Bipolar Disorder

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Alternative names
Manic depression; Bipolar affective disorder
Definition Return to top

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.

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.

Signs and tests

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

Observe your behavior and mood
Obtain your medical history, including any medical problems you have and any medications you take
Ask about your recent mood swings and how long you've experienced them
Ask about your family medical history, particularly whether anyone has or had bipolar disorder
Perform a thorough examination to identify or rule out physical causes for the symptoms
Request laboratory tests to check for thyroid problems or drug levels
Speak with your family members to discuss their observations about your behavior
Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

Treatment

Bipolar disorder is often treated with mood-stabilizing medications such as valproic acid, lithium, and carbamazepine. These are effective for treating both the manic and depressive phases, as well as preventing future symptoms.

Antidepressant drugs may be useful during the depressive phase IF the antidepressants are used with a mood stabilizer. Mood stabilizers are very important in people with bipolar disorder. Without a mood stabilizer, antidepressants may trigger mania in people with bipolar disorder. (Keep in mind that people with bipolar disorder II may be misdiagnosed with depression only because they do not experience full-fledged mania. If these patients take antidepressants without mood stabilizers, it can trigger a manic episode.)

Anti-psychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.

Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.

Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

Expectations (prognosis)

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.

Complications

Stopping or improperly taking medication can lead to symptoms coming back and the following complications:

Alcohol and/or drug abuse may be used as a strategy to "self-medicate."
Personal relationships, work, and finances may suffer as a result of mood swings.
Suicidal thoughts and behaviors are a very real complication of bipolar disorder.
This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

Calling your health care provider

Call your health provider or an emergency number right way if:

You are having thoughts of death or suicide
You are experiencing severe symptoms of depression or mania
You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

Bipolar Disorder


What is bipolar disorder?
Bipolar disorder is a mental illness that causes extreme mood swings. This condition is also called manic-depressive illness. It may be caused by a chemical imbalance in the brain.

Bipolar disorder sometimes runs in families. If you have a parent who has bipolar disorder, you have a greater chance of having it. Both men and women can have bipolar disorder. People of all ages can have it.


What are some of the signs of bipolar disorder?
At times, a person who has bipolar disorder may feel very happy, full of energy and able to do anything. The person might not even want to rest when he or she feels this way. This feeling is called mania (say: "may-nee-ah"). At other times, a person who has bipolar disorder may feel very sad and depressed. The person may not want to do anything when he or she feels this way. This is called depression. People with bipolar disorder can quickly go from mania to depression and back again.

Other signs of mania may include the following:
Feeling very irritable or angry
Thinking and talking so fast that other people can't follow your thoughts
Not sleeping at all
Feeling very powerful and important
Having trouble concentrating
Spending too much money
Abusing alcohol and drugs
Having sex without being careful to prevent pregnancy or disease
Other signs of depression may include the following:
No interest or pleasure in things you used to enjoy, including sex
Feeling sad or numb
Crying easily or for no reason
Feeling slowed down, or feeling restless and irritable
Feeling worthless or guilty
Change in appetite; unintended change in weight
Trouble recalling things, concentrating or making decisions
Headaches, backaches or digestive problems
Problems sleeping, or wanting to sleep all of the time
Feeling tired all of the time
Thoughts about death and suicide


How is bipolar disorder treated?
Bipolar disorder can be treated by your family doctor. Your family doctor may want you to see a psychiatrist too. You and your doctors will work together to control your mood swings and make sure you stay well.

Bipolar disorder is treated with medicines to stop the mood swings. Mood stabilizers are used to even out highs and lows in your mood. Antidepressant medicine can help reduce the symptoms of depression. Your doctor may add other medicines as you need them. These medicines don't start to work right away, but you will start to notice a difference in your moods after a few weeks. Be sure to take your medicines just as your doctor tells you.

Counseling can help you with stress, family concerns and relationship problems. It's important to get counseling if you have bipolar disorder.


What can I do to help myself get better?
Read about bipolar disorder and tell your family what you learn. Your doctor can suggest resources to help you learn more.
Have a regular routine. Go to bed and wake up at about the same time every day. Eat your meals and exercise at regular times.
Take your medicine every day, and don't stop taking it even if you start feeling better. Avoid caffeine and over-the-counter medicines for colds, allergies and pain. Ask your doctor before you drink alcohol or use any other medicines.
Try to avoid stress.
Learn the early warning signs of your illness. Tell your doctor when you notice changes in your mood or behavior.
Join a local support group. You and your family can share information and experiences with the support group.