Bipolar Disorder

What is Bipolar Disorder?
Bipolar Disorder used to be called manic-depression. It is a mental illness characterized by periods of extreme moods (depression, hypomania, and mania), usually separated by periods of normal moods. While a first episode can occur at any time, a person usually experiences it during his or her 20s or 30s.

There are several types of bipolar disorder. Classic, or Type I, bipolar disorder involves cycling between mania, depression, hypomania, and normal mood. Type II bipolar disorder involves depressive episodes and hypomania, but no actual manic episodes. Some people experience a mixed disorder in which mania and depression occur during the same episode

What Causes Bipolar Disorder?
Bipolar Disorder involves a disturbance or disruption in normal brain chemistry that produces mood and behavior symptoms. The disease often runs genetically in families. Mania and depressive episodes may be brought out by psychological and social stresses such as work pressures, grief or loss, medical illness, lack of sleep, and, sometimes, change of season.

Signs or Symptoms of Bipolar Disorder
Bipolar Disorder is seen as a cyclical illness because the person shifts from one mood to another often in a sequence or cycle. Each mood has its own symptoms or characteristics.

In the depressed phase (usually lasting at least two weeks), a person experiences many of the classic signs of depression: change in appetite, change in weight, change in sleep patterns, agitation, extreme sadness, fatigue, feelings of guilt or worthlessness, poor concentration, indecisiveness, and frequent thoughts of death or suicide.

A manic episode is almost completely the opposite. A person feels extreme well-being or euphoria for at least one week. He or she may be very positive but irritable, with an extremely high sense of self esteem, a decreased need for sleep, and an increased need to be physically active. He or she may talk rapidly, experience racing thoughts, have trouble staying focused, and exercise poor judgment, often leading to spending sprees, sexual promiscuity, or poor business decisions.

Psychosis (hallucinations and delusions) can occur with either depression or mania.

Hypomania is very similar to mania except it isn't as severe and doesn't involve psychosis.

Treatment Options
A thorough evaluation is the first step - and imperative - in diagnosing and treating bipolar disorder. Some medical conditions (such as thyroid problems) and medication side effects (such as IV cortisone treatments) can mimic the symptoms of mania and depression. Without a thorough evaluation, a person presenting only manic or depressive symptoms may be misdiagnosed.

Since Bipolar Disorder involves chemical imbalances in the brain, it is treated with medication. Treatment usually involves the use of an antidepressant combined with a mood stabilizer. The antidepressant works to bring the person out of a depressive episode. The mood stabilizer works to bring the person out of a manic episode and prevent a slide in either direction. During a manic episode, an anti psychotic medication and a mild tranquilizer may also be prescribed.

A person and his or her family may also seek counseling or psychotherapy, in addition to medication, to understand the disease and learn what life stressors set off episodes. Education helps all family members and the patient cope with the extremes and frustrations they experience. It can also help a family sort through what is normal behavior and what are the early signs of relapse.

The biggest obstacle to effective treatment is compliance with treatment. Patients usually must take mood stabilizers indefinitely. During a manic episode, the person feels invincible and doesn't believe help is necessary. He or she may have more energy and feel more creative and productive - until the depressive phase starts. During "normal phases," the person may not experience any symptoms and be tempted to stop all medications. A person should never stop or cut back his or her medication without speaking with his or her psychiatrist.