Bipolar disorder, also known by its older name “manic depression,” is a mental disorder that is characterized by constantly changing moods. A person with bipolar disorder experiences alternating “highs” (what clinicians call “
mania“) and “lows” (also known as
depression). Both the manic and depressive periods can be brief, from just a few hours to a few days, or longer, lasting up to several weeks or even months. The periods of mania and depression range from person to person — many people may only experience very brief periods of these intense moods, and may not even be aware that they have bipolar disorder.
A manic episode is characterized by extreme happiness, hyperactivity, little need for sleep and racing thoughts, which may lead to rapid speech. A depressive episode is characterized by extreme sadness, a lack of energy or interest in things, an inability to enjoy normally pleasurable activities and feelings of helplessness and hopelessness. On average, someone with bipolar disorder may have up to three years of normal mood between episodes of mania or depression.
Bipolar disorder is recurrent, meaning that more than 90% of the individuals who have a single manic episode will go on to experience future episodes. Roughly 70% of manic episodes in bipolar disorder occur immediately before or after a depressive episode. Treatment seeks to reduce the feelings of mania and depression associated with the disorder, and restore balance to the person’s mood.
Those with bipolar disorder often describe their experience as being on an emotional roller coaster. Cycling up and down between strong emotions can keep a person from having anything approaching a “normal” life. The emotions, thoughts and behavior of a person with bipolar disorder are often experienced as beyond one’s control. Friends, co-workers and family may sometimes intervene to try and help protect their interests and health. This makes the condition exhausting not only for the sufferer, but for those in contact with her or him as well.
Living with bipolar disorder can be challenging in maintaining a regular lifestyle. Manic episodes can lead to family conflict or financial problems, especially when the person with bipolar disorder appears to behave erratically and irresponsibly without reason. During the manic phase, people often become impulsive and act aggressively. This can result in high-risk behavior, such as repeated intoxication, extravagant spending and risky sexual behavior.
During severe manic or depressed episodes, some people with bipolar disorder may have symptoms that overwhelm their ability to deal with everyday life, and even reality. This inability to distinguish reality from unreality results in psychotic symptoms such as hearing voices, paranoia, visual hallucinations, and false beliefs of special powers or identity. They may have distressing periods of great sadness alternating with euphoric optimism (a “natural high”) and/or rage that is not typical of the person during periods of wellness. These abrupt shifts of mood interfere with reason, logic and perception to such a drastic degree that those affected may be unaware of the need for help. However, if left untreated, bipolar disorder can seriously affect nearly every aspect of a person’s life.
Identifying the first episode of mania or depression and receiving early treatment is essential to managing bipolar disorder. In most cases, a depressive episode occurs before a manic episode, and many patients are treated initially as if they have major depression. Usually, the first recognized episode of bipolar disorder is a manic episode. Once a manic episode occurs, it becomes clearer that the person is suffering from an illness characterized by alternating moods. Because of this difficulty with diagnosis, family history of similar illness or episodes is particularly important. People who first seek treatment as a result of a depressed episode may continue to be treated as someone with unipolar depression until a manic episode develops. Ironically, treatment of depressed bipolar patients with antidepressants can trigger a manic episode in some patients.
[BREAK=Who Gets Bipolar?]
Bipolar disorder affects about 2 million people in the United States in any given year. Both men and women are affected at the same rate. There are few risk factors that reliably predict a significant increased likelihood of being diagnosed with
bipolar disorder.
Genetics and one’s family history appear to both have some influence over the likelihood of being diagnosed with bipolar disorder. Bipolar disorder is more common in those who have a sibling or parent with the illness and in families having several generations affected with mood disorders.
Differing rates of bipolar disorder have not been reported for different races. Lower socioeconomic status may be slightly linked to a higher rate of bipolar disorder.
Men and women have an equal chance of being diagnosed with the disorder. The first episode in men tends to be a manic episode, while women are more likely to first experience a depressive episode.
The estimated average age for the onset of bipolar disorder is during the early 20s, although there have been reports of the disorder beginning as early as elementary school. In fact, bipolar disorder appears before age 20 in about one in five manic individuals.
Younger patients first may suffer
cyclothymia, which is basically a less extreme form of bipolar disorder characterized by hypomanic and mild depressive episodes. Although people with cyclothymia display less intense symptoms, nearly half of them will progress to having a full manic episode. Younger patients who have full manic episodes are called juvenile bipolar patients.
[BREAK=The Causes of Bipolar]
The cause of bipolar disorder is not entirely known. Genetic, neurochemical and environmental factors probably interact at many levels to play a role in the onset and progression of bipolar disorder. The current thinking is that this is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain). As a biological disorder, it may lie dormant and be activated spontaneously or it may be triggered by stressors in life.
Although, no one is quite sure about the exact causes of bipolar disorder, researchers have found these important clues:
Genetic factors in Bipolar Disorder
- Bipolar disorder tends to be familial, meaning that it “runs in families.” About half the people with bipolar disorder have a family member with a mood disorder, such as depression.
- A person who has one parent with bipolar disorder has a 15 to 25 percent chance of having the condition.
- A person who has a non-identical twin with the illness has a 25 percent chance of illness, the same risk as if both parents have bipolar disorder.
- A person who has an identical twin (having exactly the same genetic material) with bipolar disorder has an even greater risk of developing the illness about an eightfold greater risk than a nonidentical twin.
- Studies of adopted twins (where a child whose biological parent had the illness is raised in an adoptive family untouched by the illness) has helped researchers learn more about the genetic causes vs. environmental and life events causes.
Neurochemical Factors in Bipolar Disorder
Bipolar disorder is primarily a biological disorder that occurs in a specific area of the brain and is due to the dysfunction of certain neurotransmitters, or chemical messengers, in the brain. These chemicals may involve neurotransmitters like norepinephrine, serotonin and probably many others. As a biological disorder, it may lie dormant and be activated on its own or it may be triggered by external factors such as psychological stress and social circumstances.
Environmental Factors in Bipolar Disorder
- A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder.
- Even without clear genetic factors, altered health habits, alcohol or drug abuse, or hormonal problems can trigger an episode.
- Among those at risk for the illness, bipolar disorder is appearing at increasingly early ages. This apparent increase in earlier occurrences may be due to underdiagnosis of the disorder in the past. This change in the age of onset may be a result of social and environmental factors that are not yet understood.
- Although substance abuse is not considered a cause of bipolar disorder, it can worsen the illness by interfering with recovery. Use of alcohol or tranquilizers may induce a more severe depressive phase.
What is Medication-triggered Mania?
Medications such as antidepressants can trigger a manic episode in people who are susceptible to bipolar disorder. Therefore, a depressive episode must be treated carefully in those people who have had manic episodes. Because a depressive episode can turn into a manic episode when an antidepressant medication is taken, an antimanic drug is also recommended to prevent a manic episode. The antimanic drug creates a “ceiling,” partially protecting the person from antidepressant-induced mania.
Certain other medications can produce a “high” that resembles mania. Appetite suppressants, for example, may trigger increased energy, decreased need for sleep and increased talkativeness. After stopping the medication, however, the person returns to his normal mood.
Substances that can cause a manic-like episode include:
- Illicit drugs such as cocaine, “designer drugs” such as Ecstasy and amphetamines.
- Excessive doses of certain over-the-counter drugs, including appetite suppressants and cold preparations.
- Nonpsychiatric medications, such as medicine for thyroid problems and corticosteroids like prednisone.
- Excessive caffeine (moderate amounts of caffeine are fine).
If a person is vulnerable to bipolar disorder, stress, frequent use of stimulants or alcohol, and lack of sleep may prompt onset of the disorder. Certain medications also may set off a depressive or manic episode. If you have a family history of bipolar disorder, notify your physician so as to help avoid the risk of a medication-induced manic episode.
[BREAK=Symptoms of Bipolar]
In everyday life, people have a variety of moods and feelings. These feelings include frustration, joy and anger. Usually these moods last one day rather than several days. For people with bipolar disorder, however, moods usually swing from weeks of feeling overly “high” and irritable to weeks of feeling sad and hopeless with normal periods in between.
An important distinction between bipolar disorder and the normal emotions of life is that bipolar disorder results in an inability to handle daily activities. The person cannot work or communicate effectively and may have a distorted sense of reality (for example, unrealistically high or low opinion of one’s skills).
Bipolar disorder often is not recognized by the patient, relatives, friends or even physicians. However, recognizing the mood states that occur is essential. Treatment can help a person with bipolar disorder avoid harmful consequences such as destruction of personal relationships, job loss and suicide.
During a manic phase, symptoms include:
- heightened sense of self-importance
- exaggerated positive outlook
- significantly decreased need for sleep
- poor appetite and weight loss
- racing speech, flight of ideas, impulsiveness
- ideas that move quickly from one subject to the next
- poor concentration, easy distractibility
- increased activity level
- excessive involvement in pleasurable activities
- poor financial choices, rash spending sprees
- excessive irritability, aggressive behavior
During a depressed phase, symptoms include:
- feelings of sadness or hopelessness
- loss of interest in pleasurable or usual activities
- difficulty sleeping; early-morning awakening
- loss of energy and constant lethargy
- sense of guilt or low self-esteem
- difficulty concentrating
- negative thoughts about the future
- weight gain or weight loss
- talk of suicide or death
The main method used to diagnose bipolar disorder is a thorough interview with a psychiatrist, psychologist or other mental health professional. Although there are written methods for documenting the severity and number of symptoms, those tests only complement a complete interview. They do not substitute for a face-to-face evaluation by a professional. There are not yet any blood tests or other biological tests that can be used to diagnose bipolar disorder.
[BREAK=Treatment of Bipolar]
Treatment can help most people with bipolar disorder. Almost all people with bipolar disorder—even those with severe forms—can stabilize their mood swings through the use of medication.
Treatment for bipolar disorder falls into three
categories:
Acute treatment suppresses current symptoms and continues until remission, which occurs when the symptoms are diminished for a period of time.
Continuation treatment prevents a return of symptoms from the same episode.
Maintenance treatment prevents a recurrence of symptoms. The risks of long-term medication use must be weighed against the risk of getting sick again (relapse).
The types of treatment that are commonly used for bipolar disorder include:
You can monitor your own treatment progress by keeping a daily mood chart. This will enable you to keep track of your moods, sleep patterns, medication and side effects, and activities. Also keep track of why you think changes occur, for example poor night’s sleep or working late.
What doesn’t work
The following strategies are ineffective and should be avoided:
- Using intoxicants, such as alcohol, to feel better or get to sleep
- Telling a family member to snap out of it or get back to their old self
- Shaming a person for not meeting obligations and responsibilities
Who treats bipolar disorder?
Arranging for professional help does work. Psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers are skilled in the diagnosis of mental disorders; people who believe they have a mood disorder should seek them out.
People who are experiencing life-threatening symptoms, such as life-endangering impulsive behavior (e.g., substance abuse, promiscuity or aggressiveness) or psychotic symptoms (e.g., hallucinations or delusions), as well as anyone who is severely suicidal, should be evaluated by a physician.
Depending on the level of potential harm to self or others, they should go to an emergency room. Doctors there often will refer them to a psychiatrist for further treatment. In some cases, hospitalization in a psychiatric facility is a standard approach.
Prognosis
With treatment, the outlook for bipolar disorder is favorable. Most people respond to a medication and or combination of medications. Approximately 50 percent of people will respond to lithium alone.
An additional 20 to 30 percent will respond to another medication or combination of medications. Ten to 20 percent will have chronic (unresolved) mood symptoms despite treatment. Approximately 10 percent of bipolar patients will be very difficult to treat and have frequent episodes with little response to treatment.
On average, a person is free of symptoms for about five years between the first and second episodes. As time goes on, the interval between episodes may shorten, especially in cases in which treatment is discontinued too soon. It is estimated that a person with bipolar disorder will have an average of eight to nine mood episodes during his or her lifetime.
[BREAK=FAQ Bipolar]
People often have common questions about the basics of manic depression. These are some of the most commonly asked questions — and their answers — about manic depression (also known as bipolar disorder):
Is there a test to tell me if I have, or may inherit, bipolar disorder?
Currently, no test can tell a person if he is at risk of developing bipolar disorder. It is unlikely that a single gene will be discovered that is responsible for the illness in all people with bipolar disorder.
Can someone have a medical condition that appears to be bipolar disorder but actually is something else?
Certain conditions mimic mood disorders, including bipolar disorder. Common ones are:
- thyroid conditions
- neurological diseases, such as multiple sclerosis, brain tumors, stroke or epilepsy
- infections of the brain from conditions such as HIV infection, syphilis, sleep apnea and lyme disease
- deficiencies of certain vitamins, such as vitamin B12
- corticosteroid use, especially in high doses
- medicine used to prevent diseases like tuberculosis and AIDS
Telling your doctor about your medical history and the medications that you are currently taking can help her determine the cause of your condition.
What if someone I know has bipolar disorder?
Family members may want to express their concern by describing the specific behaviors to that person in a nonjudgmental fashion. The person with the disorder is less able to dismiss the observation if there is a consensus among friends or family members that a distinctive pattern has emerged.
At the work site, violations of safety codes or negligence may need to be reported to supervisors so that the person can receive a medical evaluation before injury or disability occurs.
If I am diagnosed with bipolar disorder, will I be on medication for the rest of my life?
Not necessarily. However, patients are encouraged to stay on medication indefinitely if an episode was very frightening or associated with great risk to their health, finances or family relationships.
Is there anything I can do to help my disorder?
Yes. First, learn all you can about your illness by reading books, going to lectures and talking to your doctor. Get support from others who also have the illness. The Depressive and Manic-Depressive Association is a good place to look for a support group in your area. In these groups, you can hear how others face the challenges of life and manage their mood and treatment medications. For helpful hints for managing your illness, see Coping With Bipolar Disorder.
How can lifestyle affect bipolar disorder?
Lack of a consistent routine and disrupted sleep can trigger a mood episode. Choosing work and leisure activities that allow proper sleep and rest is vital to healthy emotional functioning. Families can support good mental hygiene by going to bed and getting up at the same time each day.
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