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By Steve Bressert, Ph.D. Table of Contents:
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An Introduction to the Bipolar Series Who Gets Bipolar Disorder? Causes of Bipolar Disorder Symptoms of Bipolar Disorder Phases of Bipolar Disorder Treatment of Bipolar Disorder Frequently Asked Questions Further Information
There are a number of common types of phases that most people with bipolar disorder experience to one degree or another. The most commonly experienced type of bipolar disorder is one where the individual cycles back and forth between a state of mania (or hypomania, a lesser form of mania) and depression.
During this phase, people have an elevated mood, or ³high,´ which includes feelings of increased self-esteem and uniqueness. They often overestimate how much they can do and the quality of their ideas. Judgment becomes impaired and patients feel powerful over painful consequences. They feel ³bulletproof´ and have little regret or concern for their actions. They may have many ideas and lots of energy to carry them out. The abundance of thoughts may be difficult to follow; such thoughts are called racing thoughts or pressured speech. People in manic episode may feel such an extreme pressure to keep talking that others do not have the opportunity to interrupt them. Manic patients¶ minds are working so fast that they come up with rhymes or sing-song phrases, burst out in song or start dancing spontaneously. Their daily behavior can become disorganized or even dangerous to the point that they require hospitalization. Manic episodes can also have psychotic symptoms present. Psychosis is a state in which a person is unable to tell the difference from reality and unreality. Psychosis symptoms include hallucinations, false beliefs about having special powers or identity (such as superhuman strength or X-ray vision). Psychotic symptoms indicate a severe mood episode that requires immediate medical attention and treatment. People experiencing mania might begin several activities at once, never doubting that they can complete all of them. They may have so much energy that they operate on two or three hours of
Rapid cycling bipolar disorder is difficult to treat and often is less responsive to medication. people with bipolar disorder may stay in bed all day. During the other seasons. friends and co-workers of a person with bipolar disorder. making emergency care crucial for their safety. They may need a longer hospital stay or a combination of more than one medication to get well. They may speak or think of suicide. Patients often are hospitalized for their safety and the safety of those around them. hypomanic. Just as in a manic episode. Bipolar patients in a depressed phase often feel as if they are worthless and as if their life is meaningless. depressive or mixed episodes in a 12-month period. which can involve a hormonal imbalance that mimics mania or depression. For example. Rapid Cycling This term describes the overall course of the illness over a period of 12 months. An estimated 15 to 20 percent of bipolar patients will develop rapid cycling. a seasonal-pattern patient would tend to have manic or hypomanic episodes during a specific season of the year. The fall/winter depression pattern is more common than the spring/summer pattern. They may begin to overeat and. In bipolar disorder. All of this energy can exhaust the family. If you want to learn more about what differentiates specific types of bipolar disorder and the diagnostic criteria for each. read the official diagnostic criteria for Bipolar Disorder. This can lead to irritability. probably due to changes in light. someone who tends to become depressed during the late fall and winter and then returns to a regular mood during the spring and summer has a seasonal pattern of depression. gain weight.sleep each day. . Mixed episode This is a mood episode during which the symptoms of depression and mania are experienced at the same time. given their low activity level. often feeling that they cannot get going. especially women who have a problem with the thyroid gland. This condition is more common in women. psychotic symptoms may also occur during severe depressive episodes. April and May. Depression During this phase. hostility and physical aggression. A patient with rapid cycling bipolar disorder has four or more manic. and they take little pleasure in any activity. Seasonal pattern This term describes mood disorders that seem to be triggered by a particular season of the year. Treatment usually requires a combination of medications. They may feel that their thoughts move slowly. their mood would tend to be normal neither manic nor depressed. Suicide is far more common in March.
Psychotherapy & Self-Help Strategies Psychotherapy and self-help strategies can keep someone with bipolar disorder stabilized and prevent relapse.Treatment of Bipolar Disorder (Manic Depression) By Steve Bressert. such solutions rarely provide the type of long-term relief most people desire. However. Table of Contents: y y y y y y y An Introduction to the Bipolar Series Who Gets Bipolar Disorder? Causes of Bipolar Disorder Symptoms of Bipolar Disorder Treatment of Bipolar Disorder Frequently Asked Questions Further Information Although bipolar disorder is viewed as a long-term. more expensive medications for bipolar disorder that may provide greater symptom relief. Atypical antipsychotics Newer. People with undiagnosed bipolar disorder will sometimes self-medicate with alcohol or drugs to try and relieve their symptoms. there are a variety of effective treatments available. they often return to treatment. People with bipolar disorder often seek out treatment according to what part of the cycle they¶re in. Medication is nearly always a part of the recommended treatment course for bipolar disorder. Other treatment strategies Other treatments for bipolar disorder may include prescribing a combination of medications for bipolar. often chronic condition. When a person with bipolar disorder is in a manic or hypomanic phase. Ph. they may believe they have no further need of medications and stop taking them. which are reliable and well-tolerated by most.D. When in a depressive phase. The types of treatment that are commonly prescribed for bipolar disorder include: y y y y Mood stabilizers Older medications. they have largely been supplanted by atypical antipsychotics. Once the first-line treatment for bipolar disorder. but also have greater side effects. . including antidepressants for bipolar. such as lithium.
g. The risks of long-term medication use must be weighed against the risk of getting sick again (relapse). An additional 20 to 30 percent will respond to another medication or combination of medications. Approximately 50 percent of people will respond to lithium alone.. Continuation treatment prevents a return of symptoms from the same manic or depressive episode.Treatment for bipolar disorder can be divided into three general categories. which occurs when the symptoms are diminished for a period of time. a person is free of symptoms for about five years between the first and second episodes.. The cause of bipolar disorder is not entirely known. it may lie dormant and be activated spontaneously or it may be triggered by stressors in life. Medications are usually prescribed by a psychiatrist (or generally should be ² a general practitioner or family physician doesn¶t have the extensive background and experience in prescribing these medications on a long-term basis). hospitalization in a psychiatric facility is a standard approach. Maintenance treatment prevents a recurrence of symptoms. Psychotherapy to help learn better ways of coping and unlearn unhelpful thinking and patterns of behavior is usually provided by a psychologist or licensed clinical social worker. It is estimated that a person with bipolar disorder will have an average of eight to nine mood episodes during his or her lifetime. As time goes on. People who are experiencing life-threatening symptoms. Ten to 20 percent will have chronic (unresolved) mood symptoms despite treatment. Acute treatment focuses on suppressing current symptoms and continues until remission.g. In some cases. hallucinations or delusions). promiscuity or aggressiveness) or psychotic symptoms (e. . the outlook for someone with bipolar disorder is favorable. Doctors there often will refer them to a psychiatrist for further treatment. Who Treats Bipolar Disorder? A wide range of mental health professionals help treat bipolar disorder. The current thinking is that this is a predominantly biological disorder that occurs in a specific part of the brain and is due to a malfunction of the neurotransmitters (chemical messengers in the brain). the interval between episodes may shorten. As a biological disorder. such as life-endangering impulsive behavior (e. Usually for an initial diagnosis. Most people respond to a medication and or combination of medications. Depending on the level of potential harm to self or others. neurochemical and environmental factors probably interact at many levels to play a role in the onset and progression of bipolar disorder. Approximately 10 percent of bipolar patients will be very difficult to treat and have frequent episodes with little response to treatment. Genetic. substance abuse. especially in cases in which treatment is discontinued too soon. Prognosis for Bipolar Disorder With appropriate treatment. should be evaluated by a physician. On average. it is recommended that you consult a psychologist or psychiatrist. as well as anyone who is severely suicidal. they should go to an emergency room.
Although. Therefore. Because a depressive episode can turn into a manic episode when an . alcohol or drug abuse. As a biological disorder. or chemical messengers. Among those at risk for the illness. the same risk as if both parents have bipolar disorder. in the brain. Environmental Factors in Bipolar Disorder y y y y A life event may trigger a mood episode in a person with a genetic disposition for bipolar disorder. This apparent increase in earlier occurrences may be due to underdiagnosis of the disorder in the past. Even without clear genetic factors. What is Medication-triggered Mania? Medications such as antidepressants can trigger a manic episode in people who are susceptible to bipolar disorder. These chemicals may involve neurotransmitters like norepinephrine. such as depression. altered health habits. A person who has a non-identical twin with the illness has a 25 percent chance of illness. This change in the age of onset may be a result of social and environmental factors that are not yet understood. A person who has an identical twin (having exactly the same genetic material) with bipolar disorder has an even greater risk of developing the illness about an eightfold greater risk than a nonidentical twin. Neurochemical Factors in Bipolar Disorder Bipolar disorder is primarily a biological disorder that occurs in a specific area of the brain and is due to the dysfunction of certain neurotransmitters. Studies of adopted twins (where a child whose biological parent had the illness is raised in an adoptive family untouched by the illness) has helped researchers learn more about the genetic causes vs. Use of alcohol or tranquilizers may induce a more severe depressive phase. researchers have found these important clues: Genetic factors in Bipolar Disorder y y y y y Bipolar disorder tends to be familial. it may lie dormant and be activated on its own or it may be triggered by external factors such as psychological stress and social circumstances. no one is quite sure about the exact causes of bipolar disorder.´ About half the people with bipolar disorder have a family member with a mood disorder. a depressive episode must be treated carefully in those people who have had manic episodes. Although substance abuse is not considered a cause of bipolar disorder. or hormonal problems can trigger an episode. it can worsen the illness by interfering with recovery. serotonin and probably many others. meaning that it ³runs in families. bipolar disorder is appearing at increasingly early ages. A person who has one parent with bipolar disorder has a 15 to 25 percent chance of having the condition. environmental and life events causes.
Certain medications also may set off a depressive or manic episode. such as medicine for thyroid problems and corticosteroids like prednisone. These are some of the most commonly asked questions ² and their answers ² about manic depression (also known as bipolar disorder): Is there a test to tell me if I have. such as vitamin B12 corticosteroid use. the person returns to his normal mood. After stopping the medication. People often have common questions about the basics of manic depression. may trigger increased energy.antidepressant medication is taken. and lack of sleep may prompt onset of the disorder. frequent use of stimulants or alcohol. or may inherit. Substances that can cause a manic-like episode include: y y y y Illicit drugs such as cocaine. stroke or epilepsy infections of the brain from conditions such as HIV infection. decreased need for sleep and increased talkativeness. It is unlikely that a single gene will be discovered that is responsible for the illness in all people with bipolar disorder. including bipolar disorder. bipolar disorder? Currently. sleep apnea and lyme disease deficiencies of certain vitamins. Can someone have a medical condition that appears to be bipolar disorder but actually is something else? Certain conditions mimic mood disorders. ³designer drugs´ such as Ecstasy and amphetamines. no test can tell a person if he is at risk of developing bipolar disorder. brain tumors. notify your physician so as to help avoid the risk of a medication-induced manic episode. including appetite suppressants and cold preparations.´ partially protecting the person from antidepressant-induced mania. The antimanic drug creates a ³ceiling. such as multiple sclerosis. syphilis. Excessive caffeine (moderate amounts of caffeine are fine). for example. If you have a family history of bipolar disorder. Nonpsychiatric medications. however. Excessive doses of certain over-the-counter drugs. Appetite suppressants. If a person is vulnerable to bipolar disorder. especially in high doses medicine used to prevent diseases like tuberculosis and AIDS . stress. Certain other medications can produce a ³high´ that resembles mania. Common ones are: y y y y y y thyroid conditions neurological diseases. an antimanic drug is also recommended to prevent a manic episode.
nmha. 6th Floor Alexandria. If I am diagnosed with bipolar disorder. We recommend checking out further online resources for bipolar disorder that have been reviewed by Psych Central. The Depressive and ManicDepressive Association is a good place to look for a support group in your area. VA 22311 Telephone: 703-684-7722. Families can support good mental hygiene by going to bed and getting up at the same time each day. First. You may also want to check out our thriving online bipolar support group.org . where you¶ll meet friendly people who are also grappling with this issue. 1-800-969-NMHA (6642) Website: http://www. The person with the disorder is less able to dismiss the observation if there is a consensus among friends or family members that a distinctive pattern has emerged. going to lectures and talking to your doctor. learn all you can about your illness by reading books. Mental Health America (formerly the National Mental Health Association) 2000 N. finances or family relationships. In these groups. For helpful hints for managing your illness. How can lifestyle affect bipolar disorder? Lack of a consistent routine and disrupted sleep can trigger a mood episode. Choosing work and leisure activities that allow proper sleep and rest is vital to healthy emotional functioning. patients are encouraged to stay on medication indefinitely if an episode was very frightening or associated with great risk to their health. Is there anything I can do to help my disorder? Yes. What if someone I know has bipolar disorder? Family members may want to express their concern by describing the specific behaviors to that person in a nonjudgmental fashion. will I be on medication for the rest of my life? Not necessarily. However. At the work site. Beauregard Street. violations of safety codes or negligence may need to be reported to supervisors so that the person can receive a medical evaluation before injury or disability occurs.Telling your doctor about your medical history and the medications that you are currently taking can help her determine the cause of your condition. Get support from others who also have the illness. you can hear how others face the challenges of life and manage their mood and treatment medications. see Coping With Bipolar Disorder.
.org The International Foundation for Research and Education on Depression Website: http://www. 1-800-826-3632 FAX: 312-642-7243 Website: http://www. 1-800-950-NAMI (6264) FAX: 703-524-9094 Website: http://www. Suite 501 Chicago. National Library of Medicine Find this content and more from trusted sources.org Causes Symptoms Tests & diagnosis Treatment Prognosis Complications When to contact a doctor References U.org National Alliance for the Mentally Ill Colonial Place Three 2107 Wilson Blvd.. VA 22201-3042 Telephone: 703-524-7600.National Depressive and Manic Depressive Association 730 Franklin Street. Suite 300 Arlington.ndmda.depression. IL 60610 Telephone: 312-642-0049.nami.S.
Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression. Bipolar affective disorder Causes Bipolar disorder affects men and women equally. and/or drug use o Impaired judgment . People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone. false beliefs in special abilities) Little need for sleep Over-involvement in activities Poor temper control Reckless behavior o Binge eating. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. with less severe mood swings. drinking.Overview Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. There are two primary types of bipolar disorder. bipolar disorder I was called manic depression. People with bipolar disorder II seldom experience full-fledged mania. Bipolar disorder results from disturbances in the areas of the brain that regulate mood. The exact cause is unknown. A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression. Symptoms The manic phase may last from days to months and can include the following symptoms: y y y y y y y Agitation or irritation Elevated mood o Hyperactivity o Increased energy o Lack of self-control o Racing thoughts Inflated self-esteem (delusions of grandeur. Alternative Names Manic depression. The "mood swings" between mania and depression can be very abrupt.25. but it occurs more often in relatives of people with bipolar disorder. In the past. It usually appears between ages 15 .
particularly whether anyone has or had bipolar disorder Ask about your recent mood swings and for how long you've experienced them Observe your behavior and mood Perform a thorough examination to identify or rule out physical causes for the symptoms Request laboratory tests to check for thyroid problems or drug levels Speak with your family members to discuss their observations about your behavior Take a medical history. The health care provider may do some or all of the following: y y y y y y y Ask about your family medical history. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state. which can worsen the symptoms. While in either phase. remembering. hypomanic episodes involve similar symptoms that are less intense. including any medical problems you have and any medications . patients may abuse alcohol or other substances. Tests & diagnosis A diagnosis of bipolar disorder involves consideration of many factors.y Sexual promiscuity Spending sprees Tendency to be easily distracted o o These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II. Sometimes there is an overlap between the two phases. or making decisions Eating disturbances o Loss of appetite and weight loss o Overeating and weight gain Fatigue or listlessness Feelings of worthlessness. The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression: y y y y y y y y y y y Difficulty concentrating. hopelessness and/or guilt Loss of self-esteem Persistent sadness Persistent thoughts of death Sleep disturbances o Excessive sleepiness o Inability to sleep Suicidal thoughts Withdrawal from activities that were once enjoyed Withdrawal from friends There is a high risk of suicide with bipolar disorder.
However. may also help. discontinuing medication may have very negative consequences. Although these early manic states may feel good. Antipsychotic drugs can help a person who has lost touch with reality. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones. and lead to the following complications: . Prognosis Mood-stabilizing medication can help control the symptoms of bipolar disorder. Suicidal thoughts. Complications Stopping or improperly taking medication can cause your symptoms to come back. and mood stabilizers are typically used. and gestures in people with bipolar affective disorder require immediate emergency attention. in studies that followed patients for 2 years. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. For the depressive phase. Treatment For the manic phase of bipolar disorder. Psychotherapy may be a useful option during the depressive phase. Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible. antipsychotic medications. lithium.you take Note: Use of recreational drugs may be responsible for some symptoms. antidepressants are sometimes used. though this does not rule out bipolar affective disorder. Anti-anxiety drugs. such as benzodiazepines. However. lithium and some antipsychotics were found to be moderately successful. with or without the manic phase treatment. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications. ideas. Getting enough sleep helps keep a stable mood in some patients. Suicide is a very real risk during both mania and depression. Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. Drug abuse may itself be a symptom of bipolar disorder. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.
Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder. When to contact a doctor Call your health provider or an emergency number right way if: y y y You are having thoughts of death or suicide You are experiencing severe symptoms of depression or mania You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms .y y y Alcohol and/or drug abuse as a strategy to "self-medicate" Personal relationships. work. and finances suffer Suicidal thoughts and behaviors This illness is challenging to treat.