Bipolar disorder

Other Names: Bipolar affective disorder; Bipolar illness; Manic depression; Manic-depressive psychosis; Major affective disorder

Bipolar disorder is a serious mental illness. People who have it go through unusual mood changes. They go from very happy, "up," and active to very sad and hopeless, "down," and inactive, and then back again. They often have normal moods in between. The up feeling is called mania. The down feeling is depression. Bipolar disorder often starts in a person's late teen or early adult years. But children and adults can have bipolar disorder too. The illness usually lasts a lifetime. If not treated, bipolar disorder can lead to damaged relationships, poor job or school performance, and even suicide. However, there are effective treatments to control symptoms: medicine and talk therapy. A combination usually works best.

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Cause

The exact cause of bipolar disorder is unknown. However, research suggests that there is no single cause. Instead, a combination of factors may contribute to bipolar disorder.

Genes Bipolar disorder often runs in families, and research suggests that this is mostly explained by heredity—people with certain genes are more likely to develop bipolar disorder than others. Many genes are involved, and no one gene can cause the disorder.

But genes are not the only factor. Some studies of identical twins have found that even when one twin develops bipolar disorder, the other twin may not. Although people with a parent or sibling with bipolar disorder are more likely to develop the disorder themselves, most people with a family history of bipolar disorder will not develop the illness.

Brain Structure and Function Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.

Inheritance

Studies have strongly suggested that genetics play an important role in the development of mood disorders, but there is no clear pattern of inheritance. They are likely caused by the interaction of several genes with environmental factors (called complex or multifactorial inheritance).

Types

There are three basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior or increased activity levels (manic episodes) to very sad, “down,” hopeless, or low activity-level periods (depressive episodes). People with bipolar disorder also may have a normal (euthymic) mood alternating with depression. Four or more episodes of mania or depression in a year are termed “rapid cycling.”

Bipolar I Disorder is defined by manic episodes that last at least seven days (most of the day, nearly every day) or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features (having depression and manic symptoms at the same time) are also possible. Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above. Cyclothymic Disorder (also called cyclothymia) is defined by persistent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes. The symptoms usually occur for at least two years in adults and for one year in children and teenagers. Other Specified and Unspecified Bipolar and Related Disorders is a category that refers to bipolar disorder symptoms that do not match any of the recognized categories.

Symptoms

The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Mood episodes are intense. The feelings are intense and happen along with changes in behavior, energy levels, or activity levels that are noticeable to others.

The symptoms of bipolar disorder can vary. An individual with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Mood episodes are intense. The feelings are intense and happen along with changes in behavior, energy levels, or activity levels that are noticeable to others. Symptoms of a Manic Episode

• Feeling very up, high, elated, or extremely irritable or touchy
• Feeling jumpy or wired, more active than usual
• Racing thoughts
• Decreased need for sleep
• Talking fast about a lot of different things (“flight of ideas”)
• Excessive appetite for food, drinking, sex, or other pleasurable activities
• Thinking you can do a lot of things at once without getting tired
• Feeling like you are unusually important, talented, or powerful

Symptoms of a Depressive Episode

• Feeling very down or sad, or anxious
• Feeling slowed down or restless
• Trouble concentrating or making decisions
• Trouble falling asleep, waking up too early, or sleeping too much
• Talking very slowly, feeling like you have nothing to say, or forgetting a lot
• Lack of interest in almost all activities
• Unable to do even simple things
• Feeling hopeless or worthless, or thinking about death or suicide

Some people with bipolar disorder may have milder symptoms than others with the disorder. For example, hypomanic episodes may make the individual feel very good and be very productive; they may not feel like anything is wrong. However, family and friends may notice the mood swings and changes in activity levels as behavior that is different from usual, and severe depression may follow mild hypomanic episodes.

Diagnosis

To diagnose bipolar disorder, a doctor or other health care provider may:

• Complete a full physical exam.
• Order medical testing to rule out other illnesses.
• Refer the person for an evaluation by a psychiatrist.

A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. Some people have bipolar disorder for years before it is diagnosed. This may be because:

Bipolar disorder has symptoms in common with several other mental health disorders. A doctor may think the person has a different disorder, such as schizophrenia or (unipolar) depression. Family and friends may notice the symptoms, but not realize that the symptoms are part of a more significant problem. People with bipolar disorder often have other health conditions, which can make it hard for doctors to diagnose bipolar disorder.

Treatment

Treatment helps many people, even those with the most severe forms of bipolar disorder. Doctors treat bipolar disorder with medications, psychotherapy, or a combination of treatments.

Medications Certain medications can help control the symptoms of bipolar disorder. Some people may need to try several different medications and work with their doctor before finding the ones that work best. The most common types of medications that doctors prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium can help prevent mood episodes or reduce their severity when they occur. Lithium also decreases the risk for suicide. Additional medications that target sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan.

Talk with your doctor or a pharmacist to understand the risks and benefits of each medication. Report any concerns about side effects to your doctor right away. Avoid stopping medication without talking to your doctor first.

Psychotherapy Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can offer support, education, skills, and strategies to people with bipolar disorder and their families. Psychotherapy often is used in combination with medications; some types of psychotherapy (e.g., interpersonal, social rhythm therapy) can be an effective treatment for bipolar disorder when used with medications.

Other Treatments Some people may find other treatments helpful in managing their bipolar symptoms, including:

Electroconvulsive therapy is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. This type of therapy is usually considered only if a patient’s illness has not improved after other treatments (such as medication or psychotherapy) are tried, or in cases where rapid response is needed, as in the case of suicide risk and catatonia (a state of unresponsiveness), for example.

Regular vigorous exercise, such as jogging, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. Check with your doctor before you start a new exercise regimen.

Keeping a life chart, which records daily mood symptoms, treatments, sleep patterns, and life events, can help people and their doctors track and treat bipolar disorder.

Bipolar disorder Resources
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