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Bipolar disorder

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Illustrations

Bipolar disorder
Bipolar disorder

Alternative Names    Return to top

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    Return to top

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    Return to top

The manic phase may last from days to months and include the following symptoms:

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:

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.

Exams and Tests    Return to top

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

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    Return to top

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.

Outlook (Prognosis)    Return to top

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.

Possible Complications    Return to top

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

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

When to Contact a Medical Professional    Return to top

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

Update Date: 11/15/2006

Updated by: Paul Ballas, D.O., Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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