The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women. A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission (DSM III-R).

The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive. The hypomania state has led observers to feel that bipolar patients are "addicted" to their mania. Hypomania progresses into mania and the transition is marked by loss of judgment. Often, euphoric grandiose characters are recognized as well as a paranoid or irritable character begins to manifest. The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and behavior manifests with hyperactivity and sometimes assaultiveness.

When both manic and depressive symptoms occur at the same time it is called a mixed episode. These people are a special risk because of the combination of hopelessness, agitation and anxiety make them feel like they "could jump out of their skin"(Hirschfeld, 1995). Up to 50~ of all patients with mania have a mixture of depressed moods. Patients report feeling very dysphoric, depressed and unhappy yet exhibit the energy associated with mania. Rapid cycling mania is yet another presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12 month period. There is now evidence to suggest that sometimes rapid cycling may be a transient manifestation of the bipolar disorder. This form of the disease experiences more episodes of mania and depression than bipolar.

Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960's. It is main function is to stabilize the cycling characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was 78~ (1990). Lithium is also the primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression.

Unfortunately, there are up to 40~ of bipolar patients who are either unresponsive to lithium or who cannot tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder (those patients who experience at least four distinct episodes within one month period).