What Is Bipolar Disorder?
Bipolar disorder is a condition characterized by episodes of low mood (depression) or elated mood (mania), separated by periods of normal mood and functioning. Mania is marked by inflated self-esteem; an elated, euphoric, or grandiose mood; increased activity; and a decreased need for sleep. Episodes of mania or depression can last from a few weeks to several months and are frequently severe enough to affect day-to-day functioning at work and at home. Men tend to have more bouts of mania; women have more episodes of depression. Bipolar disorder has also been called manic-depressive illness.
Who Gets Bipolar Disorder?
According to the National Institute of Mental Health, bipolar disorder affects more than 5.7 million adults in the United States each year. Approximately 3% of people in the United States are affected. The age of onset is usually the late teens or early 20s and there is a history of depression in most cases. While bipolar disorder usually strikes initially in adolescence or early adulthood, experts estimate that about 10% of people with the condition have their first episode after age 50.
Men and women are affected in equal numbers. Women seem to have an increased risk of hypomania (mild manias) and mixtures of depression and manic symptoms (mixed episodes.)
Each type of bipolar disorder has a set of symptoms, as outlined below. Symptoms are episodic, and their length, frequency, and pattern vary from person to person. For example, some people are more prone to either mania or depression, while others alternate equally between the two.
Untreated symptoms of mania can last up to 3 months. Symptoms include the following:
- Feelings of irritability, grandeur, and inflated self-esteem.
- Decreased need for sleep
- Denial that anything is wrong
- Easily distracted
- Feeling extremely "high" or euphoric
- Racing thoughts and rapid or pressured speech
- Uncharacteristically poor judgment
- Unusually active sex drive
Delusions occur in 75% of manic episodes. In a delusional state, a person loses their perception of reality. For example, a person may believe they possess amazing strength and ability, are extremely wealthy, or are publicly desired. Auditory and visual hallucinations are common and can be dangerous.
Patients are at risk for injuring themselves or others during a manic state. In severe episodes, hospitalization may be necessary.
After a manic episode, people with bipolar disorder may experience a symptom-free phase that can last for months. Eventually, a depressive episode ensues. Symptoms of depression include the following:
- Persistent feelings of sadness, apathy, or hopelessness lasting more than two weeks.
- Anxiety; diminished ability to think or concentrate
- Lack of appetite and weight loss, or increased appetite and weight gain
- Lack of interest or pleasure in usual activities, including sex
- Loss of energy
- Sleep disturbance (too little, too much, or waking up and not being able to go back to sleep)
- Thoughts and attempts of suicide
- Older people may initially focus on physical or cognitive complaints brought on by their depression. Insomnia and agitation are also more common in older patients. Mixed Episode Symptoms
During a mixed episode, both manic and depressive symptoms are experienced daily for at least 1 week. The person usually feels very anxious and disorganized and commonly will develop insomnia, psychosis, and loss of appetite.
A mixed episode can last from a week to several months and is usually followed by a depressive episode. They occur more often in people (especially men) under 25 and over 60 years of age. Mixed episodes are seen most frequently in teenagers who have experienced major depression.
Rapid Cycling Symptoms
In rapid cycling there are more manic and depressive episodes of shorter duration, and they become more severe as the patient ages. Typically, four or more rapid-cycling episodes occur within 1 year.
- Genetics play a primary role in the development of bipolar disorder. If you have a family history of bipolar disorder, there is a greater chance that you will be vulnerable to it.
- Recurrent manic episodes may be caused by sleep deprivation or antidepressant drug therapy.
- The more episodes a patient has had, the more likely he or she is to have another.
- Physical examination and patient history by a mental health professional are necessary.
- Diagnosis can be difficult because the first episode of mania may go undetected, and an episode of depression does not necessarily predict a subsequent manic episode. Generally, however, there is a history of depression before the first manic episode.
- Because symptoms of a single manic episode occasionally mimic those of schizophrenia, patients may need several exams before getting an accurate diagnosis.
- Laboratory tests should be done to rule out an underlying medical illness (such as hyperthyroidism), an adverse drug reaction, another medical or psychiatric condition, or the effects of alcohol or illicit drugs.
The goal of treatment of bipolar disorder is to prevent both manic and depressive episodes, controlling the extreme highs and lows to create a stable mood. The core treatment is mood-stabilizing medications.
- Lithium and divalproex sodium are the treatments of choice for mania. Carbamazepine is also effective. Beneficial effects appear in two to six weeks.
- Because of the slow therapeutic response to these medications, antipsychotic (neuroleptic) medications may be administered for treatment of severe mania. These include aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel).
- Valproic acid and neuroleptics are also good options for people who have mixed states —simultaneous symptoms of mania and depression.
- Severe manic episodes may need to be treated in a hospital.
- Depressive episodes are typically treated with anti-depressant drugs, psychotherapy, or both. SSRIs (selective serotonin reuptake inhibitors), such as citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac), and other relatively new antidepressants, such as Wellbutrin or Effexor, are the most likely drugs to be used. In addition, Symbyax —a combination of an atypical neuroleptic (olanzapine) and an SSRI (fluoxetine) —has been approved by the FDA to treat depressive episodes in people with bipolar disorder.
- As with any chronic illness, managing bipolar disorder requires lifelong attention. Without treatment, episodes become more frequent and severe. When successfully controlled, however, people with bipolar disorder can lead full and productive lives.
- There is no way to prevent bipolar disorder, but the use of lithium may prevent recurrences.
When To Call Your Doctor
- Call a doctor if you or someone you know shows significant signs of bipolar disorder.
Reviewed by Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.