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Bipolar Disorder

What Is Bipolar Disorder?

Bipolar disorder, also known as manic depression, is a chronically recurring condition involving moods that swing between the highs of mania and the lows of depression. But that's not quite the whole picture; depression is by far the most pervasive feature of the illness, while the manic phase usually involves a mix of irritability, anger, and depression, with or without euphoria. The elation may manifest as unusual energy and overconfidence, playing out in bouts of overspending or promiscuity, among many other behaviors.

The disorder most often starts in young adulthood, but can also occur in children and adolescents. Misdiagnosis is common; the condition is typically confused with everything from attention-deficit/hyperactivity disorder to schizophrenia to borderline personality disorder. Biological factors probably create vulnerability to the disorder, and experiences such as sleep deprivation can kick off manic episodes.

There are different types of the disorder: Bipolar 1 and Bipolar 2. A major depressive episode may or may not accompany bipolar 1, but a major depressive episode does accompany bipolar 2. People with bipolar 1 have had at least one manic episode, which may be very severe and requiring hospital care. People with bipolar 2 normally have a major depressive episode that lasts at least two weeks along with hypomania, but this is less severe or intense and does not normally require hospital care. 

How to Recognize Bipolar Disorder

The defining feature of bipolar disorder is mania. It can be the triggering episode of the disorder, followed by a depressive episode, or it can first manifest after years of depressive episodes. The switch between mania and depression can be abrupt, and moods can oscillate rapidly.

Mania that is mild to moderate, called hypomania, can be deceptive: It is often experienced as a surge in energy that can feel good and enhance productivity and creativity. As a result, a person may deny that anything is wrong.

There is great variability in manic symptoms, but features may include: Increased energy, activity, and restlessness; euphoric mood and extreme optimism; extreme irritability; racing thoughts, pressured speech, thoughts that jump from one idea to another; distractibility and lack of concentration; decreased need for sleep; unrealistic beliefs in one's abilities and powers and ideas; poor judgment; reckless behaviors including spending sprees and fast driving, risky and increased sexual drive; provocative, intrusive, or aggressive behavior; and a denial that anything is wrong

The duration of elevated moods and the frequency with which they alternate with depressive moods can vary enormously from person to person as well. Frequent fluctuation, known as rapid cycling, is not uncommon and is defined as at least four episodes per year.

While an episode of mania is what distinguishes bipolar disorder from unipolar depression, the depression of bipolar disorder can be the predominating feature. A person may spend far more time in the depressed state than in a manic or hypomanic one.

Just as there is considerable variability in manic symptoms, there is great variability in degree and duration of depressive symptoms. Features generally include: lasting sad, anxious, or empty mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in activities once enjoyed, including sex; decreased energy, feelings of fatigue or of being "slowed down"; difficulty concentrating, remembering, or making decisions; restlessness or irritability; oversleeping or inability to sleep or stay asleep; change in appetite and/or unintended weight loss or gain; chronic pain or other persistent physical symptoms not accounted for by illness or injury; and thoughts of death or suicide, or suicide attempts

Not infrequently, the symptoms of mania and depression can occur together in "mixed" episodes. Symptoms of a mixed state can include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person can feel sad in mood yet highly energized.



What Causes Bipolar Disorder?

Both genetic and environmental factors can create vulnerability to the disorder. As a result, the causes vary from person to person.

While the disorder can run in families, no one has definitively identified specific genes that create risk for developing the condition. There is some evidence that advanced paternal age at conception can increase the possibility of new genetic mutations that underlie vulnerability.

Imaging studies have suggested there may be differences in the structure and function of certain brain areas, but no differences have been consistently found.

Life events including various types of childhood trauma are thought to play a role, as in other mental disorders. Scientists do know that once bipolar disorder occurs, life events can precipitate recurrences. Incidents of interpersonal difficulty and abuse are most commonly associated with triggering the disorder.



Can You Find Treatment?

Because bipolar disorder is a recurrent illness, long-term treatment is necessary. Mood stabilizer drugs are typically prescribed to prevent mood swings.

Lithium is perhaps the best-known of the mood stabilizers, but newer drugs such as lamotrigene have been shown to cause fewer side effects while frequently obviating the need for antidepressant medication. Used alone, antidepressants can precipitate mania and may accelerate mood cycling.

Getting the full range of symptoms under control may require other drugs as well, either short-term or long-term.

Nutritional approaches have also been found to have therapeutic value. Studies show that omega-3 fatty acids may help lower the number or dosage of medications needed. Omega-3 fatty acids play a role in the functioning of all brain cells and are incorporated into the structure of brain cell membranes.

Work and relationship problems can be both cause and effect of bipolar episodes, making psychotherapeutic treatment also important. Studies show such treatment reduces the number of mood episodes patients experience. Psychotherapy is also valuable in teaching self-management skills, which help keep the everyday ups and downs from becoming full-blown episodes.

Children and Teens Who Suffer

Most people with bipolar disorder develop the condition in their late teens or early adulthood, although symptoms can appear in children as young as six years old. Symptoms in children and teens are similar to those in adults and include the hallmark mood swings of bipolar disorder.

In some cases, however, children may display symptoms of irritability.

Children with bipolar disorder undergo extreme changes in mood and behavior, feeling unusually happy and energetic during manic episodes and becoming very sad and less active during depressive episodes. Symptoms are often severe enough to interfere with school activities and personal relationships, and can lead to self-destructive behavior. 

Treatment for bipolar disorder in children and teens may include medication and family-based therapy. 


Child Development

Living Well with Bipolar

Bipolar disorder can wreak havoc on a person's goals and relationships. But in conjunction with proper medical care, sufferers of bipolar disorder can learn coping skills and strategies in order to keep their lives on track. Bipolar disorder, like many mental illnesses, is sometimes a controversial diagnosis. While most sufferers consider the disorder to be a hardship, some appreciate its role in their lives, and others even link it to greater creative output.

While the depression of bipolar disorder is hard to treat, mood swings and recurrences can often be delayed or prevented with a mood stabilizer, on its own or combined with other drugs. Psychotherapy is an important adjunct to pharmacotherapy, especially for dealing with work and relationship problems that can accompany the disorder. Clinicians are well aware that there is no one-size-fits-all cure. In fact, an individual with a first-time manic episode will not be the same as an individual living with bipolar for a decade.


Depression, Health

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