Bipolar Disorder

Everyone has good days and bad days, but when changes in mood become dramatic and extreme, it’s not just the ups and downs of everyday life. When you experience mood swings that are so severe that they interfere with your regular daily activities, it is not a normal part of life. This is a serious medical condition called bipolar disorder, which is also known as manic-depressive illness. This condition can be difficult to recognize when it first begins, because many people dismiss the symptoms. For the same reason, it is often misdiagnosed at first. Bipolar disorder cannot be cured and does not go away, but can be effectively managed. This reading material will focus on the medical condition of bipolar disorder, not on the normal mood changes that come with daily life.

Bipolar disorder is characterized by extreme mood shifts, between lows (called depressive episodes, typically experienced as depression) and highs or elation (called mania, or manic episodes). The symptoms are severe and the shifts are very disruptive. The more serious forms of bipolar disorder can be debilitating, but all forms can be managed through medication and psychotherapy.

Symptoms of bipolar disorder vary a lot among individuals, such that the disease is classified into different types based on the occurrence and severity of the two kinds of episodes. Some types are more severe than others, but all are characterized by abnormal mood swings including sudden shifts between depressive and manic episodes.

Manic Episodes: A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, and irritable mood.  This period of abnormal mood must last at least 1 week. They also present with

• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual
• flight of ideas or subjective experience that thoughts are racing
• distractibility
• excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Depressive Episodes:  Depression appears in the following symptoms that may be noticed by others, or yourself.

• Depressed mood most of the day, nearly every day
• Diminished interest or pleasure in activities that were previously enjoyed.
• Significant weight loss or weight gain
• Sleep problems nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or inappropriate guilt
• Recurrent thoughts of death or suicide.

Other symptoms of bipolar disorder include seasonal changes in mood, very rapid mood changes, and psychosis (detachment from reality).

There is not a specific cause of bipolar disorder. Several influences or risk factors interact to trigger Bipolar Disorder. Recent genetic studies have shown that bipolar disorder shares unexpected commonalities with other psychiatric diseases.

Genetic Influence:  Bipolar disorder usually runs in the family. It is common in people who have biological relative with the condition

More than 2 million Americans live with bipolar disorder, which is approximately 4 percent. Bipolar disorder usually starts in young adulthood. Up to half of all cases are diagnosed before the age of 25. While it is more common in women than men; men typically show symptoms earlier.

Bipolar disorder can be significantly disabling, and is different from the normal mood changes that all people experience at various times in life. Left untreated, the condition can make normal life activities nearly impossible and leave individuals at a significant risk of suicide. Diagnosing and treating bipolar disorder can be challenging for at least two reasons:

1. You may be hesitant to seek help, because manic episodes may be euphoric and productive, which makes them somewhat enjoyable.
2. You may be misdiagnosed with major depression if you do not report the manic episodes, which indicate bipolar disorder.
3. Bipolar disorder often appears to be several different problems, and your or your loved ones may not notice or understand the connection between the symptoms.

Various treatments are available for bipolar disorder, but essentially all involve a combination counseling (psychotherapy) and medications.

Psychotherapy Approaches

These different approaches may be used alone or in combination to help you manage your symptoms.

• Cognitive behavioral therapy (CBT) helps you alter unhealthy thoughts, beliefs, and behaviors.
• Family-focused therapy includes family members and focuses on family coping strategies. This treatment also aims to improve communication, problem solving, and conflict resolution.
• Interpersonal and social rhythm therapy helps you to improve relationships and manage your daily routines. Regular daily routines and sleep schedules can lessen manic episodes.
• Psychoeducation helps you and your loved ones understand the illness and its treatment. This can help you to better recognize signs of relapse, so you can seek treatment before a serious episode occurs.

Medication

The medicines used are carefully chosen by your doctor based upon several factors, including the type and severity of your symptoms.

• Lithium has been used for decades to effectively manage many cases of bipolar disorder. Lithium can stabilize mood and is especially effective at managing mania. Scientists are not sure how lithium accomplishes this, but it probably has something to do with altering the activity of certain populations of brain cells. Lithium is known to change the amounts of some important brain chemicals (called neurotransmitters), including dopamine and serotonin, perhaps as a result of its effects on cell activity.
• Anticonvulsants were primarily used to treat seizure disorders. Some anticonvulsants have been found to have positive benefits in treating bipolar disorders and are also known as mood stabilizers. Common medications used to treat bipolar disorders are Valproic Acid or Divalproex Sodium (Depakote), Lamotrigine (Lamictal), Carbamazepine (Tegretol), Gabapentin (Neurontin), Topiramate (Topamax), and Oxcarbazepine (Trileptal).
• Atypical Antipsychotics have gained recent popularity in treating bipolar disorders.  Common medications include – Aripiprazole (Abilify), Asenapine Maleate (Saphris), Lurasidone (Latuda), Olanzapine (Zyprexa), Olanzapine/Fluoxetine ( Symbyax), Quetiapine (Seroquel), Risperidone (Risperdal) and Ziprasidone (Geodon)
• Antidepressants of various types are often used to treat bipolar disorder during depressive episodes.

Other Treatments

Some non-medical treatments can be effective in bipolar disorder.

• Electroconvulsive therapy (ECT) uses electrical stimulation to “reset” the activity of brain regions, and can be quite effective in some cases.
• Transcranial magnetic stimulation (TMS) uses powerful magnetic fields to alter brain activity. A large electromagnetic coil is held against the scalp (near the forehead) to produce an electrical current in the brain.

It is important to understand that bipolar disorder can be seen with other disorders, and treatment plans are different in such cases.

Several known risk factors may trigger Bipolar Disorder. These risk factors include:

Genetic factors: There are genes that predispose a person to bipolar disorder. Children of a parent with bipolar disorder are four to six times more likely to suffer from the disease. This risk is not extremely high, but is much higher than it is for the general population.

Stress: Experiencing high stress puts a person at risk for bipolar disorder. Major life changes, which also result in stress, increase risk.

Drug and alcohol abuse: People who use drugs and alcohol are at risk for developing bipolar disorder.

Age: Because bipolar disorder rarely crops up in older people, risk is higher in those less than 25 years old.

There is currently no blood test or brain scan that can detect bipolar disorder. The diagnosis is made based on the results of a mental health evaluation.

There is no absolute way to prevent bipolar disorder. However, there are steps to take in order to help manage existing risk factors. For those with a genetic history, or other risk factors, take steps to control stress, maintain a good support system, and keep chronic medical illness in control. In addition, treatment at the earliest sign of a problem can help prevent the disease from worsening.