Bipolar disorder

• Alternative Names

  Manic depression; Bipolar affective disorder

• Causes, incidence, and risk factors

  Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

  Bipolar disorder results from disturbances in the areas of the brain that regulate mood.

  There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.

  People with bipolar disorder II seldom experience full-fledged mania. 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.

  A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.

• Symptoms

  The manic phase may last from days to months and can include the following symptoms:

  • Agitation or irritation
  • Elevated mood
    • Hyperactivity
    • Increased energy
    • Lack of self-control
    • Racing thoughts
  • Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
  • Little need for sleep
  • Over-involvement in activities
  • Poor temper control
  • Reckless behavior
    • Binge eating, drinking, and/or drug use
    • Impaired judgment
    • Sexual promiscuity
    • Spending sprees
  • Tendency to be easily distracted

  These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

  The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

  • Difficulty concentrating, remembering, or making decisions
  • Eating disturbances
    • Loss of appetite and weight loss
    • Overeating and weight gain
  • Fatigue or listlessness
  • Feelings of worthlessness, hopelessness and/or guilt
  • Loss of self-esteem
  • Persistent sadness
  • Persistent thoughts of death
  • Sleep disturbances
    • Excessive sleepiness
    • 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. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

  Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.

• Signs and tests

  A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

  • Ask about your family medical history, 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, including any medical problems you have and any medications you take

  Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

• Treatment

  For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.

  There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.

  Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.

  Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. 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. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.

  Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

• Expectations (prognosis)

  Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, 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.

  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. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

  Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.

• Complications

  Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

  • 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. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

• Calling your health care provider

  Call your health provider or an emergency number right way if:

  • 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
• References

  Moore DP, Jefferson JW. Bipolar disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 80.

  Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.

  Benazzi F. Bipolar disorder -- focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935-945.

  Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev. 2007;24;(1):CD004854.

  Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722.

Review Date: 1/15/2009

Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.