The brain learns. Unfortunately for those with bipolar disorder, the brain can learn to have episodes. In episodes of depression, mania or hypomania certain brain cells are stimulated in pathways and constellations. These become more easily accessed as episodes continue or, in effect, the brain learns to have episodes in a quicker and easier way since pathways have already been established. This is a form of sensitivity, a progressively tuned trigger if you will. Like the ignition of fire in a piece of wood, the bipolar brain can kindle as well igniting full episodes when these sensitized areas are approached by stimulation.

Effects such as these probably contribute to what we consider to be progressive' mental illnesses. An illness can progress in severity and frequency. After multiple episodes an individual can have breakthrough' symptoms even when the condition is properly managed. Similarly, one may become brittle', unable to achieve a good level of illness management after multiple episodes. The types of symptoms do seem to progress in nature and severity as well. For example, one may begin to have psychotic symptoms (hallucinations and/or delusions) in either phase of the illness. Once these have begun, there is a greater possibility of having them in future episodes.

It is essential that a treatment regiment be followed without interruption-particularly if that routine maintains an episode-free stability. This will prevent the kindling effect. It is equally important that an effective medication not be interrupted. Experience has shown us that when medications for bipolar disorder have been discontinued there is some chance that they will not be as effective when started again.

The beauty of bipolar disorder is that it can be managed beautifully. It is simply that once managed it must remain so in order to prevent the often severe difficulties mentioned here.

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