Friday, April 15, 2011

Understanding what bipolar disorder is and how to diagnose if you have it.

Bipolar disorder involves periods of elevated or irritable mood (mania), alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.
Causes, incidence, and risk factors


Types of bipolar disorder:

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

People with bipolar disorder type II have never experienced 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 depression.

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

In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people who are vulnerable to the illness:

Life changes such as childbirth

Medications such as antidepressants or steroids

Periods of sleeplessness

Recreational drug use



Agitation or irritation


Little need for sleep

Noticeably elevated mood


Increased energy

Lack of self-control

Racing thoughts

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



Daily low mood

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 make the symptoms worse.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.
Signs and tests




Observe your behavior and mood


Request laboratory tests to check for thyroid problems or drug levels

Speak with your family members to discuss their observations about your behavior



Spells of depression or mania return in most patients, in spite of treatment. The major goals of treatment are to:

Avoid cycling from one phase to another

Avoid the need for a hospital stay

Help the patient function as best as possible between episodes

Prevent self-destructive behavior, including suicide

Reduce the severity and frequency of episodes

The doctor will first try to determine what may have triggered the mood episode, and identify any medical or emotional problems that might interfere with or complicate treatment.

Drugs called mood stabilizers are considered to be the first-line treatment. The following are commonly used mood stabilizers:




Valproate (valproic acid)

Other antiseizure drugs may also be tried.

Other drugs used to treat bipolar disorder include:

Antipsychotic drugs and anti-anxiety drugs (benzodiazepines), which can be used to stabilize mood

Antidepressant medications can be added to mood-stabilizing drugs to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, an antidepressant is only used in people who are also taking a mood stabilizer.

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder that does not respond to medication.



Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses that target affected areas of the brain. It is most often used as a second-line treatment after ECT.

Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stabilized and their behaviors are under control.

Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the potential risks and benefits of treatment for their children.


Family treatments that combine support and education about bipolar disorder (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Important skills include:

Coping with symptoms that are present even while taking medications


Learning to take medications correctly and how to manage side effects

Learning to watch for early signs of a relapse, and knowing how to react when they occur

Family members and caregivers are very important in the treatment of bipolar disorder. They can help patients seek out proper support services, and help make sure the patient follows medication therapy.

Getting enough sleep is extremely important in bipolar disorder, because a lack of sleep can trigger a manic episode. 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.

A patient with bipolar disorder cannot always reliably tell the doctor about the state of the illness. Patients often have difficulty recognizing their own manic symptoms.

Mood variations in bipolar disorder are not predictable, so it is sometimes difficult to tell whether a patient is responding to treatment or naturally emerging from a bipolar phase.

Treatment strategies for children and the elderly have not been well-studied, and have not been clearly defined.

Expectations (prognosis)






Personal relationships, work, and finances suffer

Suicidal thoughts and behaviors

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



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

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