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What happened after the hospitalization?

I spent a year in a 12-step program, really committed, because I could not believe what had happened--that I might have killed myself. During that year, I started having episodes that were very unpleasant and very intense. Someone would hurt my feelings, and I would get upset and stay upset for hours. I'd sit in my house sobbing, unable to stop, inconsolable. Sometimes I'd get very frustrated, I broke a lot of phones. This was embarrassing to me because I really didn't think of myself as temperamental and spoiled. There was a lot of shame associated with some of the behaviors that I had. I went to a doctor and told him I felt normal on acid, that I was a light bulb in a world of moths. That is what the manic state is like. He put me on lithium. I liked that for a while, but soon I missed my little pal, my up mood. I didn't fully accept the bipolar diagnosis. I thought, well, everybody's moody...maybe I'm just telling myself a story. Maybe there's no such thing. Maybe it's an exaggeration. I went to Australia to do a film. I went off the lithium, and if I was ever manic, it was then. It came back with a vengeance and it wanted to go traveling and we (me and the mood and my brother) ended up in China because it was near. I looked at a map and I thought, "It's only six inches away. That's great."

So now you're in China, totally manic, and you're off your medication.

Yes, and a lot of it was funny in the beginning. I would just go on these rambles. For example, we went to the Great Wall of China and they said, "The left side is where the Chinese people go up, and the tourist side is on the right because it's easier..." And I thought, "They're lying to me," because I knew that at Disneyland, the left side of the Matterhorn was faster than the right side. This is the kind of logic I have when I'm manic.

When did you finally accept the fact that you were suffering from bipolar disorder?

I didn't accept it fully until I had the psychotic break four years ago, in 1997. There was a lot of pressure in my life. I was still wrangling with my moods, and I was living in a house, which is a lot of responsibility. I had a child, and for her sake I was trying to act as if I hadn't been hurt by her father, who had left me for a man. I was hiding, and I am not used to doing that. I just started to feel weirder and weirder, and I think I was improperly medicated. I was intermittently on drugs at this time too. I got unbelievably depressed. My daughter was going to camp, and I would get up every day out of this bed, this swamp, and go pick her up. That was the most complicated thing in the world. I don't know how I did it. It must have been very unpleasant for her. I went to a doctor who gave me all these new medications that sounded like they came from Venus--they had no vowels in them--and something very bad happened. The medications collided, and I became very, very ill. I collapsed, I stopped breathing, and I was taken to the hospital where they sent me home and put me on a "medication vacation." I didn't sleep for six days, and I was scared. My mind split open, and some bad thing oozed out, and that's what I was left with. I thought that if I fell asleep I would die. I wasn't connecting at all, but I kept talking and talking and talking. At a certain point, I lost my mind. The birthing was over, and I got to the other side of the looking glass. When I went back to the hospital, I was hallucinating.

How long was the treatment?

I'm not sure how long I was in the hospital, but I was an outpatient for five months. Afterward, my friend Penny Marshall and I had our big annual party. All the tables had IV hookups on them with colored water, and the cake was me in bed with Penny visiting. It was performance art. It was beautiful.

How are you now?

I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three times a day. !his constantly puts me in touch with the illness I have. I'm never quite allowed to be free of that for a day. It's like being a diabetic.

Do you feel at this point that the problem is under control?

No. I feel that the medication that I'm on can handle it, but I still have the impulse to ride the "white lightning" again.

Do you have a message for people who suffer with bipolar disorder?

Oh, yes. You can outlast anything. It's complicated, it's a job, but it's doable. One of the greatest things that happened for me was that psychotic episode. Having survived it, I now know the difference between a problem and an inconvenience. Bipolar disorder can be a great teacher. It's a challenge, but it can set you up to be able to do almost anything else in your life.

You do seem like Princess Leia, after all--conquering foes even darker than Darth Vader. Is there turmoil in your future?

Most likely. I would like to keep that to a minimum. But now I know how to put these things in perspective.

Treating Bipolar Disorder: Present and Future

Bipolar disorder is a long-term illness requiring long-term treatment. Mood-stabilizer medications remain the mainstay of treatment. Lithium's effectiveness has been well-established for more than 30 years, end carbamazepine end valproate have also become widely accepted first-line treatments in the past decade. In general, these medications are effective in controlling symptoms of both depression and mania or agitation.

Antidepressant medications used to treat unipolar depression are a common supplement to mood stabilizers, but may actually trigger high or manic episodes--especially if used alone. These treatments are at least moderately effective for 50 to 75 percent of bipolar disorder sufferers.

Unfortunately, these standard treatments are often ineffective or only partially effective. To address this gap, recent research has identified several promising alternatives. Newer or atypical antipsychotic medications such as olanzapine, risperidone and quetiapine appear to help control manic episodes. Several new anticonvulsant or antiepilepsy drugs such as lamotrigine, topiramate end gabapentin may also help stabilize mood when traditional medications prove ineffective. Five years from now, there should be a wider range of effective mood-stabilizer medications to choose from.

Several forms of psychotherapy or counseling have also been developed specifically for treatment of bipolar disorder. Cognitive and behavioral treatments focus on recognizing early warning signs, interrupting unrealistic thoughts and maintaining positive activities. Social rhythm therapies focus on maintaining healthy patterns of sleep, activity and social involvement, while family therapies look at the ways family interactions can either support or undermine stability and health. Recent research suggests that these treatments may be valuable treatment components, adding significant benefit to medication management.

To successfully treat bipolar disorder, persistence is key. Different treatments help different people, and individual response to a particular treatment is difficult to predict. Side effects of medication also vary widely and unpredictably, but if treatment is unsatisfactory, good options likely remain. The one common element in any successful treatment is a long-term partnership with healthcare providers.

--Gregory Simon, M.D., M.P.H.

Carrie's Biography

1956: Born to Debbie Reynolds and Eddie Fisher

1972: Broadway debut in Irene, starring her mom

1975: Attended Central School of Speech and Drama, London. Appeared in first film, Shampoo

1977: Through 1983: Appeared in the classic Star Wars film trilogy as Princess Leia

1983: Married pop icon Paul Simon, divorced after 11 months

1987: Wrote autobiographical novel, Postcards From the Edge

1990: Wrote novel Surrender the Pink, about her marriage to Simon and wrote screenplay for Postcards

1992: Gave birth to daughter, Billie Catherine

1994: Wrote novel, Delusions of Grandma

2000: Cowrote These Old Broods, starring Debbie Reynolds

Since 1980s: Appeared in films--including When Harry Met Sally as witty best friend

Since 1990s: Script-doctored films including Hook, Sister Ret, Lethal Weapon 3, Outbreak, The Wedding Singer

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