Bipolar Disorder
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Bipolar Disorder

(Manic-Depressive Illness; Manic Depression; Manic Disorder; Manic Affective Disorder)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Bipolar disorder results in extreme swings in mood, energy, and ability to function. The mood changes of bipolar disorder are more dramatic than normal ups and downs. They can hurt relationships and cause poor job or school performance. Bipolar disorder can be treated. Contact your doctor if you think you may have this condition.

The two extremes of the illness are mania and depression . In mania, energy peaks. The mood may be overly happy or irritable. In depression, lethargy takes over. The mood may be very blue.

There are three forms of this condition:

  • Bipolar I disorder involves recurrent episodes of mania and depression
  • Bipolar II disorder involves milder episodes of mania (called hypomania) that alternate with episodes of depression
  • Cyclothymic disorder may be diagnosed in patients who experience frequent depressive symptoms and hypomania for at least two years and who have been without symptoms for no more than two months

Causes

The cause of bipolar disorder is not known. This condition tends to run in families. Specific genes may play a role. It is most likely many different genes that act together.

The Brain

Color coded brain

Bipolar disorder may be a result of genetic influences on the brain.

© 2008 Nucleus Medical Art, Inc.

Risk Factors

Having family members with the disorder increases your chance of developing it. Tell your doctor if you have a family member with bipolar disorder.

Symptoms

Symptoms include:

  • Dramatic mood swings, ranging from elated excitability to hopeless despondency
  • Periods of normal mood in between ups and downs
  • Extreme changes in energy and behavior

Signs and symptoms of mania include:

  • Persistent and inexplicable elevation in mood
  • Increased energy and effort toward goal-directed activities
  • Restlessness and agitation
  • Racing thoughts, jumping from one idea to another
  • Rapid speech or pressure to keep talking
  • Trouble concentrating
  • Decreased need for sleep
  • Overconfidence or inflated self-esteem
  • Poor judgment, often involving spending sprees and sexual indiscretions

Signs and symptoms of depression include:

  • Prolonged sad, hopeless, or empty mood
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy or fatigue
  • Trouble concentrating, remembering, and/or making decisions
  • Restlessness or diminished movements
  • Agitation
  • Sleeping too much or too little
  • Unintended weight loss or gain
  • Thoughts of death or suicide with or without suicide attempts

Severe episodes of mania or depression may sometimes be associated with psychotic symptoms such as:

  • Hallucinations
  • Delusions
  • Disorders of thought

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam may be done. In some cases, lab tests are ordered to rule out other causes of mood and behavior symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on:

  • Presence of symptoms over time
  • Absence of other causes, such as some medications, thyroid disease, or Parkinson's disease
  • Family history of bipolar disorder

Mania is diagnosed if the mood is elevated and there are three or more of the mania symptoms listed above. The symptoms must last during most of the day, nearly every day, for one week or longer. If the mood is irritable, not elevated, four symptoms must be present for a diagnosis of mania.

A depressive episode diagnosis requires that five or more of the depressive symptoms listed above. The symptoms must last for most of the day, nearly every day, for a period of two weeks or longer.

Some medicines and other medical issues may show similar features. Corticosteroids, thyroid disease, and multiple sclerosis are some examples. The diagnosis is made only when none of these causes are present.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

The following may be used. Many patients are treated with a combination of two or more of these medications:

  • Lithium —a mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
  • Valproate ( Depakote ), carbamazepine (Tegretol), lamotrigine (Lamictal), topiramate (Topamax)—antiseizure medications, also used as mood stabilizers instead or in combination with lithium
  • Benzodiazepines ( clonazepam [Klonopin] or lorazepam [Ativan]) can be used to treat agitation or insomnia
  • Zolpidem (Ambien)—used to treat insomnia
  • Antidepressants (serotonin reuptake inhibitors or bupropion [Wellbutrin])—used to treat depression
  • Antipsychotic medications—used for acute manic or mixed episodes and maintenance treatment
    • Classic antipsychotic medications (eg, haloperidol [Haldol]) are not often used because of risks of tardive dyskinesia (uncontrollable movements)
    • Atypical antipsychotic medications (eg, risperidone , olanzapine , aripiprazole , ziprasidone , and quetiapine ) are more effective with less risk of tardive dyskinesia

The plan is based on the pattern of the illness. Treatment may need to be continued indefinitely to prevent significant mood swings.

Psychotherapy

Psychotherapy may include:

  • Cognitive-behavioral therapy
  • Counseling
  • Family therapy
  • Interpersonal and social rhythm therapy, a form of therapy designed to treat bipolar disorder

Electroconvulsive Therapy

Electroconvulsive therapy may be effective when medications fail. It can be used for both mania and depression.

Prevention

There are no guidelines for preventing bipolar disorder.

RESOURCES:

Child and Adolescent Bipolar Foundation
http://www.bpkids.org/

Depression and Bipolar Support Alliance
http://www.dbsalliance.org/

National Institute of Mental Health
http://www.nimh.nih.gov/

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org/

Mood Disorder Association of Canada
http://www.mooddisorderscanada.ca/

References:

Belmaker R. Medical progress: bipolar disorder. N Eng J Med . 2004;351:476-486.

Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/bipolar.cfm . Accessed November 10, 2005.

Hirschfeld RMA. Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder . 2nd ed. Arlington, VA: American Psychiatric Association; 2005. Available at: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm . Accessed January 20, 2007.

Hirschfeld RMA, Bowden CL, Gitlin MJ, et al. Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision). American Psychiatric Association; 2002. Available at: http://www.psych.org/psych_pract/treatg/pg/Practice%20Guidelines8904/BipolarDisorder_2e.pdf . Accessed on January 20, 2007.



Last reviewed January 2008 by Janet H. Greenhut, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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