Bipolar is a mental disorder characterized by extreme shifts in mood, with fluctuations in energy and activity levels.
During these abnormal shifts, the patient commonly finds it difficult to complete everyday tasks. Bipolar disorder used to be known as manic-depressive illness.
Bipolar disorder is a serious mental illness that can destroy relationships, undermine career prospects, and seriously affect academic performance.
The American Psychological Association says that these emotional shifts can become so overwhelming that individuals may choose suicide.
Fast facts on bipolar disorder
Here are some key points about bipolar disorder. More detail and supporting information is in the main article.
- Bipolar disorder is a serious and relatively common condition
- Millions of Americans have a diagnosis of bipolar disorder
- Bipolar disorder used to be known as manic depression
What is bipolar disorder?
People with bipolar disorder have alternating episodes of extreme euphoria (mania) and major depression
A patient with bipolar disorder has severe fluctuations in mood - from depression to mania. Usually, moods are normal in between the peaks and troughs.
Bipolar disorder has nothing to do with the ups and downs we all experience in life; it is much more severe, debilitating, and incapacitating.
Fortunately, it is treatable, and with proper care and the right medication, patients can perform well at work and academically and lead full, productive lives.
An estimated 2.9 percent of Americans are diagnosed with bipolar disorder and more than half of all cases start when patients are aged 15-25. Males and females are affected equally.
Causes of bipolar disorder
Most experts agree that bipolar disorder has no single cause. It is more likely the result of many factors acting together.
Genetics - some small twin studies have indicated that there is a genetic contribution to bipolar disorder risk. People with a blood relative who has bipolar disorder have a higher risk of developing it themselves.
Biological traits - experts say that patients with bipolar disorder often show physical changes in their brains. Nobody is sure why the changes lead to the disorder.
Brain-chemical imbalance - neurotransmitter imbalances play a key role in many mood disorders, including bipolar disorder.
Hormonal problems - hormonal imbalances might trigger or cause bipolar disorder.
Environmental factors - abuse, mental stress, a "significant loss," or some other traumatic event may contribute to bipolar disorder risk.
Symptoms of bipolar disorder
Symptoms during manic/hypomanic episodes:
- A feeling of being on top of the world, exhilaration, or euphoria.
- Over-self-confidence, an inflated sense of self-esteem.
- The patient's judgment may be impaired.
- The patient talks a lot, and very rapidly.
- Thoughts come and go quickly (racing thoughts). Sometimes, bizarre ideas come to the patient's mind, and they are acted upon.
- In this phase, the individual may be extremely forthcoming, sometimes aggressively so.
- The individual is more likely to engage in risky behavior, including promiscuity (higher libido), abuse illegal drugs and/or alcohol, and take part in dangerous activities.
- The patient may squander money.
- Easily distracted.
- Missing work or school and/or underperforming.
Symptoms during depressive episodes:
- A feeling of gloom, blackness, despair, and hopelessness.
- Extreme sadness.
- In severe cases, the patient will think about ending their life, and may act on those thoughts.
- Insomnia and sleeping problems.
- Anxiety about trivial things.
- Guilt - a feeling that everything that goes wrong or appears to be wrong is their fault.
- Eating patterns - some people eat more, others eat less.
- Weight loss or weight gain.
- Extreme tiredness, fatigue, listlessness.
- Inability to feel pleasure with activities or interests that were usually enjoyed.
- Low attention span.
- Easily irritated - this could be triggered by noises, smells, tight clothing, and other things that would usually be tolerated or ignored.
- Some patients are unable to face going to work or school; those that do typically underperform.
Psychosis - in both the manic and depressive episodes there may be psychosis, during which patients cannot differentiate fantasy from reality. Symptoms of psychosis may include delusions (false but strongly felt beliefs) and hallucinations (hearing or seeing things that are not there).
Major Depressive Disorder, with seasonal pattern - previously known as seasonal affective disorder (SAD). Some bipolar disorder patients have moods which fluctuate with the seasons.
Symptoms in pediatric cases of bipolar disorder - children and teenagers are more likely to have temper tantrums, rapid mood changes, outbursts of aggression and explosive anger, and reckless behavior.
It is important to remember that bipolar disorder is a treatable mental illness - it is possible to control the symptoms with proper care and to lead a normal and productive life.
Diagnosing the condition
A psychiatrist or psychologist bases the diagnosis on self-reported experiences of the patient's behavior abnormalities reported by household members, close friends, work colleagues, and teachers, as well as any secondary signs detected by other healthcare professionals.
A series of physical diagnostic tests may be ordered after carrying out a physical exam, including blood and urine tests.
There are three broad types of bipolar disorder:
1) Bipolar I Disorder
There has been at least one manic episode or mixed episodes (with/without previous depressive episodes). Most patients have had at least one depressive episode.
They must also rule out clinical mood disorders which are not associated with bipolar disorder, such as schizophreniform disorder, delusional disorder, or some other psychotic disorder.
2) Bipolar II Disorder
The patient has experienced one or more episodes of depression and at least one hypomanic episode.
A hypomanic state is less severe than a manic one. During a hypomanic episode the patient sleeps much less, is very competitive and outgoing, and is full of energy - but they are fully functioning; this may not be the case with manic episodes.
Unlike manic episodes, during a hypomanic state, there are no symptoms of psychosis or grandiosity.
This is seen as a sub-threshold (milder) form of bipolar disorder. There are numerous mood disturbances, with bouts of hypomanic symptoms which alternate with periods of moderate or mild depression.
At baseline level, a patient with cyclothymia may feel stable, but will go through noticeable fluctuations involving emotional highs during hypomanic episodes, with mania-like symptoms (but less severe), and emotional troughs with depressive symptoms, but not severe enough to meet the criteria for major depressive episodes.
Treatments for bipolar disorder
The aim of treatment for bipolar disorder is to minimize the frequency of manic/depressive episodes and to reduce the severity of symptoms so that the patient can lead a relatively normal and productive life.
If the symptoms are left untreated, a bout of depression/mania can persist for up to 1 year. With treatment, however, improvements are seen within the first 3-4 months.
Mood changes may still occur in patients receiving continuous treatment. However, if the patient works closely with his or her medical team and communicates openly, treatment is usually much more effective.
Treatment for bipolar disorder includes a combination of different therapies, which may include medications and physical and psychological interventions.
Hospitalization - this is much less common today. If the medical team believe there is a risk that the patient may harm themselves or others, they may be hospitalized until they feel better.
Lithium carbonate - the most commonly prescribed long-term drug to treat long-term episodes of depression, mania/hypomania. Patients usually take lithium for at least 6 months. Experts say that treatment compliance (adherence) is vital for it to work; the patient must follow the doctor's instructions on when and how to take their medication.
Other treatments include:
- Anticonvulsants - sometimes prescribed to treat mania episodes.
- Antipsychotics - including aripiprazole, olanzapine, and risperidone. Prescribed if behavior is very disturbed and symptoms are severe.
- Rapid cycling - rapid high-to-low fluctuations with no "normal" in-between periods. Patients with rapid cycling may be advised to take a valproate-lithium combination. If the combination is not effective enough, the doctor may recommend lithium, valproate, and lamotrigine in combination.
- Psychotherapy - the aim is to alleviate core symptoms, to help the patient identify and recognize the key triggers, minimize negativity in relationships, recognize the first symptoms that indicate the onset of an episode, and work on the factors that help maintain the "normal" periods for as long as possible.
- CBT (cognitive behavioral therapy) - psychoeducation and family-focused therapy have been found to be the most effective in preventing relapses. Interpersonal and social rhythm therapy, as well as CBT, can also help with depressive symptoms.