As the name implies, patients who suffer from bipolar disorder constantly shift between the two poles of the affective spectrum, that is, from depression to mania (or hypomania). There is no specific pattern that allows clinicians to predict what affective state the patient will present next, nor when he or she will cycle into a manic or depressive state. The fact that many patients can often last in a state of affective normalcy for years and then suddenly lapse into depression or mania makes this disorder horrendously difficult for the patient, clinician,

The addition of mood stabilizing drugs is one of the two ways in which bipolar disorder treatment differs from that of major depression. The other way is that, whereas cognitive and interpersonal therapy can be extremely effective in the treatment of depression, these therapies provide little in the way of relief for bipolar patients. The best that one can hope for in therapy with a bipolar patient is to educate them about their disease, try to increase compliance with medication, and help them to deal with the psychosocial impact that the disease has had and will continue to have on their life. One of the most vital elements in effective treatment of bipolar disorder is to make the patient understand that they have a chronic, organic disease, much like diabetes, and that they will require medication for the rest of their lives.

A clinical manic state consists of several essential elements. In particular, patients who are experiencing mania suffer from persistent insomnia and often can go several days with little or no sleep. This insomnia is associated with a sense of euphoria or irritability. People in a manic state have highly mercurial moods, and can shift between euphoria and irritability very quickly (very much like mixed episodes where euphoria and depression can be interchanged quite rapidly). Other symptoms of mania include a fast, pressured speech, a flight of often unrelated ideas, poor insight, and, in rare cases, frank psychosis, assaultiveness, and suicidality. This combination of symptoms can have detrimental consequences, such as wild spending sprees and impulsiv

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