What is Bipolar Disorder (Manic Depression) ?

Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Symptoms

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

• Agitation or irritation
• Elevated mood
  • Hyperactivity
  • Increased energy
  • Lack of self-control
  • Racing thoughts
• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
• Little need for sleep
• Over-involvement in activities
• Poor temper control
• Reckless behavior
  • Binge eating, drinking, and/or drug use
  • Impaired judgment
  • Sexual promiscuity
  • Spending sprees
• Tendency to be easily distracted

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:

• Difficulty concentrating, remembering, or making decisions
• Eating disturbances
  • Loss of appetite and weight loss
  • Overeating and weight gain
• Fatigue or listlessness
• Feelings of worthlessness, hopelessness and/or guilt
• Loss of self-esteem
• Persistent sadness
• Persistent thoughts of death
• Sleep disturbances
  • Excessive sleepiness
  • Inability to sleep
• Suicidal thoughts
• Withdrawal from activities that were once enjoyed
• Withdrawal from friends

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.

Causes & Risk Factors

Bipolar disorder affects men and women equally. It usually appears between ages 15 - 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.

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.

Tests & Diagnostics

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

• Ask about your family medical history, particularly whether anyone has or had bipolar disorder
• Ask about your recent mood swings and for how long you've experienced them
• Observe your behavior and mood
• Perform a thorough examination to identify or rule out physical causes for the symptoms
• Request laboratory tests to check for thyroid problems or drug levels
• Speak with your family members to discuss their observations about your behavior
• Take a medical history, including any medical problems you have and any medications you take

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.

Treatments

For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.

There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.

Antipsychotic 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.

Alternative Therapies

General recommendations include maintaining a calm environment, avoiding over-stimulation, getting plenty of rest, regular exercise, and proper diet. Some Chinese herbs may soften mood swings, but care must be taken (and good communication with the physician is essential) when combining herbal therapies with medications. Biofeedbackis effective in helping some patients control symptoms such as irritability, poor self-control, racing thoughts, and sleep problems. A diet low in vanadium (a mineral found in meats and other foods) and high in vitamin C may be helpful in reducing depression.

Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

• Alcohol and/or drug abuse as a strategy to "self-medicate"
• Personal relationships, work, and finances suffer
• Suicidal thoughts and behaviors

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

Prevention

The ongoing medical management of bipolar disorder is critical to preventing relapse (recurrence) of manic episodes. Even in carefully controlled treatment programs, bipolar patients may experience recurring episodes of the disorder. Patient education in the form of psychotherapy or self-help groupsis crucial for training bipolar patients to recognize signs of mania and depression and to take an active part in their treatment program.