Bipolar Disorder

Bipolar disorder (also known as manic-depressive illness or manic depression) is a serious brain disorder in which a person experiences extreme variances in thinking, mood, and behavior.

The two most common phases of bipolar disorder are a depressed phase and a manic phase. Severe mood swings may occur many times during a patient's life. Some people may experience mostly depressed states while other people will have mostly manic phases. Still others will have both depressed and manic symptoms simultaneously.

Approximately one percent of the population will develop a bipolar disorder with the rates of diagnosis being equal between men and women. 

Symptoms 

The symptoms of bipolar disorder are characterized by extreme mood shifts accompanied by changes in energy and activity levels, sleep patterns, and behaviors.

A person with bipolar disorder may experience long periods of unstable moods rather than explicit episodes of depression or manic behavior. The symptoms of bipolar disorder are easily distinguished from normal "highs and lows."

Bipolar disorder often results in poor job performance, trouble in school, or in damaged relationships. In the most serious cases, a sufferer will commit suicide.

Individuals with bipolar disorder experience intense emotional states known as "mood episodes."

Symptoms of a depressive mood episode may include: 

  • feelings of emptiness or worthlessness
  • loss of interest in once-pleasurable activities including sex
  • behavioral changes
  • fatigue or low energy
  • problems with concentration, decision-making, or forgetfulness
  • restlessness or irritability
  • changes in eating or sleeping habits
  • suicidal ideation or a suicide attempt

On the other extreme side of the spectrum are manic episodes. Symptoms of mania may include: 

  • long periods of intense joy, excitement, or euphoria
  • extreme irritability, agitation, or a feeling of being "wired" (jumpiness)
  • being easily distracted or restless
  • having racing thoughts
  • speaking very quickly (often so fast others are unable to keep up)
  • taking on more new projects than one can handle (excessively goal-directed)
  • having little need for sleep
  • unrealistic beliefs about one's abilities
  • participating in impulsive or high-risk behaviors such as gambling, spending sprees, unsafe sex, or making unwise investments 

Some people with bipolar disorder experience "mixed mood states" in which depressive and manic symptoms coexist. In a mixed state, a person will often have symptoms that include agitation, insomnia, extreme changes in appetite, and suicidal ideation all while feeling "energized."

Without treatment, symptoms of bipolar disorder generally worsen over time. 

Types of Bipolar Disorders

Bipolar I

Characterized by manic or mixed episodes that last at least one week, or by severe manic symptoms that require immediate hospital care, depressive episodes usually last at least two weeks. The symptoms of both the depression and mania must be extremely unlike the patient's normal behavior.

Bipolar II

Characterized by a pattern of depressive episodes interspersed with hypomanic episodes that lack "full-blown" manic (or mixed) episodes.

?Bipolar Disorder Not Otherwise Specified (BP-NOS)

Bipolar Disorder Not Otherwise Specified (BP-NOS) is sometimes diagnosed when a patient has symptoms that do not meet the criteria for bipolar I or bipolar II. For instance, symptoms may not last long or be too few in number to qualify for another diagnosis. Nonetheless, the person's behavior is not "normal."

Cyclothymic Disorder (Cyclothymia)

Cyclothymic Disorder is a mild form of bipolar disorder in which a person has mild depression interspersed with hypomanic episodes for at least two years.

Rapid-Cycling Bipolar Disorder 

Some people may also be diagnosed with what is known as "rapid-cycling bipolar disorder." Patients with rapid-cycling bipolar disorder have four or more episodes of major depression, mania, hypomania (less severe than full-blown mania), or mixed states within one year. It is more common in people with severe bipolar disorder and in those who were diagnosed at an earlier age (often during mid to late teens), and affects more women than men.  

Diagnosis

Most cases of bipolar disorder begin before a person reaches 25 years of age, although some people may experience their first symptoms in childhood or, alternately, late in life. The intensity of bipolar symptoms range from low mood to severe depression; hypomania to severe mania. Because bipolar disorder often comes on slowly and gradually worsens over time, it is often difficult to diagnose.

A doctor will usually begin by asking a patient questions about his or her symptoms, medical history, and any alcohol or drug use. He may also perform laboratory tests to rule out any other medical conditions. Because most patients will only seek help during a depressive episode, it is important for clinicians to perform a complete diagnostic evaluation before making a diagnosis of bipolar disorder.

Individuals with bipolar disorder at a higher risk for a number of other mental and physical illnesses including post-traumatic stress disorder (PTSD), anxiety disorders, social phobias, attention deficit hyperactivity disorder (ADHD), migraine headaches, thyroid disease, diabetes, and obesity. Substance abuse problems are also common among patients with ?bipolar disorder.

There is no known cause for bipolar disorder, but it tends to run in families. Research into the genetic causes of bipolar disorder is ongoing.

?Treatment

Bipolar disorder cannot be cured. It is considered a chronic illness like diabetes and must be carefully managed and treated throughout the patient's life. Treatment usually includes both medication and psychotherapies, such as cognitive behavioral therapy. Medications used in the treatment of bipolar disorders include:

  • mood stabilizers such as lithium (Eskalith or Lithobid)
  • atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal)
  • anti-anxiety medications such as benzodiazepine
  • anti-seizure medications (also known as anticonvulsants) such as divalproex sodium             (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)

Bipolar patients will sometimes be prescribed antidepressants to treat symptoms of their depression, however, they often must take a mood stabilizer, as an antidepressant alone may increase a person's chances of becoming manic or hypomanic (or of developing symptoms of rapid cycling).

Suicide Risk

Bipolar disorder is a serious but highly treatable condition. If you are considering harming yourself or others (or know someone who is) call 911 immediately, proceed to a hospital emergency room or contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).