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.

2. ANGER IS NOT AN ALL-OR-NOTHING PHENOMENON.

Anger typically occurs in degrees, ranging from mild annoyance to intense rage. Some people have a problem labeling negative feelings. They consider any experience of hostility as an intense, urgent crisis, even if it’s just a momentary frustration. Such people tend to have an over-active “inner brat” that makes mountains out of molehills.

3. IT IS NOT ALWAYS NECESSARY TO LET YOUR ANGER OUT.

Anger does not work like steam in a teakettle. It is not necessary to release it in order to avoid explosion. While it’s true your stress level does increase when you dwell on angry thoughts, you can reduce stress without having to resort to an outburst or tirade.

4. NOT ALL ANGRY PEOPLE YELL OR SCREAM

In fact, many people keep their anger to themselves, or so they think. Even though they don’t come right out and say, “I’m mad at you,” they show it in their behavior -- by being “passive aggressive.” They sulk; they have a “tone” to their voice; they slam doors, etc. Such people have an inner brat that I call “The Smolderer.” You kind of know they’re angry, but you don’t know exactly what they’re angry about.

5. ANGER MANAGEMENT DOES NOT MEAN KEEPING YOUR MOUTH SHUT.

Anger management involves keeping your inner brat from saying or doing something that you’ll later regret. It involves calming yourself, making cool-headed assessments of situation, and finally taking sensible action. With practice, this can be accomplished in a matter of seconds.

Effective anger management means learning to differentiate what is truly a situation worth getting angry about, and what is just your inner brat over-reacting. It also means learning to express your anger directly and constructively, without losing emotional control. Not only will you be less stressed by your anger, but you will also get better results.

Pauline Wallin, Ph.D. is a psychologist in Camp Hill, PA, and author of "Taming Your Inner Brat: A Guide for Transforming Self-defeating Behavior" (Beyond Words Publishing, 2001)

Visit http://www.innerbrat.com for more information, and subscribe to her free, monthly Inner Brat Newsletter.