Bipolar disorder

Bipolar disorder, once known as manic-depressive disorder or manic depression, is a form of depression in which periods of deep depression alternate with periods of hyperactivity and uncontrolled elation (mania).

People with bipolar disorder differ from those with other depressive disorders in that their moods swing from depression to mania, often with periods of relatively normal mood between the two extremes.

The disorder usually begins with a depressive episode in adolescence or early adulthood. The first manic phase may not follow until several years later. The length of the cycle, from the heights of mania to deep depression, varies from person to person. The risk of suicide is high among people with bipolar disorder; an estimated 1 of 4 people attempt suicide, and 1 of 10 succeed.

Heredity is an important factor in bipolar disorder. Close relatives of people suffering from bipolar disorder are much more likely to develop it, or some other form of depression, than the general population. Environmental factors, such as troubled family relationships, may aggravate this disorder.

Symptoms

Bipolar disorder is a recurring disease that goes in cycles. One part of the cycle is marked by symptoms of mania, the other by symptoms of depression. These "mood episodes" are often intense. During the manic phase, an individual can be cheerful, outgoing, talkative, and energetic. Until the mania gets out of control, he or she can be extremely productive and wonderful company.

During a manic episode an individual may:

  • feel very energetic
  • talk a lot about different things
  • have trouble sleeping or relaxing
  • jump from thought to thought or project to project
  • develop exaggerated self-confidence or thoughts of power and wealth
  • do risky things like abuse alcohol or other drugs, recklessly spend or invest money, engage in reckless sex

During a depressive episode an individual may:

  • feel down or worried
  • lose interest in activities or relationships
  • have trouble concentrating
  • have trouble sleeping
  • think about death or suicide

The symptoms of bipolar disorder are not always easy to distinguish from other serious conditions. Mania can be difficult to tell from schizophrenia. People who take amphetamines or corticosteroid drugs or people with overactive thyroid glands have symptoms similar to those of people with the manic phase of bipolar disorder. Some people have bipolar disorder for months, if not years, before it is diagnosed.

Untreated, the manic phase can last as long as 3 months. As the mania fades, the individual may have a period of normal mood and behavior that lasts for weeks, or even years. Eventually, the depressive phase of the illness sets in.

About 10% to 20% of people with bipolar disorder develop what is known as rapid cycling, with more than four episodes of mania and depression a year. The chance that there will be future attacks rises with each new episode.

Treatment options

If you or someone you are close to is experiencing the symptoms of bipolar disorder, medical attention is urgently needed. A person in a period of mania often does not know that he or she is behaving strangely and in need of medical attention. A complete evaluation by a psychiatrist is critical to arriving at an accurate diagnosis, which is the first step toward an appropriate treatment plan. Sometimes, manic people are so out of control that they pose a threat to themselves and others and need to be hospitalized.

Bipolar disorder is highly treatable. The most commonly used medications are mood stabilizers such as lithium, antiseizure drugs, and atypical antipsychotics. Antidepressants and sleep medications may also be used. These medications are usually most effective when they are combined with psychosocial treatment.

Even with treatment, though, relapse is common. In one study, people who were treated with lithium and continued to take it averaged 1½ weeks a year when they were severely ill, whereas people who stopped taking the medicine averaged 13 weeks a year of severe illness.

Lithium

Lithium is the most frequently used mood stabilizer. It prevents the mania and, to a lesser extent, the depression, although how it does this isn't known.

Seventy percent of people with bipolar disorder who take lithium experience fewer and less-intense manic episodes. In about 20% of people with bipolar disorder, lithium completely relieves symptoms.

However, lithium is not a cure. The mood cycle often emerges if treatment is stopped, even after many years of treatment. Lithium use must also be monitored carefully. Its side effects include weight gain, hand tremors, drowsiness, excessive thirst, and frequent urination.

Because lithium can injure the heart, kidneys, or thyroid gland, it's important to have a physical examination and blood tests before taking it. The dose is usually increased gradually until the drug begins to work, and is then periodically adjusted. Blood levels of lithium are checked regularly; it is ineffective if the level is too low and risky if the level is too high.

Antiseizure medications

Antiseizure drugs may be used instead of lithium, especially when the mood cycle is very rapid. These medications can have mood-stabilizing effects and may be especially useful for treating someone in the midst of a bipolar episode and also for preventing further episodes of it. Antiseizure medications commonly used for treating bipolar disorder include:

  • valproate (Depakote, Depakene)
  • carbamazepine (Tegretol)
  • oxcarbazepine (Trileptal)
  • lamotrigine (Lamictal)

Like lithium, antiseizure drugs can have unwanted side effects.

Atypical antipsychotics

Second-generation antipsychotics, also called atypical antipsychotics, can also be used to treat manic episodes of bipolar disorder. Examples of these medications include:

  • risperidone (Risperdal)
  • aripiprazole (Abilify)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • ziprasidone (Geodon, Zeldox)
  • olanzapine plus fluoxetine (Symbyax)
  • asenapine (Saphris)

Antidepressants and sleep aids

An antidepressant may help individuals cope with the depressive phase of bipolar disorder. Sleep aids may be needed during the manic phase.

Electroconvulsive therapy

Electroconvulsive therapy, also known shock therapy, can be an effective treatment for severe manic or depressive episodes, especially among individuals having serious suicidal or psychotic symptoms, or when medical therapy is not working.