Some people with Bipolar disorder are very high functioning. The main thing that distinguishes people who do well from people who don’t is the ability to accept that one has a disease and take medication.
Often, people who have mental illnesses refuse to accept that they have an illness. They refuse to see a doctor and often refuse to take their medication. This obviously makes for a very negative outcome with the illness getting worse and worse and finally hospitalization after hospitalization and maybe even worse. With bipolar symptoms getting worse and worse due to not taking their medication, many people also have problems with the law as in arrests and legal trouble.
As was so tragically illustrated with the death of Robin Williams just recently, mental illness can be a terminal illness.
The best outcomes occur for people who go to their doctor regularly and take the recommended medications at the proper doses. I have found thinking about it in terms of the molecular mechanisms of the disease helps me understand the illness as something totally molecular which is helped by taking medication.
Neurotransmitters such as Serotonin, Epinephrine, Norepinenephrine, and Gamma Amino Butyric Acid (GABA), are the molecules that carry information from one neuron to another. This information may be thoughts, emotions, or feelings.
Again remember the presynaptic neuron (yellow) and the space which is the synapse, and the post synaptic neuron? Well the presynaptic neuron, upon firing, empties it’s vesicles into the synapse, thereby releasing its supplies of neurotransmitters, eg. Serotonin. The Serotonin then binds to a receptor on the post synaptic neuron and exerts its effect via proteins that are in close proximity to the receptor. How long the Serotonon stays active depends on how fast the post synaptic neuron reuptakes it. If the reuptake is too fast then Serotonin cannot exert its effect. This reuptake is blocked by drugs such as Zoloft, Prozac, Wellbutryn (this actually blocks reuptake of dopamine and norepinephrine.) That is how they are hypothesized to alleviate depression.
SSRI stands for selective Serotonon reuptake inhibitor.
SNRI stands for serotonin norepinephrine reuptake inviter.
DRI stands for dopamine reuptake inhibitor.
Soon to come: mechanism of lithium action :-))