BIPOLAR DISORDER

Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. The "mood swings" between mania and depression can be very quick.

Bipolar disorder affects men and women equally. It usually starts between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Types of bipolar disorder:

• People with bipolar disorder type I have had at least one manic episode and periods of major depression. In the past, bipolar disorder type I was called manic depression.
• People with bipolar disorder type II have never had full mania. Instead they experience periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). These periods alternate with episodes of depression.
• A mild form of bipolar disorder called cyclothymia involves less severe mood swings. People with this form alternate between hypomania and mild depression. People with bipolar disorder type II or cyclothymia may be wrongly diagnosed as having depression.

In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people with bipolar disorder:

• Life changes such as childbirth
• Medications such as antidepressants or steroids
• Periods of sleeplessness
• Recreational drug use

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

Easily distracted

Little need for sleep

Poor judgment

Poor temper control

Reckless behavior and lack of self control

            Binge eating, drinking, and/or drug use

            Poor judgment

            Sex with many partners (promiscuity)

            Spending sprees

Very elevated mood

            Excess activity (hyperactivity)

            Increased energy

            Racing thoughts

            Talking a lot

Very high self-esteem (false beliefs about self or abilities)

Very involved in activities

Very upset (agitated or irritated)

These symptoms of mania occur with bipolar disorder I. In people with bipolar disorder II, the symptoms of mania are similar but less intense.

The depressed phase of both types of bipolar disorder includes the following symptoms:

Daily low mood or sadness

Difficulty concentrating, remembering, or making decisions

Eating problems

Loss of appetite and weight loss

Overeating and weight gain

Fatigue or lack of energy

Feeling worthless, hopeless, or guilty

Loss of pleasure in activities once enjoyed

Loss of self-esteem

Thoughts of death and suicide

Trouble getting to sleep or sleeping too much

Pulling away from friends or activities that were once enjoyed

There is a high risk of suicide with bipolar disorder. Patients may abuse alcohol or other substances, which can make the symptoms and suicide risk worse.

Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.

Treatment

Periods of depression or mania return in most patients, even with treatment. The main goals of treatment are to:

• Avoid moving from one phase to another
• Avoid the need for a hospital stay
• Help the patient function as well as possible between episodes
• Prevent self-injury and suicide
• Make the episodes less frequent and severe

The health care provider will first try to find out what may have triggered the mood episode. The provider may also look for any medical or emotional problems that might affect treatment.

The following drugs, called mood stabilizers, are usually used first:

• Carbamazepine
• Lamotrigine
• Lithium
• Valproate (valproic acid)

Other antiseizure drugs may also be tried.

Other drugs used to treat bipolar disorder include:

• Antipsychotic drugs and anti-anxiety drugs (benzodiazepines) for mood problems
• Antidepressant medications can be added to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, antidepressants are only used in people who also take a mood stabilizer.

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder if it does not respond to medication. ECT uses an electrical current to cause a brief seizure while the patient is under anesthesia. ECT is the most effective treatment for depression that is not relieved with medications.

Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. It is most often used after ECT.

Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stable and their behavior is under control.