Uncovering Bipolar Disorder Health Article

Uncovering Bipolar Disorder

Picture riding a roller coaster in the dark, not knowing when a steep drop or sharp turn is ahead, feeling totally out of control. That's the tough reality faced by people with bipolar disorder, also called "manic depression," an illness best known for causing dramatic swings in mood. For the sufferer, the chaotic changes are at best disruptive, at worst disabling.

What is it?

In bipolar disorder, episodes of mania (a "wired," overexcited, euphoric feeling) typically alternate with periods of depression (deep sadness and hopelessness). However, the nature of the illness varies from person to person. Episodes may last for months in some, only hours in others. Some may feel relatively normal for weeks or months between episodes, and some whose manic symptoms are mild may actually enjoy the heightened energy and confidence they feel. Manic and depressive symptoms can even occur at the same time.

Manic symptoms can include increased energy, restlessness and irritability, a reduced need for sleep or food, a short attention span or a change to a much more outgoing personality.

On the other hand, signs of depression include sadness, low energy or an "empty" sensation, trouble concentrating or making decisions or the loss of interest in fun activities.

People with severe symptoms may even have psychotic feelings like hallucinations or delusions during either manic or depressive states. Excessive worry is also common. Episodes tend to worsen and become more frequent over time without treatment, and the risk of suicide is as high as 15%.

Who does it affect?

Bipolar disorder most often appears during the late teens or young adulthood. The disorder tends to run in families. Experts believe that certain genes may put a person at risk, but that a stressful event or illness actually triggers it to start. It affects men and women of all races equally, though women are more likely to have rapid cycles of mood changes. Women also report more episodes of depression than men and much more likely to have a companion diagnosis of alcoholism or anxiety disorder.

About six million Americans have the disorder, but experts think the true count could be much higher because many symptoms also accompany other medical or psychological causes. Doctors may attribute restlessness and lack of focus to attention deficit disorder, for example, and substance abuse can cause similar mood swings and reckless behavior. People are most likely to seek help during a depressive episode, so the disorder can be mistaken for major (or "unipolar") depression, which does not include periods of mania. It commonly can take 10 years or more to get the right diagnosis.

How is it diagnosed?

There is no lab test for bipolar disorder, but blood or urine tests can rule out a medical cause like thyroid trouble, diabetes, or a chronic infection, particularly in people over 40. Doctors also may do a CT scan to check for a brain injury.

If no other causes turn up, a doctor or mental health professional then performs a thorough mental health evaluation, asking about current feelings and moods, how the symptoms have developed over time, and any family history of mental illness. The doctor should also seek a spouse's or close family member's perspective about the person's behavior.

What is the treatment?

Bipolar disorder requires lifelong treatment, even during periods between episodes. There is no cure for the disorder, but proper treatment can make a full, stable, and well-balanced life possible. Treatment usually includes a combination of medications and psychotherapy.

Not everyone responds to medications in the same way, so doctors usually will tailor a cocktail of drugs for each individual. Drugs used may include:

• Mood stabilizers, including lithium and anticonvulsant drugs like Depakote or Lamictal prevent manic episodes and lessen symptoms of mania when they do occur. Lithium has long been the first-choice medication, but people taking it must have their kidney and thyroid function watched closely.
• Antidepressants like Paxil or Zoloft, are frequently taken with mood stabilizers to treat depressive feelings. Taking an antidepressant alone, however, can set off a manic episode.
• Atypical antipsychotic drugs (so named to distinguish them from older "typical" antipsychotics) are gaining in popularity, especially for sudden, severe, or mixed manic episodes. Seroquel was the first drug approved to treat both manic and depressive symptoms.
• Sleep medications sometimes are needed when other drugs don't help with sleeplessness.

Most people with bipolar disorder still have some symptoms even while taking medications. Psychotherapy ("talk therapy") can also help them learn to deal with symptoms in a positive way, and to recognize when an episode is beginning. It's good for family members to join in therapy as well, to learn how best to cope and to support their loved ones.