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Bipolar disorder, sometimes called manic-depressive illness, is a serious mental illness characterized by extreme shifts in mood and energy levels-resulting in episodes of mania to depression. The National Institute of Mental Health reports that the disorder affects an estimated 5.7 million American adults (2.6% of the population), and it affects all ages, races, ethnic groups, and social classes. The World Health Organization reports that bipolar disorder is the sixth leading cause of disability worldwide and can lead to a 9.2 year reduction in lifespan. If left untreated, bipolar disorder can cause relationship problems, job loss, and erratic behavior that may be life threatening. People with bipolar disorder alternate between periods of depression and mania, which are both characterized by vastly different behaviors.
Depressive episodes are defined by the following behaviors:
Manic behaviors include:
It is also possible to have episodes of mixed mania or hypomania. Mixed mania episodes are characterized by both manic and depressive behaviors occurring simultaneously. Hypomania episodes include all of the same behaviors of manic episodes; only the behaviors are less severe.
There are four types of Bipolar Disorder:
The precise cause of bipolar disorder is not known. The most common belief is that it is a biological disorder that occurs in a specific part of the brain due to the misfiring of neurotransmitters such as norepinephrine and serotonin. The misfiring of neurotransmitters is thought to be caused by a genetic predisposition, in combination with a triggering event. To learn more about what makes you more likely to develop bipolar disorder, read about the disorder’s risk factors.
While the cause of bipolar disorder is unknown, there are known factors that influence the development of the disease.
Risk factors for bipolar disorder include:
Bipolar disorder can be a challenging condition to diagnose. According to The Depression and Bipolar Support Alliance (DBSA), people with bipolar disorder may face up to ten years of coping with symptoms before getting an accurate diagnosis. Only one in four receive an accurate diagnosis in less than three years. The DBSA also reports that a gender bias exists in the diagnosis of bipolar disorder – women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia.
Diagnostic criteria for bipolar disorder have been flexible over the years, changing to accommodate new findings from research and data. For example, with the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for manic and hypomanic episodes now includes an emphasis on changes in energy level and activity instead of only mood.
When making a diagnosis, your physician will take the following into account:
Symptoms of bipolar disorder can vary greatly as some people are more prone to depression or mania, while others alternate these conditions or experience both at the same time. The severity and frequency of symptoms can vary as well.
The following may be signs of bipolar disorder in varying forms:
Manic Episodes
Hypomania
Symptoms for hypomania are similar to those for mania, but less severe. You can still function day to day, however hypomania can escalate to full mania or cycle into major depression.
Bipolar Depression
Bipolar disorder in children and adolescents
According to the National Institute of Mental Health, when children and adolescents are manic they are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, the youngsters may headaches, stomachaches, fatigue, irritability, social isolation, and extreme sensitivity to rejection or failure. Poor performance in school is common.
The disease can be severe and long term in some and less severe and infrequent in others. However, all sufferers should be able to lead normal lives with medication, therapy, and self-management skills including learning to recognize triggers such as irregular sleep, stressors, and changes in medication dosage.
Living with bipolar disorder can be challenging. Changes in moods and behaviors can put stress on your job, relationships, and family life. Luckily, there are things you can do to help manage your disorder. These include:
Bipolar disorder affects over 2.5 million adult Americans annually. It is a serious disorder and if you have some of the symptoms – i.e.: extreme mood swings, reckless behavior, euphoria – you should go to a doctor for a psychological assessment, a physical exam, and blood and urine tests.
Bipolar disorder is often screened for in primary practice through the use of the mood disorder questionnaire (MDQ). The MDQ was developed by psychiatrists and researchers to accurately detect bipolar disorder in patients visiting their primary care physicians. It consists of about 15 questions regarding mood irregularity, energy levels, and sporadic behaviors. The MDQ has been found to be effective in identifying individuals with mood-related disorders, though its questions may not accurately distinguish bipolar disorder from other mood conditions in those who respond positively to the questionnaire; further testing may be required before a diagnosis is reached.
There are no proven ways to prevent bipolar disorder. If you have been diagnosed and are in treatment, stay on your medications to lessen your chances of recurrence. Note that even small changes in mood, energy, sleep, and focus can be signs of an imminent episode. If you have had two or three full-blown episodes, you will most likely be advised to indefinitely continue the medication.
Bipolar disorder is most commonly treated with mood stabilizers. Antipsychotics and antidepressants can be prescribed along with mood stabilizers to help further control symptoms.
Medication
Mood stabilizers have been clinically shown to successfully reduce the severity of manic/depressive symptoms. They work by affecting communication within the nervous system to limit brain activity that leads to manic/depressive behaviors. Mood stabilizers often take several weeks for their full effects to be observed. They are most effective when distributed throughout the body at an optimal level, which can take several weeks of close blood monitoring to arrive at. Do not alter your medication regimen without first talking to your doctor. These include:
Lithium (Eskalith, Eskalith CR, Lithobid). After being approved by the FDA in the 1970s for the treatment of both manic episodes and depressive episodes, lithium established itself as a primary medication for the treatment of bipolar disorder. Researchers are still unsure of why this naturally occurring element works as an effective treatment for bipolar disorder. The effects of lithium typically do not begin to take effect until about two weeks after the initial dose, with full effects emerging three to six weeks after the initial dose. It works best for those who experience euphoric mania (as opposed to mixed mania or anxious mania), and about 50% of the patients who take lithium notice an improvement in their condition. The FDA warns that because lithium toxicity can occur at therapeutic doses, lithium therapy must be monitored with blood tests. Women who are pregnant or breastfeeding should not take lithium due to the risk of birth defects. According to researchers at the University of South Florida, a safer form of lithium called lithium salicylate is on the horizon. Findings on the new drug were published in the March 2014 issue of RSC Advances, the journal of the Royal Society of Chemistry.
Side effects of lithium include:
Anticonvulsant medications were originally developed to treat seizures but were found to help control moods as well. These include:
Anticonvulsants can have serious side effects, including:
If you experience any increased symptoms of depression or suicidal thoughts or behaviors, talk to your doctor as soon as possible. If you are contemplating suicide, call 1-800-273-TALK for immediate support.
Atypical antipsychotics can be used in combination with mood stabilizers to treat symptoms of bipolar disorder. Initially, these were thought only to treat psychosis, a symptom of other mental disorders such as schizophrenia. Atypical antipsychotics used to treat bipolar disorder include:
Mild side effects of atypical antipsychotics include:
Serious side effects of atypical antipsychotics include:
SSRI Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder, however people with bipolar disorder should not take an antidepressant on its own because doing so can cause the person to switch rapidly from depression to mania. Doctors typically prescribe an antipsychotic along with an antidepressant for patients with bipolar disorder. Recent studies suggest that antidepressants are not as effective in treating individuals with bipolar as initially thought. A study funded by the National Institute of Mental Health found that antidepressants were no more effective than a placebo to help treat depression in people with bipolar disorder. Use of antidepressants as treatment for bipolar disorder is therefore controversial, however doctors may still choose to prescribe SSRI anti-depressants including:
Serious side effects of antidepressants are among the reasons why their use for bipolar disorder treatment is controversial. These include:
Women who are pregnant should not take these medications, as SSRI antidepressants have been shown to cause birth defects.
Psychotherapy
In addition to medications, various types of psychotherapy may be helpful in treating and managing your bipolar symptoms.
These include:
In addition to medications and therapies, alternative treatments may help reduce bipolar disorder symptoms. Keep in mind that most of these treatments are only backed by anecdotal evidence that has not been validated by statistical data and are therefore not endorsed by the FDA as official treatments for bipolar disorder.
The following alternative medicines may be helpful in treating bipolar disorder:
Nutritional supplementation. Certain supplements may be useful in controlling high and low moods associated with bipolar disorder.These include:
Herbal supplements. Certain herbal supplements may also be helpful in lessening bipolar disorder symptoms.Possibly beneficial herbal supplements include:
Acupuncture. Acupuncture is a form of ancient Chinese medicine that focuses on replenishing the bodily flow of energy though the placement of small needles in acupuncture points around the body. Anecdotal evidence suggests that acupuncture can help raise energy levels, regulate moods, and alleviate stress, though there is little statistical evidence suggesting it as an effective treatment for bipolar disorder.
Mind/body practices such as yoga, tai chi, and meditation can help individuals concentrate on finding a bodily rhythm that reduces stress and anxiety levels.
If you have been diagnosed with bipolar disorder, the following tips can help you manage your symptoms and lead a more balanced, happier lifestyle:
If you suspect you have bipolar disorder, track your emotions for at least two weeks. Pay special attention to what affects your emotions and look for possible triggers. This will be helpful when you see a mental health professional, which is definitely a good step to take so that you can figure out what is going on.
If you have suicidal thoughts, call 911 or the suicide helpline at 1-800-273-TALK immediately.
If you have already been diagnosed with bipolar disorder and experience any of the following, contact your doctor immediately:
These could be signs of serious complications with your medications.
Your care team for your bipolar disorder will most likely have several members. You may wish to include:
Finding the right members for your team can be a difficult task. Here are some suggestions to help make the process easier:
It is best to be as pro-active as possible in your treatment. Asking your doctor questions can help you better understand your condition, and communication can help make treatment more effective and efficient.
Here are some good questions to ask:
For more information about bipolar disorder:
For information on support groups and suicide helplines, visit:
If contemplating suicide, please call 1-800-273-TALK
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