Q: What is bipolar disorder, and why is it sometimes called manic depression?
A: Bipolar disorder is a mental illness that causes changes in mood and energy, with episodes of both mania and depression. During the manic episodes, patients swing into an unrealistically high state of mind and can sometimes lose touch with reality. On the extreme end, they may believe they have super powers, or to a lesser extent, shop impulsively for expensive items they don’t need and usually can’t afford.
These episodes alternate with periods of normal mood, as well as periods of depression. During depressive episodes, there is typically a lack of energy and motivation, irritability, sadness, and a feeling of hopelessness. In between manias and depressions, there can be periods where the patient seems normal, balanced, and in control. A small percentage of bipolar patients do, however, experience chronic residual symptoms.
The early designation for this condition was “manic depression.” Now, it is called bipolar disorder to indicate polar opposites, or shifts in mood and perception.
Q: What are the symptoms of bipolar disorder?
A: Bipolar disorder is defined by distinct episodes of mania and depression that represent a change from someone’s usual baseline mood state.
The defining symptom of bipolar disorder is alternating cycles of mania and depression.
In the manic phase, behaviors include:
- Dramatic increase in energy with a decreased need for sleep
- Racing thoughts that are sometimes expressed during rapid-fire conversation
- Feelings of being “high” or euphoric — as if they could do almost anything
- Easy distractibility and sometimes irritability
- Poor judgment — for example, purchasing things one can’t afford or use
- An increased need for sex and reckless sexual behaviors
- Alcohol or drug abuse, particularly cocaine and sleeping pills
- Aggressive behavior, sometimes provocative
- Denial that anything is wrong or different
In the depressive phase, behaviors include:
- Persistent sadness, anxiety, or a feeling of despair
- Pessimism or hopelessness that is not justified by circumstances
- Feelings of guilt, worthlessness, or helplessness
- Extreme fatigue, loss of interest in pleasurable activities
- Decreased interest in sexSleep disturbances
- Food issues, loss of appetite and weight or increased appetite and weight gain
- Suicidal thoughts or attempts
Q: How is bipolar disorder diagnosed?
A: Bipolar disorder typically develops during the adolescent or young adult years. One form of bipolar disorder is a condition known as “hypomania.” During this phase there is a period of abnormally increased energy and productivity that — unlike mania — doesn’t involve psychosis and doesn’t interfere with someone’s ability to function. Left untreated, however, hypomania can occasionally progress to severe mania and, more often, to episodes of depression.
A true manic episode is diagnosed if an elevated mood occurs with three or more of the symptoms related to sleep, energy, thinking, and behavior most of the day, nearly every day, for at least one week, and the symptoms interfere with someone’s ability to function. If irritability is present, then four or more symptoms are required for diagnosis.
A depressive episode is said to exist if five or more depressive symptoms exist for most of the day, every day, for two weeks or more.
A psychiatrist is usually the type of doctor who makes the determination of bipolar disorder. Frequently blood and urine tests are done to rule out drug use as the cause of symptoms, or certain illnesses such as thyroid disorder.
Q: What is meant by “bipolar I” and “bipolar II”?
A: Bipolar I disorder defines patients with full manic (rather than hypomanic) episodes: Recurring episodes of mania and depression, in which the high periods impair functioning and may also include psychosis.
Bipolar II disorder defines those who never experience severe mania; instead the high periods (called hypomania) are milder, do not impair functioning, and more often involve extensive time spent with depression.
A subtype of both forms of bipolar disorder is rapid cycling, which defines patients with bipolar I or II disorder who experience four or more bipolar episodes within 12 months. Some researchers believe that “mini” episodes can occur as frequently as within one week or even within one day, although the meaning and classification of such frequent mood shifts is controversial and not well-understood. A pattern of rapid cycling can come and go at any point in the course of bipolar I or II disorder, and appears to be more common among women.
Q: Who is at greatest risk for bipolar disorder?
A: Typically, the onset of bipolar disorder occurs in the late teens or early 20s. However, the first symptoms — often unrecognized — may occur in early childhood, or, less commonly, as late as the senior years. According to the National Alliance on Mental Illness (NAMI), more than 10 million Americans are affected, with men and women affected equally. Some studies suggest a genetic susceptibility.
Q: What causes bipolar disorder?
A: There is no single explanation doctors can point to as the cause of bipolar disorder. One current theory suggests an underlying defect in brain circuitry involving areas that control mood, thinking, and behavior. Stress may also play a role and, in women, hormonal fluctuations may worsen symptoms. In January 2006, two Scottish researchers isolated a gene that doubles the risk of developing bipolar disorder, advancing the theory that there is a genetic part of this disease. However, it is thought that no single gene confers risk for bipolar disorder, and no specific series of genes has been identified that increases the risk for developing bipolar disorder.
Q: How is bipolar disorder treated?
A: Medications called mood stabilizers are used to treat bipolar disorder. Several types are available.
For mania, common treatments include mood stabilizers such as lithium, Depakote, and Tegretol, as well as antipsychotic medications and/or the tranquilizers like benzodiazepines. While hospitalization was once considered necessary during this phase, more patients are being treated with outpatient care.
Treatment for depressive episodes can include lithium and/or certain anticonvulsive drugs, as well as the atypical antipsychotics Latuda (lurasidone), Seroquel (quetiapine), and Symbyax (olanzapine-fluoxetine combination). Sometimes, the combination of lithium or an anticonvulsant drug plus an antidepressant can be helpful, although antidepressants in general have not been proven to be effective for the treatment of bipolar depression.
In addition to medication, psychosocial treatment like cognitive therapy can be helpful for support education and guidance.
When medications and psychotherapy are not effective, electroconvulsive therapy (ECT) or “shock treatments” is said to help 75% of patients who try it.
Q: Are women affected by bipolar disorder any differently from men?
A: Although the rate is equal among the genders, women are more likely than men to develop bipolar II disorder. While manic episodes are milder than in men, they still alternate with depression. Women are also at higher risk for rapid cycling of symptoms, which some believe may be linked to fluctuations in reproductive hormones, or the activity of the thyroid gland. Women are more frequently misdiagnosed as having depression only, and then prescribed antidepressant medication. This may induce manias or increase the frequency of multiple relapses.
The hormonal changes of perimenopause and menopause can sometimes worsen symptoms of bipolar disorder, although hormone therapy is not a proven treatment for mood symptoms of bipolar disorder. Additionally, changes in medication regimens may become necessary during this time to offset the effects of changing hormones.
Q: Are people with bipolar disorder considered dangerous to others?
A: During the manic phase of bipolar disorder, behavior can become reckless. This may increase the risk of danger for both the patient and those who may be in their care, such as children. Additionally, in rare cases, patients experiencing mania may become psychotic, hearing voices or seeing things, which may incite dangerous or high-risk behavior. During an episode patients should be discouraged from driving, operating any machinery, or making important life decisions. If a friend or family member suffers from bipolar disorder, contact their doctor as soon as an episode becomes apparent. Sometimes early treatment can help reduce the incidence of dangerous behaviors.
Q: How real is the threat of suicide in bipolar disorder, and what can be done to reduce the risk?
A: The threat of suicide among patients with bipolar disorder is very real — and it can occur during either the depressive or the manic state. Stress as well as personal traumatic events can also increase the risk. Up to 15% of people with bipolar disorder complete the act of suicide, and many more try. Although treatment reduces risks, friends and family members should be on the lookout for signs of impending suicide. These include talking about suicide or death; writing a suicide note; talking about feelings of hopelessness; abusing drugs or alcohol; and participating in life-threatening activities. During a crisis do not leave a person with bipolar disorder alone and remove car keys, weapons, or large amounts of medication. Call 9-1-1 for assistance.