Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinks, judgment, and social behavior is ways that cause serious problems and embarrassment. Mania, left untreated, may worsen to a psychotic state. Bipolar disorder is primarily a biological disorder that occurs in a specific area of the brain and is due to the dysfunction of certain neurotransmitters, or chemical messengers, in the brain. These chemicals may involve neurotransmitters like norepinephrine, serotonin and probably many others. As a biological disorder, it may lie dormant and be activated on its own or it may be triggered by external factors such as psychological stress and social circumstances. This serious medical problem is not due to personal weakness or a character flaw. The mood swings associated with bipolar disorder are different from the average ups and downs of every day life. Bipolar disorder is associated with psychotic symptoms such as hallucinations, delusions or disorders of thought. It can result in months or years of instability, difficulties and damaged relationships with family and friends, poor job or school performance and even suicide. Bipolar disorder is a long term illness that must be carefully managed throughout a person's life. A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder. Even without clear genetic factors, altered health habits, alcohol or drug abuse, or hormonal problems can trigger an episode. Among those at risk for the illness, bipolar disorder is appearing in increasingly early ages. This apparent increase in earlier occurrences may be due to under diagnosis of the disorder in the past. The change in the age of onset may be a result of social and environmental factors that are not yet understood. Although substance abuse is not considered a cause of bipolar disorder, it can worsen the illness but interfering with recovery. Medications such as antidepressants, excessive doses of certain over-the-counter drugs, including appetite suppressants and cold preparations, medicine for thyroid problems and corticosteroids like prednisone, illicit drugs such as cocaine and amphetamines as well as lack of sleep may prompt onset of the disorder. People with bipolar disorder can be charming and charismatic in front of doctors. They may initially appear to be functioning normally. Learning one has bipolar disorder can be traumatic but once diagnosed; energies can be directed towards treatment, education and developing coping strategies. When treated appropriately people with this illness can lead full and productive lives.