Bipolar Disorder

Overview

Bipolar disorder is a brain disorder that is also called manic depression or manic depressive disorder. It causes shifts in mood, energy, and activity levels that are much more severe than the ups and downs everyone experiences now and then. With bipolar disorder, these shifts can be so severe that a person can’t carry out the tasks of daily life. Relationships and school or job performance can also be disrupted by bipolar symptoms, and some people with the disorder may consider suicide. Fortunately, effective treatment of bipolar disorder is available and can help people live full, productive lives. Bipolar disorder is, however, a long-term illness that needs to be managed for a person’s entire life.

It is thought that bipolar disorder develops as a result of several factors. Genetics, environmental influences, and brain chemistry may each play a role. Though family history (genetic predisposition) appears to increase a person’s likelihood of developing bipolar disorder, not everyone with a family history will develop the disorder. Imaging studies are being used to examine the brains of people with bipolar disorder, with some findings suggesting that their brains may differ from those of people without the condition.

In most cases, bipolar disorder develops relatively early in an affected person’s life—often before age 25. Some people experience their first symptoms during childhood, while others have symptoms later in life.

There are several conditions that may coexist with bipolar disorder, though it’s not entirely understood why or how these conditions are linked to bipolar disorder. Possible coexisting conditions include substance abuse, anxiety disorders (such as post-traumatic stress disorder and social phobia), and attention deficit hyperactivity disorder. People with bipolar disorder are also at a higher risk for physical illnesses including thyroid disease, migraine headaches, heart disease, diabetes, and obesity.

Symptoms

Bipolar disorder is characterized by periods of different intense emotional states, or “mood episodes.” These emotional states include mania (a manic episode) and depression (a depressive episode), and both are associated with mood and behavior changes. It is thought that stressful situations, particularly those that cause loss of sleep, may trigger episodes. Between episodes, a person may have no symptoms, but for some symptoms linger. Symptoms of each include:

Mania

  • Feeling “high,” overly happy or outgoing for a long period
  • Feeling extremely irritable, agitated, jumpy, or wired
  • Talking very fast
  • Having racing thoughts, jumping from one idea to another
  • Being easily distracted
  • Taking on new projects and other goal-directed activities
  • Being restless
  • Sleeping little

Depression

  • Feeling worried or empty for a long period
  • Losing interest in activities once enjoyed
  • Feeling tired
  • Having trouble concentrating and making decisions
  • Having problems with memory
  • Being restless or irritable
  • Changing eating and sleeping patterns and other habits

It’s possible for mood episodes to include symptoms of both mania and depression. This is known as a mixed state.

Treatments

Treatment of bipolar disorders begins with accurate diagnosis. This may involve a physical examination, a discussion a personal and family medical history, and lab tests. There are no lab tests to diagnose bipolar disorder, but tests can rule out other illness that may cause similar symptoms (such as a brain tumor or stroke). A family doctor can begin the process of diagnosing bipolar disorder but will often refer the patient to a mental health professional to complete the diagnosis.

Bipolar disorder can’t be cured, so the goal of treatment is to help patients control mood swings and symptoms so that they can lead functional, full, and productive lives. Effective long-term treatment involves a combination of medication and psychotherapy.

Medication

Prescription medications for bipolar disorder include:

  • Mood stabilizing medication to help control mood; for example, lithium
  • Atypical antipsychotic medication to treat the symptoms of bipolar disorder, including manic, mixed, or depressive episodes; for example, Zyprexa® (olanzapine)
  • Antidepressant medication to treat the symptoms of bipolar depression; for example, Prozac® (fluoxetine)

All of the medications used to treat bipolar disorder may cause side effects, some of them very serious. Ask your doctor about the risks and benefits of medications prescribed to you before you begin taking them. To prevent or manage side effects and get the best results from treatment, work closely with your doctor  and take medications only as prescribed—this involves notifying your doctor immediately if you are experiencing side effects and making any changes, such as discontinuing a medication, under your doctor’s supervision.

For some severe episodes of mania or depress, hospitalization may be required.

Psychotherapy

Methods of psychotherapy or “talk” therapy used in the treatment of bipolar disorder include:

  • Cognitive behavioral therapy, which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors
  • Family-focused therapy, which works with family members to enhance coping strategies, communication, and problem-solving
  • Interpersonal and social rhythm therapy, which helps to improve relationships and manage daily routines
  • Psychoeducation, which teaches people with bipolar disorder about the illness and treatments, including how to recognize signs of a relapse and seek treatment to prevent a full-blown episode

Living with Bipolar Disorder

Bipolar disorder does not go away over time or with treatment. It’s therefore important that people with the condition see their healthcare providers regularly, follow their treatment plan, and take all medications as prescribed. As well, any changes in health status should be reported to healthcare providers. Know that even with long-term treatment, mood changes can occur.

If you have bipolar disorder, there are several things you can do in addition to medical treatment to help manage the condition:

  • Talk with your doctor regularly.
  • Maintain a regular routine (including meal times and when you go to bed and wake up).
  • Get plenty of sleep.
  • Take medication regularly.
  • Learn about warning signs of a shift into depression or mania.

As well, know where you can find addition support. Your healthcare team can be great support resource. Additional sources for help include community mental health centers, hospital psychiatry departments and outpatient clinics, bipolar disorder support groups, and church groups.

If You or Someone You Know Is in Crisis…

If you are thinking about harming yourself or know someone who is, this is an emergency. Call for help immediately. Call your doctor, dial 9-1-1, or go to the emergency room. Ask a friend for help if you’re not able to do these things on your own.

You can also call the National Suicide Prevention Hotline at 1-800-273-TALK (1-800-273-8255) or speak to a trained counselor at 1-800-799-4TTY (1-800-799-4889).

A person who is considering suicide should never be left alone.

Resources

National Institute of Mental Health

American Psychiatric Association

Mental Health America>

SOURCES

Bipolar Disorder. The National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml. Accessed December 2010.

Bipolar Disorder. Healthy Women. Available at: http://www.healthywomen.org/condition/bipolar-disorder. Accessed December 2010.