Q. I've been depressed for years, and now my doctor says it's bipolar disorder (manic depression). What gives?

A. You're not alone: Surveys show an average delay in diagnosis of eight years. That's not good, as the chance of suicide is 20 times higher in bipolar people. In fact, the risk of attempted suicides in bipolars is double that of those with only depression. And special drugs are needed for bipolars.

We often miss the diagnosis because most bipolars come to us with depression, not mania — excessively good or high mood — and we don't ask about previous episodes of mania. And you don't need full-blown mania to be bipolar; you can have so-called hypomania, where elevated mood lasting at least four days is not disabling. A National Institutes of Health Web site notes: "It's tremendous ... ideas are fast ... like shooting stars you follow till brighter ones appear."

You have high self-confidence and make others laugh with wisecracks. You share impressive achievements and talk of even grander plans. Or you may be irritable, demanding, constantly dissatisfied, and intolerant of others with violent outbursts.

Mania occurs nearly every day for at least seven days; there's often increased energy, racing thoughts or talking very fast, distractibility, little sleep, poor judgment, spending sprees, increased sex drive, abuse of drugs such as cocaine, alcohol, and sleeping pills; intrusive or aggressive behavior; and a denial that anything's wrong. A period of normal mood lasting days, weeks, or decades follows, and then depression occurs and the cycle repeats itself. Depressed people feel down or blue, or no longer enjoy doing things.

Thought to occur in 1 percent of the population, it may actually be as high as 5 percent. A major cause of disability, it usually starts at age 19 to 29, but can occur in children, who often have fast mood swings between depression and mania many times a day. Kids with mania may be irritable or have tantrums, then be overly happy.

Mood stabilizing drugs like lithium, divalproex, or carbamazepine are generally needed long term and prevent relapse during times of normal mood. Lithium reduces suicide risk the best. In a 2003 study of 20,638 bipolars by Dr. Frederick Goodwin of George Washington University and others, risk of suicide was almost three times lower in those on lithium than in those on divalproex.

Antidepressants may need to be added, but can cause mania or be ineffective unless combined with drugs like lithium.

And cognitive therapy helps reduce relapse.

Tell your doctor or counselor if you think you may be bipolar. It is lethal, disabling — and underdiagnosed.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife @honolulu advertiser.com. This column is not intended to provide medical advice.