Bipolar Disorder

Bipolar disorder is a medical condition that involves rapid mood swings between periods of good moods and those of irritability and depression. The condition is experienced equally by both men and women and generally manifests itself for the first time when the individual is between the ages of 15 and 25. So far, the cause of bipolar disorder is not known, but those who suffer from the condition are likely to have family members who also have bipolar disorder.

There are three types of bipolar disorder:

• Bipolar disorder type I
• Bipolar disorder type II
• Cyclothymia

Bipolar disorder type I was once known as manic-depression. It indicates those sufferers who have experienced any manic period-strong feelings of euphoria-as well as the depressive periods of the disorder at least once in their lifetimes. Bipolar disorder type II is a condition in which the individual doesn’t have fully manic episodes. Instead, the person has periods of hypomania. Hypomania is defined as a period of extremely high energy levels accompanied by impulsive behavior. Type II sufferers do experience the same depressive episodes as individuals with type I. Cyclothymia is the mildest form of bipolar disorder. Those with this type of the disorder experience less extreme mood swings, going from mild hypomania to depression. Because the hypomania is less severe, it is often overlooked as a symptom. This often leads those with the condition to be diagnosed as suffering only from depression.

Although the cause of the disorder may be unknown, there are a few common triggers. These include serious life changes, the taking of steroids or antidepressants, illicit drug use and sleepless periods.

Symptoms of the Condition

The manic phase experienced by those with bipolar disorder can last from several days up to as long as a few months at a time.

During this phase, individuals will exhibit a variety of symptoms, which may include:

• Lowered sleep requirements
• An inability to control emotions
• Lack of judgment
• Distraction
• Recklessness
• Elevated moods
• Being easily irritated
• An increase in involvement in activities

During the depressive phase, people with the disorder generally experience:

• Low moods
• A lack of concentration
• Difficulty in making decisions
• Memory problems
• A lack of appetite or overeating
• A loss of energy
• Lowered self-esteem
• Feelings of hopelessness, guilt or worthlessness
• Suicidal thoughts
• Sleep disorders
• Withdrawal from normal activities and friends

Because of the depressive periods, suicide rates are higher than normal among those with bipolar disorder. Those with the disorder are also more likely to abuse drugs or alcohol, increasing the severity of the condition.
In addition to the distinct high and low periods, those with the disorder may sometimes find that the symptoms of each can occur simultaneously. The manic and depressive states may also change quickly from one to the other, a condition known as a mixed state.

Testing for the Disorder

Diagnosing bipolar disorder requires extensive testing. A physician testing for the disorder will ask about the patient’s family history, looking for anyone else in the family who has the disorder. The physician will also ask about any mood swings experienced recently, and take a history of the mood swings including when they began. A medical history is also taken, which will include any other conditions that the patient may have and a list of all medications taken. The doctor will also supervise the individual’s mood for signs of mania and depression, as well as asking the patient’s family about any changes in behavior.

After medical questioning, the doctor will provide a thorough physical exam to determine if there is any other illness that may be causing the symptoms of the disorder. This exam will include laboratory tests for any thyroid conditions as well as checking on any drugs in the patient’s system. Though some drugs mimic symptoms of the disorder, the presence of those drugs does not mean that the disorder does not exist, as taking the drugs may itself be a symptom.

Treatment of Bipolar Disorder

Treatment of bipolar disorder is aimed at stabilizing the patient’s mood as much as possible. Even when the treatment proves successful, the patient may still experience both manic and depressive phases. With treatment, that the patient may avoid hospital stays, have a lowered desire to self-injure and function better in all of the phases of the condition.

During treatment, a physician will try to determine the triggers of the mood swings and provide the patient with exercises to complete when these triggering events occur. These exercises may help prevent the moods or lower their severity.

The physician will also use mood stabilizers, some of which include:

• Valproate
• Carbamazepine
• Lithium
• Lamotrigine

Along with mood stabilizers, the doctor might also prescribe antianxiety medications or antipsychotics to handle mood issues. Antidepressants are also used to help the patient deal with the depressive phases. The use of antidepressants raises the likelihood of experiencing hypomanic or manic periods, so they are usually used in conjunction with mood stabilizers.
For those patients who do not respond to medicine, electroconvulsive therapy might be used. This therapy consists of electrical currents applied to the patient while under anesthesia and will cause brief seizures when used. After the electroconvulsive therapy application, the physician may also use transcranial magnetic stimulation, which applies magnetic pulses of a high frequency to the patient’s brain.

Those patients experiencing severe symptoms may require hospitalization while the mood is stabilized. This may be necessary for either the manic or depressive stages of the disorder.

Treatment Issues

Outcomes tend to be more favorable for those patients who get help as soon as possible after the bipolar disorder first manifests. Issues with treatment sometimes occur when it has been successful. Those on medication who experience positive results often stop taking the medication, mistaking it for a cure rather than an ongoing stabilizing treatment. Patients may also stop taking medication if they miss the feelings of mania.

If the medication is stopped, the symptoms of the disorder often return. Stopping medication may also lead to an even higher chance of drug or alcohol abuse, an increase in suicidal thoughts and extreme judgment issues.

• Cover, editors, experts, and contents pages from the guidelines
• Patient-family guide

View Resources

• NIMH – Most Children with Rapidly Shifting Moods Don’t Have Bipolar Disorder
• Umm.edu – Bipolar disorder – Prognosis
• Bipolar.hs.columbia.edu – Bipolar Disorder and Genetics
• Wexner Medical Center – Manic Depression / Bipolar Disorder
• Faculty.washington.edu – Bipolar Disorder