Bipolar Disorder (Manic Depression)
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Bipolar Disorder (Manic Depression)

What Is Bipolar Disorder?

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

People who have bipolar disorder commonly go through periods of depression or mania. They may also experience frequent mood swings.

The condition is not the same for every person who has it. Some people may experience mostly depressed states. Other people may have mostly manic phases. It can even be possible to have both depressed and manic symptoms simultaneously.

Over 2 percent of Americans will develop bipolar disorder.

What Are the Symptoms?

The symptoms of bipolar disorder include mood shifts (sometimes quite extreme) as well as changes in:

  • energy
  • activity levels
  • sleep patterns
  • behaviors

A person with bipolar disorder may not always experience a depressive or manic episode. They can also experience long periods of unstable moods. People without bipolar disorder often experience “highs and lows” in their moods. The mood changes caused by bipolar disorder are very different from these “highs and lows.”

Bipolar disorder often results in poor job performance, trouble in school, or damaged relationships. People who have very serious, untreated cases of bipolar disorder sometimes commit suicide.

People with bipolar disorder experience intense emotional states referred to as "mood episodes."

Symptoms of a depressive mood episode may include: 

  • feelings of emptiness or worthlessness
  • loss of interest in once pleasurable activities such as 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 or spending sprees, unsafe sex, or making unwise investments 

Some people with bipolar disorder may experience hypomania. Hypomania means “under mania” and symptoms are very similar to mania, but less severe. The biggest difference between the two is that symptoms of hypomania generally do not impair your life. Manic episodes can lead to hospitalization.

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
  • suicidal ideation

The person will usually feel energized while they are experiencing all of the above symptoms.

Symptoms of bipolar disorder will generally get worse without treatment. It is very important to see your primary care provider if you think you are experiencing symptoms of bipolar disorder.

Types of Bipolar Disorder

Bipolar I

This type is characterized by manic or mixed episodes that last at least one week. You may also experience severe manic symptoms that require immediate hospital care. If you experience depressive episodes, they usually last at least two weeks. The symptoms of both the depression and mania must be extremely unlike the person’s normal behavior.

Bipolar II

This type is characterized by a pattern of depressive episodes mixed with hypomanic episodes that lack "full-blown" manic (or mixed) episodes.

Bipolar Disorder Not Otherwise Specified (BP-NOS)

This type is sometimes diagnosed when a person has symptoms that do not meet the full diagnostic criteria for bipolar I or bipolar II. However, the person still experiences mood changes that are very different from their normal behavior.

Cyclothymic Disorder (Cyclothymia)

Cyclothymic disorder is a mild form of bipolar disorder in which a person has mild depression mixed 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." Within one year, patients with this disorder have four or more episodes of:

  • major depression
  • mania
  • hypomania

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.

Diagnosing Bipolar Disorder

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

Your primary care provider will usually begin by asking you questions about your symptoms and medical history. They will also want to know about your alcohol or drug use. They may also perform laboratory tests to rule out any other medical conditions. Most patients will only seek help during a depressive episode, so it’s important for your primary care provider to perform a complete diagnostic evaluation before making a diagnosis of bipolar disorder. Some primary care providers will refer to a psychiatric professional if a diagnosis of bipolar disorder is suspected.

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
  • ADHD
  • migraine headaches
  • thyroid disease
  • diabetes
  • 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.

Treating Bipolar Disorder

Bipolar disorder cannot be cured. It is considered a chronic illness, like diabetes, and must be carefully managed and treated throughout your life. Treatment usually includes both medication and therapies, 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 are sometimes used in the acute phase of mania
  • anti-seizure medications (also known as anticonvulsants) such as divalproex-sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
  • People with bipolar disorder will sometimes be prescribed antidepressants to treat symptoms of their depression, or other conditions (such as co-occurring anxiety disorder). 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).

Outlook

Bipolar disorder is a very treatable condition. If you suspect that you have bipolar disorder it’s very important that you make an appointment with your primary care provider and get evaluated. Untreated symptoms of bipolar disorder will only get worse. It’s estimated that about 15 percent of people with untreated bipolar disorder commit suicide.

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 1-800-273-8255.

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