Manic depression, more commonly known as bipolar, is a mood disorder caused by a chemical imbalance in the brain. It has several different manifestations, ranging from mild to severe.

Bipolar I is the most intense, from what I have observed. Moods swing from highly manic to incredibly depressed, with a longer term for the depression than the mania. As I understand it, it was once thought that the depression caused the mania, but the commonly accepted opinion now is that the mania causes the depression. This is the version most likely to have psychosis within the depression or the mania.

Psychotic manifestation does not mean that the afflicted will always have psychotic symptoms. In those who have bipolar, the psychosis may evidence itself during particularly intense mood swings. Basically, a bipolar person may hear and see things that are not actually there, and believe things that they have no evidence for.

A close friend of mine and my mother both had bipolar I. Once, I was riding in the car with my friend, and she abruptly swerved into the oncoming lane. Luckily, we were on a road out in the middle of nowhere, and nothing came of it. I grabbed my seat and shouted, and she swerved back into her lane immediately, saying, "I didn't want to hit that rabbit." There had been no rabbit.

Back at her house, I mentioned the incident to her father, and he explained that when she stops taking her medication and rockets into a mania or depression, she will often suffer auditory and visual hallucinations.

My mother's form of psychosis was a little different, and more insidious. When my mother went into a severe depression or mania, she would become incredibly paranoid. She was convinced that the various women in our church were miserable in their marriages and determined to sleep with my father. She would lock the doors, terrified that an ex-boyfriend of mine who lived in California was going to return and kill her in her sleep. She stopped feeding the cat, because she was certain that it wanted to harm her.

However, if a person is diagnosed with any of the other bipolar types, they aren't necessarily protected from mood swings evidencing psychosis. Left untreated, a mild bipolar can progress to a more severe form.

The other forms of bipolar range from cyclothymic disorder, which is the mildest -- minor depressions and hypomanias.

Hypomania is similar to a mania, but manifests fewer of the manic symptoms and in less intensity.

Bipolar II is more intense than cyclothymic, but less so than Bipolar I. Bipolar II is characterized by shorter depressions than those of Bipolar I, and hypomanias.

Two other forms of bipolar are rapid-cycling disorder and mixed bipolar. These can manifest either in Bipolar I or Bipolar II, and are different in the way the mood swings present themselves.

Normally, bipolar moods can be charted. In fact, charting bipolar moods is one way to diagnose the illness. If someone's mood follow a cycle, with long periods of depression followed by short bursts of incredible energy and excitement, they most likely have some form of bipolar. To an extent, the mood cycles can be predicted according to past precedent.

Rapid-cycling disorder was once described to me by a psychiatrist as "russian roulette with your moods." In essence, while most bipolar moods are somewhat predictable in their time-frame occurance, rapid cycling is the essence of unpredictibility. In it's more severe forms, a rapid-cycler can swing from mania to depression in the course of a week, or a day -- and they cannot chart when it will occur, or what mood they can expect.

Mixed bipolar evidences both manic and depressive symptoms when in either a manic or depressive state. The afflicted may have the energy of a mania, but will also evidence irritability, pessimism, and other depressive symptoms. In a depression, they may have the lack of energy, the desire to stay in and sleep, but will be so full of restlessness that they prowl their house, their un-focused and unwanted energy manifesting in irritability and anger, even aggression.

Any one of these bipolar types can eventually shift into the most severe form of bipolar, Bipolar I. The most effective way to control any form of bipolar is medication and therapy.

Those who have bipolar often go off their medication once they're feeling better, thinking that it's no longer necessary. Either that, or they'll stop taking their medication due to side effects, or the fact that they don't like how it feels to have their moods damped down, fearing that it halts or ruins the creativity often present in the bipolar person.

The fact of the matter is, side effects are better than exaggerated moods, and no medication can take away inherent talent and creativity (although it may need to be accessed in a new way). Furthermore, medication does not "cure" bipolar. It does not remove the bipolar moods -- it dampens them down to a manageable level. Nothing can remove bipolar. It is a life-long condition.

The only way to manage bipolar and the psychosis that may evidence itself is through regular medication and therapy. Therapy is essential because this is a disorder that manifests itself through your moods, and therefore impacts your interactions and perceptions of society. Therapy provides a sounding board that helps the bipolar person better assess social situations and personal relationships.

Medication is essential because without it, any form of bipolar will become more severe. Furthermore, it dampens moods to a manageable level, and increases well-being and the ability to become fairly steady, dependable, and reliable -- all essential qualities for maintaing work and family relationships.

If a bipolar person has stopped taking their medications, or their medications aren't working properly (which happens as the body adjusts to the drug, over long periods of time), then they may go into a depression or mania that requires they be hospitalized. If psychosis is evidencing, hospitalization is essential.

Electric Shock Therapy treatments, which consist of brief electric shocks to the brain, will help "reset" the bipolar person, bringing them out of the mood and creating a viable environment for treatment. This treatment has been highly demonized in the media, but is actually quite humane and safe. The worse side effect is a temporary loss of short-term memory.

Bipolar, in any of its forms and any of its symptoms, is not an illness to be taken lightly. Those who live with someone with bipolar need to be steady, understanding, and patient. They should understand that the bipolar person may say or do hurtful things that they don't really mean, but think they absolutely do at the time. They may swing from extreme anger to loving friendliness. The best thing to do is to educate yourself fully and completely about mental illness.

Two helpful websites are NIMH -- the national institue of mental health -- and WebMD. There are also many books available that address the illness and their symptoms in depth. I particularly like The Bipolar Handbook by Wes Burgess and Bipolar for Dummies by Candida Fink and Joe Kraynak, which both cover the information in an informative and friendly manner. To best understand what it's like inside the bipolar mind, read the memoir An Unquiet Mind, by Kay Redfield Jamison.