Bipolar disorder Health Article

Definition

Bipolar disorder is characterized by periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Alternative Names

Manic depression; Bipolar affective disorder

Causes, incidence, and risk factors

Bipolar disorder affects men and women equally and usually appears between the ages of 15 and 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Bipolar disorder results from disturbances in the areas of the brain that regulate mood. During manic periods, a person with bipolar disorder may be overly impulsive and energetic, with an exaggerated sense of self. The depressed phase brings overwhelming feelings of anxiety, low self-worth, and suicidal thoughts.

There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.

People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.

A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less-severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.

Symptoms

The manic phase may last from days to months and include the following symptoms:

• Elevated mood
  • Racing thoughts
  • Hyperactivity
  • Increased energy
  • Lack of self-control
• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
• Over-involvement in activities
• Reckless behavior
  • Spending sprees
  • Binge eating, drinking, and/or drug use
  • Sexual promiscuity
  • Impaired judgment
• Tendency to be easily distracted
• Little need for sleep
• Easily agitated or irritated
• Poor temper control

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

• Persistent sadness
• Fatigue or listlessness
• Sleep disturbances
  • Excessive sleepiness
  • Inability to sleep
• Eating disturbances
  • Loss of appetite and weight loss
  • Overeating and weight gain
• Loss of self-esteem
• Feelings of worthlessness, hopelessness and/or guilt
• Difficulty concentrating, remembering, or making decisions
• Withdrawal from friends
• Withdrawal from activities that were once enjoyed
• Persistent thoughts of death

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.