led a mixed episode. These people are aspecial risk because of the combination of hopelessness,agitation and anxiety make them feel like they "could jumpout of their skin"(Hirschfeld, 1995). Up to 50% of allpatients with mania have a mixture of depressed moods.Patients report feeling very dysphoric, depressed andunhappy yet exhibit the energy associated with mania. Rapidcycling mania is another symptom of bipolar disorder. Maniamay be present with four or more distinct episodes within a12 month period. There is now evidence to suggest thatsometimes rapid cycling may be a transient manifestation ofthe bipolar disorder. This form of the disease experiencesmore episodes of mania and depression than bipolar. Lithium has been the primary treatment of bipolardisorder since its introduction in the 1960's. It is mainfunction is to stabilize the cycling characteristic ofbipolar disorder. In four controlled studies by F. K.Goodwin and K. R. Jamison, the overall response rate forbipolar subjects treated with Lithium was 78% (1990).Lithium is also the primary drug used for long- termmaintenance of bipolar disorder. In a majority of bipolarpatients, it lessens the duration, frequency, and severityof the episodes of both mania and depression. Unfortunately,there are up to 40% of bipolar patients who are eitherunresponsive to lithium or who cannot tolerate the sideeffects. Some of the side effects include thirst, weightgain, nausea, diarrhea, and edema. Patients who areunresponsive to lithium treatment are often those whoexperience dysphoric mania, mixed states, or rapid cyclingbipolar disorder (those patients who experience at leastfour distinct episodes within one month period). Among theproblems associated with lithium includes the fact thelong-term lithium treatment has been associated withdecreased thyroid functioning in patients with bipolardisorder. Preliminary evidence also suggest thathypothyroidism may actually lead to rapid-cycling (Bauer e...
