Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness or manic depression, is a mental illness that causes unusual and dramatic shifts in mood, energy, activity levels, the ability to think clearly, and the ability to carry out day-to-day tasks. People with bipolar disorder have extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood changes differ from the typical ups and downs most people experience. With mania, people may feel extremely irritable or euphoric. People living with bipolar disorder may experience several extremes, such as agitation, sleeplessness and talkativeness or sadness and hopelessness. They may also have extreme pleasure-seeking or risk-taking behaviors. Mood shifts may occur only a few times a year or as often as several times a week.

Symptoms of bipolar disorder are severe and can result in damaged relationships, poor job or school performance, and even suicide. The symptoms and the severity of mania or depression vary widely among individuals with the disorder.

The causes of bipolar disorder are not clear, but it tends to run in families. Abnormal brain structure and function may also play a role. Bipolar disorder often starts in a person's late teen or early adult years, and the average age of onset is 25. Bipolar disorder affects men and women equally.

Bipolar disorder is treated and managed in with several approaches, often in combination, including medications, such as mood stabilizers, antipsychotic medications, and antidepressants; psychotherapy, such as cognitive behavioral therapy and family-focused therapy; electroconvulsive therapy; self-management strategies and education; and complementary health approaches such as mediation and spiritual support.

If left untreated, the symptoms usually get worse. However, with a lifestyle that includes self-management and a good treatment plan, many people live well with the condition and lead full and productive lives.

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." Each mood episode represents a drastic change from a person’s usual mood and behavior. An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode. Extreme changes in energy, activity, sleep, and behavior accompany these changes in mood.

Symptoms of mania or a manic episode include:

• A long period of feeling "high," or an overly happy or outgoing mood
• Extreme irritability
• Talking very fast, jumping from one idea to another, or having racing thoughts
• Being easily distracted
• Increasing activities, such as taking on new projects
• Being overly restless
• Sleeping little or not being tired
• Having an unrealistic belief in one's abilities
• Behaving impulsively and engaging in pleasurable, high-risk behaviors

Symptoms of depression or a depressive episode include:

• An overly long period of feeling sad or hopeless
• Loss of interest in activities once enjoyed, including sex
• Feeling tired or "slowed down"
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other habits
• Thinking of death or suicide, or attempting suicide

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, you may feel very good, be highly productive, and function well.

Bipolar disorder may also be present in a mixed state, in which mania and depression are present at the same time. During a mixed state, people might feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

People with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a mental illness.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically recur. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as biological differences, imbalances in neurotransmitters, and inherited traits.

The chances of developing bipolar disorder are increased if a person's parents or siblings have the disorder. But the role of genetics in bipolar disorder has not been confirmed. A child from a family with a history of bipolar disorder may never develop the disorder. And studies of identical twins have found that even if one twin develops the disorder the other may not.

A stressful event such as a death in the family, an illness, a difficult relationship or financial problems can trigger the first bipolar episode. Therefore, an individual’s style of handling stress may also play a role in the development of the illness. In some cases, drug abuse can trigger bipolar disorder.

Brain scans cannot diagnose bipolar disorder in an individual. However, researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. While brain structure alone may not cause it, there are some conditions in which damaged brain tissue can predispose a person. Concussions and traumatic head injuries can increase the risk of developing bipolar disorder.

When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis, and check for any related complications. These tests may include a physical exam, a psychological evaluation, mood charting, and a review of signs and symptoms.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania.

Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from your normal mood or behavior. There are 4 basic types of bipolar disorder:

• Bipolar I Disorder, which is defined by manic or mixed episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well and typical last at least 2 weeks.
• Bipolar II Disorder, which is defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
• Bipolar Disorder Not Otherwise Specified (BP-NOS), which is diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. The symptoms of BP-NOS are still outside of the person's normal range of behavior.
• Cyclothymic Disorder or Cyclothymia, which is a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania and mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

A severe form of bipolar disorder is called Rapid-cycling Bipolar Disorder, which is defined as 4 or more episodes of major depression, mania, hypomania, or mixed states, within 1 year. Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age.

Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent or more severe over time without treatment. Also, delays in getting the correct diagnosis and treatment can contribute to personal, social, and work-related problems. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

People with bipolar disorder are at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression or they may also result from treatment for bipolar disorder.

People with bipolar disorder also commonly experience:

• Anxiety disorders
• Attention-deficit hyperactivity disorder (ADHD)
• Posttraumatic Stress Disorder (PTSD)
• Substance abuse

These other illnesses can make it hard to diagnose and treat bipolar disorder. For example, the antidepressants used to treat obsessive-compulsive disorder and the stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. Successfully treating bipolar disorder almost always improves these related illnesses. And successful treatment of PTSD, ADHD, or substance abuse usually improves the symptoms of bipolar disorder.

If you have bipolar disorder, you will be advised to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. You may need to:

• Quit drinking or using illegal drugs
• Avoid unhealthy relationships
• Get regular physical activity and exercise
• Get plenty of sleep

Bipolar disorder cannot be cured, but it can be treated effectively with long-term, continuous management. The goal of treatment is to provide control of mood swings and related symptoms. However, even with proper treatment, mood changes can occur. An effective treatment plan usually includes a combination of medication and psychotherapy.

The types of medications generally used to treat bipolar disorder include:

• Mood stabilizers such as lithium (Eskalith or Lithobid) and anti-seizure medications that can be used as mood stabilizers such as valproic acid or divalproex sodium (Depakote), lamotrigine (Lamictal), gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal)
• Atypical antipsychotics such as olanzapine (Zyprexa), aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon)
• Antidepressants such as Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin)

Psychotherapy, especially when used in combination with medication, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

• Cognitive behavioral therapy
• Family-focused therapy
• Interpersonal and social rhythm therapy
• Psychoeducation

Electroconvulsive therapy, formerly known as "shock therapy," can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments.