suspicion that something might be seriously amiss.

Betting that his future earnings would more than cover large expenses, he put off filing his state tax returns. No one seemed to recognize just how impaired his judgment had become. Even the judge who placed him on probation for failure to file tax returns missed the real story.

When I met Bruce in a consultation, he spoke loudly and rapidly, and I had difficulty interrupting him. It wasn’t hard to figure out that he had been living with an unrecognized and untreated psychiatric illness that had driven him to the edge of ruin — bipolar disorder, also known as manic depression.


by Richard A. Friedman, M.D., New York Times

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