At first sign of discontent, begin some reality-testing. Ask at least six people (the Goodwin Rule of Six) how they feel. Word your questions carefully: "I love it here. What do you think?" Newcomers can find themselves labeled M for "malcontent," even when they ask most innocent questions.

You may need only a quick fix. I've seen people blossom when they transfer to a new department or move six blocks away. But you may have identified a deeper discontent.

Once you've identified source, find a friend you trust. Tell that friend, "If I tell you I'm tempted to move again, remind me why I was miserable here."

Most friends -- along with many professional advisors -- are reluctant to become wet blankets who smother your dreams. Yet if you're trying to avoid repeating a mistake, a large bucket of ice water may save you from drowning when you dive into your next pond.

Moreover, this type of patients doesn’t need a lot of sleep. At night, they are very busy making phone calls, cleaning house, and starting new projects. Despite apparent lack of sleep, they are still very energetic in morning — ready to establish new business endeavors. Because they believe that they have special powers, they involve in unreasonable business deals and unrealistic personal projects.

They also become hypersexual — wanting to have sex several times a day. One–night stands can happen resulting in marital conflict. Like depressed patients, manic patients develop delusions (false beliefs). I know a manic patient who thinks that he is “Chosen One.” Another patient claims that President of USA and Prime Minister of Canada ask for her advice.

So big difference between two is presence of mania. This manic episode has treatment implications. In fact treatment of these disorders is completely different. While major depression needs antidepressant, manic-depression requires a mood stabilizer such as lithium and valproic acid. Recently, new antipsychotics, for example risperidone, olanzapine, and quetiapine, have been shown to be effective for acute mania.

In general, giving an antidepressant to manic–depressed patients can make their condition worse because this medication can precipitate a switch to manic episode. Although there are some exceptions to rule (extreme depression, lack of response to mood stabilizers, among others), it is preferable to avoid antidepressants among bipolar patients.

When considering use of antidepressant in a depressed bipolar patient, clinicians should combine medication with a mood stabilizer and should use an antidepressant (e.g. bupropion) that has a low tendency to cause a switch to mania.

Copyright©2004. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.