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Bipolar Disorder Explained

Bipolar Disorder, frequently called Manic-Depressive illness, or Manic Depression is a psychiatric disorder causing shifts in mood, activity levels, energy, and ability to carry out day-to-day tasks. Bipolar Disorder symptoms are very serious. They are more extreme than the normal ups and downs that most people go through from time to time. Symptoms of Bipolar Disorder can lead to poor job or school performance, damaged relationships, and in extreme cases, suicide. The good news is Bipolar Disorder can be treated, and people with Bipolar Disorder can lead full, productive lives.


What Causes Bipolar Disorder?

Researchers are currently studying the causes of Bipolar Disorder. The majority of the evidence suggests many factors likely act together to produce the illness or increase risk. In other words, there is no one cause of the disorder. Bipolar Disorder tends to run in families. It is likely that people with certain genes are more prone to developing Bipolar Disorder. Individuals with a first-degree relative who has Bipolar Disorder are much more likely to develop the illness. However, most people with a family history of Bipolar Disorder do not go on to develop the illness.

Newer technological advances are accelerating research on Bipolar Disorder. One notable instance of this is the creation of the Bipolar Disorder Phenome Database. This database will enable researchers to link symptoms of the disorder with the genes that may influence them. Researchers are also studying similar illnesses, such as depression and schizophrenia, to locate genetic differences that may affect an individual's risk for developing Bipolar Disorder. 

Numerous studies of identical twins have shown that the twin of a person with Bipolar Disorder does not necessarily go on to develop the disorder. This is notable as identical twins share the same genes, suggesting genes are not the only factor. This,  many different genes and environmental factors are likely implicated in the development of the disorder. Nonetheless, at present, scientists do not fully understand how these factors cause Bipolar Disorder.


Symptoms of Bipolar Disorder

Individuals who have Bipolar Disorder experience intense, fluctuating emotional states occurring in distinct periods called "mood episodes." Each episode is a drastic change from a person’s usual mood and behavior. A Manic Episode is defined as an overexcited state, and an extremely sad, hopeless state is called a Depressive Episode. Sometimes, individuals with Bipolar Disorder also may be angry and irritable during a Manic Episode.A Mixed Episode is one that includes symptoms of both depression and mania. Additionally, extreme changes in sleep, activity, energy, and behavior accompany the shifts in mood. 

Symptoms of Bipolar Disorder Can Include: 

  • A long period of feeling "high," or an overly happy or outgoing mood
  • Extreme irritability
  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing activities, such as taking on new projects
  • Being overly restless
  • Sleeping little or not being tired
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and engaging in pleasurable, high-risk behaviors
  • An overly long period of feeling sad or hopeless
  • Loss of interest in activities once enjoyed, including sex.
  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

Oftentimes, individuals with Bipolar Disorder also abuse alcohol or drugs, perform poorly at work or school, and have significant relationship difficulties. It can be hard to identify these difficulties as symptoms of a serious mental illness. Even with treatment Bipolar Disorder usually lasts a lifetime. Mania and depression usually come back over time. In-between episodes, most people with Bipolar Disorder don't experience any symptoms, and treatment can extend these periods indefinitely.

Bipolar Disorder generally has its initial onset during late teens or early adulthood.  Half or more cases begin before the age of 25. However, many people experience the first symptoms in childhood, and others may develop symptoms late in life.


Accurate Diagnosis of Bipolar Disorder

Four types of Bipolar Disorder Exist

Bipolar I Disorder involves manic and/or mixed episodes at least seven days in duration, or by manic symptoms that are severe enough to warrant immediate hospitalization. In addition, depressive episodes usually occur as well, lasting two weeks or longer.

Bipolar II Disorder involves a pattern of depressive episodes and hypomanic episodes, but no presence of manic or mixed episodes.

Bipolar Disorder Not Otherwise Specified involves symptoms of the illness existing but not meeting the criteria for either Bipolar I or II. Nonetheless, the symptoms must clearly be out of the person's normal range of behavior.

Cyclothymic Disorder/ Cyclothymia is a milder form of Bipolar Disorder. Cyclothymia includes episodes of hypomania and depression for at minimum two years. As it is milder, the symptoms do not meet the criteria for any other Bipolar Disorder.

Unfortunately, Bipolar Disorder can't be diagnosed through a medical test, but these tests can help rule out other factors that may contribute to mood problems, such as a stroke, brain tumor, or thyroid condition. If the other illnesses can be ruled out, your health care provider should provide a referral to a trained mental health professional, such as a psychologist, who is experienced in diagnosing and treating bipolar disorder.

Generally, Bipolar Disorder worsens if left untreated. Mood episodes usually become more frequent  and more severe over time without treatment. Accurate diagnosis and proper treatment help people with bipolar disorder lead full lives. Usually treatment can help reduce the frequency and severity of episodes. Also, delays in getting the correct diagnosis and treatment can lead to numerous personal and work problems.


Treatment for Bipolar Disorder

There is no "cure" for Bipolar Disorder, although it can be treated very effectively. Appropriate treatment helps individuals with Bipolar Disorder—even the most severe forms— control mood swings and other symptoms.  As it is a lifelong illness, long-term, continuous treatment is needed to control symptoms. Treatment is most effective when you work closely with a doctor and talk honestly about your concerns and choices. The most effective treatment includes a combination of medication and Cognitive Behavioral Therapy (CBT).


Cognitive Behavioral Therapy for Bipolar Disorder

Cognitive Behavioral Therapy (CBT) is an effective treatment for Bipolar Disorder when provided in combination with medication. Cognitive Behavioral Therapy helps people with Bipolar Disorder learn to change harmful or negative thoughts behaviors.  CBT also helps enhance coping strategies, such as early recognition of mood episodes. Additionally, CBT can improve communication and problem-solving.

In a STEP-BD study on psychotherapy, scientists compared people in two groups: one group who received traditional talk-therapy, and a second group receiving intensive CBT. The findings indicated the CBT group had fewer relapses, less hospitalizations, and better outcomes in general. People in this group were also more likely to get well faster and stay well longer.

A licensed psychologist typically provides psychotherapy. However, social workers and Marriage and Family Therapists (MFT) can also legally provide therapy, though their training is of shorter duration. Your psychologist should work with your psychiatrist to track your progress. Your unique treatment needs should determine the number and frequency of sessions. Following the doctor's instructions for any psychotherapy will likely provide the greatest benefit.

Click for more information about What CBT is and How it Works 


Medications for Bipolar Disorder

Different types of medications can help control symptoms of bipolar disorder. Not everyone responds to medications in the same way. You may need to try several different medications before finding ones that work best for you.Keeping a daily life chart that makes note of your daily mood symptoms, treatments, sleep patterns, and life events can help you and your doctor track and treat your illness most effectively. If your symptoms change or if side effects become intolerable, your doctor may switch or add medications.

The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics, and antidepressants. For the most up-to-date information on medication use and their side effects, contact the U.S. Food and Drug Administration (FDA).

Mood stabilizers are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Lithium (also known as Eskalith or Lithobid) is an effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes. Anticonvulsants are also used as mood stabilizers. They were originally developed to treat seizures, but they also help control moods. Anticonvulsants used as mood stabilizers include: Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania. It is a popular alternative to lithium. However, young women taking valproic acid face special precautions. Lamotrigine (Lamictal), FDA-approved for maintenance treatment of bipolar disorder. It is often effective in treating depressive symptoms. Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal).

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be monitored closely for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. If you take any of these medications, do not make any changes to your dosage without talking to your doctor.

Atypical antipsychotics are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications, such as antidepressants. Atypical antipsychotics include:

Olanzapine (Zyprexa), which when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine can be taken as a pill or a shot. The shot is often used for urgent treatment of agitation associated with a manic or mixed episode. Olanzapine can be used as maintenance treatment as well, even when psychotic symptoms are not currently present.

Aripiprazole (Abilify), which is used to treat manic or mixed episodes. Aripiprazole is also used for maintenance treatment. Like olanzapine, aripiprazole can be taken as a pill or a shot. The shot is often used for urgent treatment of severe symptoms.

Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) also are prescribed to relieve the symptoms of manic episodes.

Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression. However, taking only an antidepressant can increase your risk of switching to mania or hypomania, or of developing rapid-cycling symptoms. To prevent this switch, doctors usually require you to take a mood-stabilizing medication at the same time as an antidepressant.


Less Common Treatments for Bipolar Disorder

Electroconvulsive Therapy (ECT)—For cases in which medication and psychotherapy do not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments.

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.

Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes. But it is generally not used as a first-line treatment. ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.

Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, your doctor may suggest a change in medications. If the problems still continue, your doctor may prescribe sedatives or other sleep medications.

Herbal Supplements—In general, not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder. St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications. Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder. Study results have been mixed. Be sure to tell your doctor about all prescription drugs, over-the-counter medications, or supplements you are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.


What To Do If Someone You Know Might Have Bipolar Disorder

If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.

To help a friend or relative, you can:

  • Offer emotional support, understanding, patience, and encouragement
  • Learn about bipolar disorder so you can understand what your friend or relative is experiencing
  • Talk to your friend or relative and listen carefully
  • Listen to feelings your friend or relative expresses and be understanding about situations that may trigger bipolar symptoms
  • Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
  • Remind your friend or relative that, with time and treatment, he or she can get better.
  • Never ignore comments from your friend or relative about harming himself or herself. Always report such comments to his or her therapist or doctor.

Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, or poor work or school performance. These behaviors can have lasting consequences. Caregivers usually take care of the medical needs of their loved ones. But caregivers have to deal with how this affects their own health as well. Caregivers' stress may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.

It can be very hard to cope with a loved one's bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode. If you are a caregiver of someone with bipolar disorder, it is important that you also make time to take care of yourself.

This information is provided courtesy of the National Institute of Health.