Bipolar disorder - also known as manic-depression or manic-depressive illness - is a mental illness characterized by mood instability that is often serious and disabling. A person with bipolar disorder has unusual shifts in mood, energy, and ability to function that can last for weeks or months. The fluctuations of bipolar disorder are different from the general "ups" and "downs" that everyone goes through because symptoms are severe and can result in damaged relationships, poor job or school performance, or even suicide. There are treatments available for bipolar disorder that have allowed people to lead full and productive lives.
Bipolar disorder can be classified into the following types:
Bipolar I disorder: At least one manic episode, with or without previous depressive episodes.
Bipolar II disorder. At least one episode of depression and at least one hypomanic episode (a brief and less severe manic episode). The periods of depression are usually much longer than the periods of hypomania in bipolar II disorder.
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Cyclothymia: A mild form of bipolar disorder with mood swings and less severe highs and lows compared to full bipolar disorder.
Many people have their first symptoms of bipolar disorder during late adolescence or early adulthood, but some have first symptoms during childhood and others later in life. People often suffer for years because it can be difficult to diagnose and, therefore, may not be properly treated.
What causes bipolar disorder?
Although we do not know the exact cause of bipolar disorder, there are several factors that are thought to be associated with causing the disorder and triggering bipolar episodes. For example, physical changes in the brain have been observed by analyzing biochemicals in the brains of people with bipolar disorder. Brain chemicals called neurotransmitters and certain hormonal imbalances are likely involved in triggering episodes.
Bipolar disorder may also be a hereditary condition. That is, the disorder is more common in people who have family members that also have the condition. Currently it is unknown which genes are responsible for bipolar disorder.
Environmental factors - such as self-esteem problems, significant loss, childhood trauma, or high stress - may also cause bipolar disorder or bipolar episodes.
What are the symptoms of bipolar disorder?
Symptoms of bipolar disorder differ from the periods of lows and highs - the episodes of depression and mania. The changes in mood occur with similar changes in energy and behavior. Although symptoms may vary from person to person, a summary of common ones is below.
Signs and symptoms of manic episodes (mania):
Euphoria
Excessively "high," overly good mood
Inflated self-esteem
Poor judgment
Rapid speech and racing thoughts
Aggressive and intrusive behavior
Agitation and extreme irritability
Increased energy, activity, and restlessness
Risky behavior
Spending sprees
Increased drive to perform or achieve goals
Increased sexual drive
Decreased need for sleep
Tendency to be easily distracted and difficulty concentrating
Drug abuse, particularly cocaine, alcohol, and sleep aides
Unrealistic beliefs in one's abilities and powers
Denial that anything is wrong
Signs and symptoms of depressive episodes (depression):
Sadness
Feeling of emptiness
Hopelessness or pessimism
Decreased energy
Suicidal thoughts or behavior
Anxiety
Guilt, worthlessness, and helplessness
Sleep problems
Appetite problems
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Unintentional weight gain or loss
Fatigue
Loss of interest in daily activities
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Difficulty making decisions
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Chronic pain without a known cause
Who is at risk of having bipolar disorder?
About one percent of the population has bipolar disorder, but this number is estimated to be as high as six percent when additional forms of the disorder and undiagnosed or misdiagnosed cases are taken into consideration. Although bipolar I disorder affects men and women equally, bipolar II disorder is much more common in women. Both sexes are at highest risk between the ages of 15 and 30. Additional risk factors include a family history of bipolar disorder, periods of high stress, drug and alcohol abuse, and significant life changes such as the death of a loved one.
How is bipolar disorder diagnosed?
In order to diagnose bipolar disorder, physicians will conduct a series of tests. A standard physical exam will provide information on height and weight, heart rate, blood pressure, heart and lung function, and abdominal state. Blood and urine may be sent to a laboratory for a complete blood count (CBC), thyroid test, and urinalysis.
The key piece of the bipolar diagnosis comes from a psychological evaluation. Thoughts, feelings, and behaviors will be evaluated by a mental health provider such as a psychologist or psychiatrist. The doctor may ask about alcohol and drug abuse and may ask to talk to close friends and family members in order to better understand symptoms and the events during mania or depressive episodes.
A diagnosis of bipolar I disorder usually requires one or more manic or mixed episodes with or without a major depressive episode. A bipolar II disorder diagnosis usually requires hypomanic episodes and at least one major depressive episode. A diagnosis of cyclothymia usually requires a presence or history of hypomanic episodes with periods of depression, but not major depressive episodes.
Bipolar disorder treatments
Bipolar disorder treatments primarily consist of medications and psychotherapy. In order to reduce the frequency and severity of both manic and depressive episodes, it is important to treat the disorder during episodes and during periods of remission. Additional complications, such as alcohol or substance abuse, should also be treated since they may exacerbate bipolar disorder symptoms.
A psychiatrist or other mental health professional may prescribe one or several medications to help control bipolar disorder. Because many medications have side effects like diabetes, obesity and high blood pressure, it may take some time to find the optimal treatment regimen.
Common medications prescribed to treat bipolar disorder include:
Mood stabilizers - Lithium, for example, is one of the most frequently prescribed medications for bipolar disorder.
Anti-seizure medications (anticonvulsants) - Valproic acid, divalproex, and lamotrigine are often used as mood regulators.
Antidepressants - Though they may lead to manic episodes, antidepressants have been carefully prescribed for bipolar disorder.
Atypical antipsychotics and anti-anxiety - Olanzapine, risperidone, and quetiapine are common antipsychotics, and benzodiazepines are common anti-anxiety drugs.
Psychotherapy treatments for bipolar disorder include:
Cognitive behavioral therapy - Individual therapy that focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones as well as managing stress and coping with upsetting situations.
Family therapy - Group therapy that focuses on identifying and reducing stressors within your family and improving communication and problem-solving.
Group therapy - With other bipolar disorder sufferers that focuses on communication and learning from others.
An additional treatment for bipolar disorder is electroconvulsive therapy (ECT) - electricity is passed through the brain to trigger a seizure. It is primarily for those who have episodes of severe depression with suicidal tendencies or for people who have not seen improvements in their symptoms after other treatments. Sometimes, people with bipolar disorder may benefit from inpatient hospitalization and psychiatric treatment.
How is bipolar disorder prevented?
Unfortunately, there is no sure way to prevent bipolar disorder. Treatment at the earliest sign of mental health disorder can help prevent bipolar disorder from worsening, and long-term preventive treatment can help prevent minor episodes from becoming full manic or depressive episodes.
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Written by Peter Crosta M.A.
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