Library

Bipolar Disorder

Definition

The two basic mood disorder categories are unipolar and bipolar.

In unipolar illness, mood is depressed.

Bipolar disorders (manic-depressive illness) are marked by periods of manic, greatly elated moods or excited states as well as by periods of depression.

Unipolar depression is far more common than bipolar illness.

Description

Some people who experience clinical depression also have periods of euphoria, elation, or excitement known as mania, and thus suffer from one of the forms of bipolar illness. They go from the depths of despair to the top of the world, or vice versa. From not being able to get out of bed or talk to anyone, they become talkative and hyperactive, with unbelievable reserves of energy and no desire to sleep.

During a euphoric, manic phase, some people go on spending sprees or stints of sexual activity, have a hasty marriage, or display exhibitionistic behavior, yet, their experience can also be very unpleasant in this overexcited stage.

The depression of bipolar disorder is indistinguishable from the unipolar varieties. The pattern of mild or severe mania in addition to depression may warrant the diagnosis of bipolar disorder. Many people experience a predominance of episodes of one mood over the other, with occasional shifts to the opposite state. Rare individuals experience elevated mood only.

The severe, acute form of the illness is known as bipolar disorder. Compared with major depression, it is quite rare, affecting only about 1 percent of the population. The milder, chronic form is called cyclothymia.

Causes and Risk Factors

The cause of bipolar disorder is unknown.

Symptoms

Usually the illness appears suddenly (sometimes precipitated by life stresses), although onset may be gradual. Episodes of mania, which can last from days to weeks or months, are generally briefer than episodes of depression.

Without treatment, symptoms usually become more severe and unpleasant. Some people cycle directly from one mood to the other, while others experience normal moods between episodes. Some people go for years without a recurrence, while others suffer from increasingly frequent episodes. As in depression, a small percentage suffer impaired mood chronically.

Diagnosis

The diagnosis is made by a physician based on the clinical findings, after a complete medical history and physical examination.

Treatment

To treat acute episodes of mania and depression, to reduce the cycling, and to prevent relapse, doctors often use medications.

Acute mania: This may require hospitalization to protect the individual or others from impulsiveness. Lithium is generally the drug of choice to stabilize the person. Response to lithium treatment may take several days initially. If the individual is experiencing psychotic symptoms, antipsychotics (e.g. haloperidol) are usually provided. Anticonvulsant drugs such as carbamazine (Tegretol) may also be used.

Acute depression: Lithium can be a very effective treatment for the depression that occurs in bipolar disorder. Antidepressants may be prescribed in addition.

Maintenance

Lithium is usually prescribed for long-term maintenance treatment. Lithium significantly decreases the frequency and severity of both manic and depressive attacks in 70 percent of all patients. Testing to monitor potential side effects and to be certain the person is taking the medication is important.

Other medications that may be used include valproic acid (divalproex), carbamazepine and verapamil (or another calcium-channel blocker). Antidepressant medication may also continue.

Psychotherapy

Between episodes, most people with bipolar disorder return to their normal functioning. Individuals with cyclothymia are almost always in one mood state or the other. For both types of disorder, psychotherapy is indicated to help the person deal with the effects of the illness in his or her life, to work on coping with the stresses that can trigger episodes, or to help individuals who have psychological difficulties when their moods are stable. Family therapy can help all family members learn about the illness and deal with it better as a family.

Compliance With Medication

Many individuals with bipolar disorder keep their illness under good control as long as they continue taking medication. If they stop their their symptoms may recur. When a cycling pattern of starting and stopping medication develops, the results can be difficult, even devastating, for both the person suffering from the disorder and those who live with him or her. Symptoms of illness reappear when blood levels of medication drop, and unpleasant side effects return when the body readjusts to resuming the drug therapy.

Questions to Ask Your Doctor

Was there a specific incident that may have caused this disorder?

What treatment do you recommend?

Will you be prescribing any medications? What are the side effects? Are there any side effects that should be reported right away?

What testing is required while on lithium and how often is the testing required?

What if the medication is skipped?

If antidepressants are used, can they trigger a manic episode?

What signs would indicate severe, dangerous depression, such as suicide?

Are there any signs that indicate immediate contact of the medical staff?

Do you recommend family therapy?

How can the family learn ways to handle the mood swings and behavior?

Is diet important and can it affect the behavior and drugs?