Bipolar Disorder
Bipolar disorder, or manic depression is a serious brain disorder that causes extreme shifts in mood, energy and functioning. It affects 2.3 million Americans, or 1.2% of the population. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. It is a chronic condition with recurring episodes that often begin in adolescence or early adulthood. It generally requires ongoing treatment.
While the exact cause of biploar disorder is not known, researchers believe it is the result of a chemical imbalance in certain parts of the brain.
Scientists have found evidence of a genetic predisposition to the illness. Bipolar disorder tends to run in families and close relatives of someone with bipolar disorder are more likely to be affected by this disorder. Sometimes serious life events such as a serious loss, chronic illness, or finanacial problems, can trigger an episode in some individuals with a predisposition to the disorder. There are other possible "triggers" of bipolar episodes: the treatment of depression with an antidepressant medication may trigger a switch into mania. Sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability.
Symptoms/Causes
Mania describes the activated phase of bipolar disorder. Symptoms of mania include: happy mood or irritable, angry, unpleasant mood; increased activity or energy; more thoughts and faster thinking than normal; increased talking, more rapid speech than normal; ambitious, often grandiose plans, increased sexual interest and activity; decreased need for sleep.
Depression is the other phase of the disorder. Symptoms of depression include: depressed or apathetic mood; decreased activity and energy; restlessness and irritability; fewer thoughts than usual and slowed thinking; less talking and speech; less interest or participation in activities usually enjoyed; decreased sexual interest and activity; hopeless and helpless feelings; feelings of guilt and worthlessness; pessimistic outlook; thoughts of suicide; change in appetite; change in sleep patterns.
A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state, depressed mood accompanies manic activation. The symptoms during a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis and suicidal thinking. Sometimes individuals may experience regurlaly alternating periods of mania and depression. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common among women.
Prognosis
While there is no cure for bipolar disorder, it is a highly treatable and manageable illness.
After accurate diagnosis, most people (80-90%) can be successfully treated. Medication is an essential part of successful treatment. Maintenance treatment reduces the number and severity of episodes for most people, although episodes of mania or depression may occur and require additional treatment. In addition, psychological therapies are important to help people understand the illness and cope with the stresses that can trigger episodes.
Treatment
Two medications commonly used to treat manic episodes of bipolar disorder are called mood stabilizers, and they include lithium (Eskalith or Lithobid) and divalproex sodium (Depakote).
Lithium has long been used as a first line treatment for acute mania in people with bipolar disorder. Lithium is effective for preventing episodes of mania from occuring and for treating an episode after it has begun. However, for some individuals lithium is ineffective, and for others lithium has a variety of side effects that may make it an undesirable option.
Depakote is an anticonvulsant that seems to be effective as lithium for treating mania and it has fewer side effects, although it may not be appropriate for people with a history of liver problems.
Other anticonvulsant medications have also been found to be efective treatments for mania, including carbamazepine (Tegretol) and lamotrigine (Lamictal).
Mania may also be treated acutely with antipsychotic medications.
During depressive episodes, people with bipolar disorder may need additional treatment with an antidepressant medication. Because of the risk of triggering mania, doctors often prescribe lithium or an anticonvulsant mood stablilzer with an antidepressant. Antidepressant medications relieve depression, elevate mood, and activate behavior, but it often takes three to four weeks to get a response. Sometimes a variety of different antidepressants and doses will be tried before finding the medication that works best for a particular individual.
There are several different types of antidpressants used to treat depression, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), or newer antidepressants that function in different ways.
The risk of suicide may temporarily increase during the early stages of treatment while energy levels and the ability to take action return before mood improves.