Bipolar Disorder

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Bipolar Disorder is a complex and challenging mood disorder that affects millions of people. It is characterized by episodes of mania, hypomania, or a "mixed" mood that typically alternate with episodes of major depression. These mood fluctuations from one extreme or "pole" to the other are the basis for the name "bipolar". Bipolar disorder is also often referred to as "manic-depressive disorder".

Anyone can develop bipolar disorder. Although the onset may occur at any age, symptoms most frequently first appear in one’s mid-twenties. In males, the first mood episode is often manic. Women, however, are more likely to have an episode of major depression prior to their first manic, hypomanic, or mixed episode.

Symptoms of bipolar disorder

Mania - Manic episodes last for at least 1 week. During that time, the person has an unusually upbeat or "euphoric", irritable, or expansive mood (an expansive mood involves excessive enthusiasm and friendliness). The person’s mood may alternate between irritability and euphoria. Several other symptoms must also be present, which may include:

  • Decreased need for sleep
  • Excessive amounts of energy, restlessness
  • Grandiosity or overblown self-esteem
  • Talkativeness or rapid, pressured speech
  • Racing thoughts, or jumping from one topic to another
  • Pursuing multiple goals or tasks (more than usual)
  • Lack of focus / high degree of distractibility
  • Engaging in highly pleasurable (and usually high risk) activities (e.g. sleeping with multiple partners over a short period of time; spending large amounts of money on a wild shopping spree)

In mania, the symptoms are severe enough to cause significant impairment in functioning, require hospitalization, and / or include psychotic features. They must not be due to a substance or a medical condition.

Manic episodes typically involve erratic, reckless behavior and impaired judgment. They can be very dangerous and often result in serious consequences.

Hypomania - Hypomania is essentially a milder form of mania. The episodes must last at least 4 days. Hypomania includes all of the above criteria except that the symptoms are not serious enough to cause significant problems with functioning or require hospitalization, and psychotic symptoms are never present. The mood must also be notably different than the person’s normal mood.

Major Depression - Major depressive episodes must last for at least 2 weeks. The episode must include a depressed mood most of the time or a significant loss of interest or pleasure in almost everything. At least four other symptoms must also be present, which may include:

  • Insomnia or excessive sleep
  • Changes in appetite or a significant change in weight (not due to dieting)
  • Poor concentration or indecisiveness
  • Low energy or fatigue
  • Being noticeably slowed down or agitated
  • Frequent thoughts of suicide or death, or a suicide plan or attempt

Mixed Episode - The symptoms in a mixed episode are severe enough to meet the criteria for both mania and major depression. The episode lasts for at least a week. It must cause significant impairment, require hospitalization, and / or include psychotic symptoms.

The symptoms of mania, hypomania, mixed episode, and major depression must not be due to the effects of a substance or medical condition.

Types of Bipolar Disorder

Bipolar I Disorder

Bipolar I Disorder is the most severe type. Only one manic or mixed episode is required for a diagnosis. While a small percentage of individuals never go on to have another manic episode or a major depressive episode, the vast majority have recurring episodes. In many cases, manic episodes take place just before or after an episode of major depression. It is not uncommon for the first manic episode to be preceded by some type of stressor.

Without treatment, a small percentage of individuals do have several mood episodes per year (referred to as "rapid cycling"). Most, however, have only a few episodes over a span of several years. Without treatment, though, episodes usually become more frequent with age.

Bipolar II Disorder

Bipolar II disorder involves recurrent episodes of hypomania and major depression. There is no history of manic or mixed episodes. If a manic or mixed episode does occur in the future, the diagnosis is changed to bipolar I disorder.

Bipolar Disorder Not Otherwise Specified

This diagnosis is given when bipolar features are clearly present but don’t fit bipolar I disorder, bipolar II disorder, or cyclothymic disorder.

Cyclothymic Disorder

This mood disorder is also considered a type of bipolar disorder. Cyclothymia involves multiple episodes of depressive symptoms alternating with multiple episodes of hypomanic symptoms. However, unlike bipolar I or bipolar II disorder, the depressive symptoms don’t meet the requirements for major depression. These fluctuations must occur regularly for at least 2 years. During the first two years of cyclothymia there are no manic, mixed, or major depressive episodes.

If someone with cyclothymic disorder goes on to have a manic or mixed episode after the first two years, an additional diagnosis of bipolar I disorder is given. If a major depressive episode occurs after the first two years (but no manic or mixed episodes), an additional diagnosis of bipolar II disorder is given.

Risk Factors

One of the primary risk factors for bipolar disorder is a family history (especially a biological parent or sibling) of bipolar disorder or major depressive disorder. Other risk factors may include:

  • Family history of other mental health disorders, especially ADHD, anxiety disorders, schizophrenia, or schizoaffective disorder.
  • Times of significant stress, including a major life transition or loss
  • Substance abuse

Causes

No one knows exactly what causes bipolar disorders. Many studies show a strong hereditary factor. Multiple genes rather than one specific gene are believed to be involved. Other factors likely include imbalances in brain chemicals, anomalies in brain development, hormonal influences, and environmental factors.

Seasonal changes, lack of sleep, and childbirth may also trigger a manic episode in someone predisposed to the disorder.

Diagnosis

As with most psychiatric disorder, there is no blood test or other test for bipolar disorder. Bipolar I disorder is usually diagnosed by a mental health or medical professional during or following the first manic episode. Lab tests and a physical examination may be given to rule out the effects of a substance or an underlying medical condition that better explains manic or hypomanic symptoms.

Unfortunately, alcohol and drugs can mask or mimic the symptoms of bipolar disorder. As a result, the disorder may go undiagnosed or misdiagnosed for a long period of time or even indefinitely.

Treatment

For most people, bipolar disorder is a lifelong condition. While there is currently no cure for bipolar disorder, it can often be managed with appropriate treatment. Treatment for bipolar disorder typically involves a combination of medication and psychotherapy. Manic, mixed, and severe depressive episodes may require psychiatric hospitalization to prevent harm to self or others and stabilize mood symptoms.

Medication

Lithium is a mood stabilizer and the most commonly prescribed medication for bipolar disorder. Anticonvulsant medications, such as Depakote, Lamictal, Tegretol, and Trileptal, also work as mood stabilizers. All of these medications help stabilize current mood symptoms and reduce the risk of future episodes when taken on an ongoing basis. Saphris, another anticonvulsant drug, is particularly beneficial for treating mixed episodes.

Antipsychotic medications such as Abilify®, Zyprexa®, and Seroquel® are often prescribed for psychotic symptoms. Some antipsychotics also help relieve symptoms of mania or depression. Antipsychotic medications are typically prescribed in combination with a mood stabilizer.

Antidepressants, primarily SSRIs and some atypical antidepressants, may be prescribed in conjunction with mood stabilizers to treat depressive symptoms. Caution must be used as antidepressants prescribed alone – particularly the older tricyclic antidepressants - can trigger a manic episode. Symbyax is a combination antidepressant and antipsychotic medication (fluoxetine and olanzapine) that has been FDA-approved for the treatment of bipolar disorder.

For sleep problems and anxiety, benzodiazepines such as Ativan or Klonopin may be prescribed for a brief period.

Psychotherapy

Psychotherapy plays an important role in the treatment of bipolar disorder. It can help individuals with the disorder identify triggers, manage mood symptoms, and reduce stress. Psychotherapy may include individual, group, couples, and / or family therapy. Psychoeducation can help both the patient and family members better understand the disorder.

Other Types of Treatment

The treatment of bipolar disorder may also include ECT (electroconvulsive therapy) for severe symptoms of depression or lack of response to other types of treatment. Transcranial magnetic stimulation is another potential treatment for the depressive symptoms of bipolar disorder.

Photo by John Nyboer

Article reprinted with permission from PsyWeb.com

 
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