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By Steve Bressert, Ph.D.




| ’ I troductio to the Bipolar Series


| îho Gets Bipolar Disorder?
| áauses of Bipolar Disorder
| Symptoms of Bipolar Disorder
| c  
   
| `reatme t of Bipolar Disorder
| Jreque tly ’sked Questio s
| Jurther I formatio

`here are a umber of commo types of phases that most people with bipolar disorder
experie ce to o e degree or a other. `he most commo ly experie ced type of bipolar disorder is
o e where the i dividual cycles back a d forth betwee a state of ma ia (or hypoma ia, a lesser
form of ma ia) a d depressio .



Duri g this phase, people have a elevated mood, or ³high,´ which i cludes feeli gs of i creased
self-esteem a d u ique ess. `hey ofte overestimate how much they ca do a d the quality of
their ideas. Judgme t becomes impaired a d patie ts feel powerful over pai ful co seque ces.
`hey feel ³bulletproof´ a d have little regret or co cer for their actio s. `hey may have ma y
ideas a d lots of e ergy to carry them out.

`he abu da ce of thoughts may be difficult to follow; such thoughts are called raci g thoughts
or pressured speech. People i ma ic episode may feel such a extreme pressure to keep talki g
that others do ot have the opportu ity to i terrupt them. Ma ic patie ts¶ mi ds are worki g so
fast that they come up with rhymes or si g-so g phrases, burst out i so g or start da ci g
spo ta eously. `heir daily behavior ca become disorga ized or eve da gerous to the poi t that
they require hospitalizatio .

Ma ic episodes ca also have psychotic symptoms prese t. Psychosis is a state i which a perso
is u able to tell the differe ce from reality a d u reality. Psychosis symptoms i clude
halluci atio s, false beliefs about havi g special powers or ide tity (such as superhuma
stre gth or X-ray visio ). Psychotic symptoms i dicate a severe mood episode that requires
immediate medical atte tio a d treatme t.

People experie ci g ma ia might begi several activities at o ce, ever doubti g that they ca
complete all of them. `hey may have so much e ergy that they operate o two or three hours of
sleep each day. ’ll of this e ergy ca exhaust the family, frie ds a d co-workers of a perso
with bipolar disorder.

 

Duri g this phase, people with bipolar disorder may stay i bed all day, ofte feeli g that they
ca ot get goi g. `hey may feel that their thoughts move slowly, a d they take little pleasure i
a y activity. Bipolar patie ts i a depressed phase ofte feel as if they are worthless a d as if
their life is mea i gless. `hey may begi to overeat a d, give their low activity level, gai
weight. `hey may speak or thi k of suicide, maki g emerge cy care crucial for their safety. Just
as i a ma ic episode, psychotic symptoms may also occur duri g severe depressive episodes.

   

`his is a mood episode duri g which the symptoms of depressio a d ma ia are experie ced at
the same time. `his ca lead to irritability, hostility a d physical aggressio . Patie ts ofte are
hospitalized for their safety a d the safety of those arou d them. `hey may eed a lo ger
hospital stay or a combi atio of more tha o e medicatio to get well.

  


`his term describes the overall course of the ill ess over a period of 12 mo ths. ’ patie t with
rapid cycli g bipolar disorder has four or more ma ic, hypoma ic, depressive or mixed episodes
i a 12-mo th period. Rapid cycli g bipolar disorder is difficult to treat a d ofte is less
respo sive to medicatio . `reatme t usually requires a combi atio of medicatio s. `his
co ditio is more commo i wome , especially wome who have a problem with the thyroid
gla d, which ca i volve a hormo al imbala ce that mimics ma ia or depressio . ’ estimated
15 to 20 perce t of bipolar patie ts will develop rapid cycli g.


  

`his term describes mood disorders that seem to be triggered by a particular seaso of the year.
Jor example, someo e who te ds to become depressed duri g the late fall a d wi ter a d the
retur s to a regular mood duri g the spri g a d summer has a seaso al patter of depressio . I
bipolar disorder, a seaso al-patter patie t would te d to have ma ic or hypoma ic episodes
duri g a specific seaso of the year. Duri g the other seaso s, their mood would te d to be
ormal either ma ic or depressed. `he fall/wi ter depressio patter is more commo tha the
spri g/summer patter . Suicide is far more commo i March, ’pril a d May, probably due to
cha ges i light.

If you wa t to lear more about what differe tiates specific types of bipolar disorder a d the
diag ostic criteria for each, read the official diag ostic criteria for Bipolar Disorder.
  
    
 
By Steve Bressert, Ph.D.




| ’ I troductio to the Bipolar Series


| îho Gets Bipolar Disorder?
| áauses of Bipolar Disorder
| Symptoms of Bipolar Disorder
|   
   
| Jreque tly ’sked Questio s
| Jurther I formatio

’lthough bipolar disorder is viewed as a lo g-term, ofte chro ic co ditio , there are a variety
of effective treatme ts available. People with bipolar disorder ofte seek out treatme t accordi g
to what part of the cycle they¶re i . îhe a perso with bipolar disorder is i a ma ic or
hypoma ic phase, they may believe they have o further eed of medicatio s a d stop taki g
them. îhe i a depressive phase, they ofte retur to treatme t.

Medicatio is early always a part of the recomme ded treatme t course for bipolar disorder.
People with u diag osed bipolar disorder will sometimes self-medicate with alcohol or drugs to
try a d relieve their symptoms. However, such solutio s rarely provide the type of lo g-term
relief most people desire.

`he types of treatme t that are commo ly prescribed for bipolar disorder i clude:

|  
 
Older medicatio s, such as lithium, which are reliable a d well-tolerated by most. O ce
the first-li e treatme t for bipolar disorder, they have largely bee suppla ted by atypical
a tipsychotics.
| ’ 
  
Newer, more expe sive medicatio s for bipolar disorder that may provide greater
symptom relief, but also have greater side effects.
| c    
 
 
Psychotherapy a d self-help strategies ca keep someo e with bipolar disorder stabilized
a d preve t relapse.
| ‰    
Other treatme ts for bipolar disorder may i clude prescribi g a combi atio of
medicatio s for bipolar, i cludi g a tidepressa ts for bipolar.
`reatme t for bipolar disorder ca be divided i to three ge eral categories. ’cute treatme t
focuses o suppressi g curre t symptoms a d co ti ues u til remissio , which occurs whe the
symptoms are dimi ished for a period of time. áo ti uatio treatme t preve ts a retur of
symptoms from the same ma ic or depressive episode. Mai te a ce treatme t preve ts a
recurre ce of symptoms. `he risks of lo g-term medicatio use must be weighed agai st the risk
of getti g sick agai (relapse).

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’ wide ra ge of me tal health professio als help treat bipolar disorder. Medicatio s are usually
prescribed by a psychiatrist (or ge erally should be ² a ge eral practitio er or family physicia
does ¶t have the exte sive backgrou d a d experie ce i prescribi g these medicatio s o a
lo g-term basis). Psychotherapy to help lear better ways of copi g a d u lear u helpful
thi ki g a d patter s of behavior is usually provided by a psychologist or lice sed cli ical social
worker. Usually for a i itial diag osis, it is recomme ded that you co sult a psychologist or
psychiatrist.

People who are experie ci g life-threate i g symptoms, such as life-e da geri g impulsive
behavior (e.g., substa ce abuse, promiscuity or aggressive ess) or psychotic symptoms (e.g.,
halluci atio s or delusio s), as well as a yo e who is severely suicidal, should be evaluated by a
physicia . Depe di g o the level of pote tial harm to self or others, they should go to a
emerge cy room. Doctors there ofte will refer them to a psychiatrist for further treatme t. I
some cases, hospitalizatio i a psychiatric facility is a sta dard approach.

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îith appropriate treatme t, the outlook for someo e with bipolar disorder is favorable. Most
people respo d to a medicatio a d or combi atio of medicatio s. ’pproximately 50 perce t of
people will respo d to lithium alo e. ’ additio al 20 to 30 perce t will respo d to a other
medicatio or combi atio of medicatio s. `e to 20 perce t will have chro ic (u resolved)
mood symptoms despite treatme t. ’pproximately 10 perce t of bipolar patie ts will be very
difficult to treat a d have freque t episodes with little respo se to treatme t.

O average, a perso is free of symptoms for about five years betwee the first a d seco d
episodes. ’s time goes o , the i terval betwee episodes may shorte , especially i cases i
which treatme t is disco ti ued too soo . It is estimated that a perso with bipolar disorder will
have a average of eight to i e mood episodes duri g his or her lifetime.

`he cause of bipolar disorder is ot e tirely k ow . Ge etic, eurochemical a d e viro me tal


factors probably i teract at ma y levels to play a role i the o set a d progressio of bipolar
disorder. `he curre t thi ki g is that this is a predomi a tly biological disorder that occurs i a
specific part of the brai a d is due to a malfu ctio of the eurotra smitters (chemical
messe gers i the brai ). ’s a biological disorder, it may lie dorma t a d be activated
spo ta eously or it may be triggered by stressors i life.
’lthough, o o e is quite sure about the exact causes of bipolar disorder, researchers have fou d
these importa t clues:

  
    

| Bipolar disorder te ds to be familial, mea i g that it ³ru s i families.´ ’bout half the
people with bipolar disorder have a family member with a mood disorder, such as
depressio .
| ’ perso who has o e pare t with bipolar disorder has a 15 to 25 perce t cha ce of
havi g the co ditio .
| ’ perso who has a o -ide tical twi with the ill ess has a 25 perce t cha ce of ill ess,
the same risk as if both pare ts have bipolar disorder.
| ’ perso who has a ide tical twi (havi g exactly the same ge etic material) with
bipolar disorder has a eve greater risk of developi g the ill ess about a eightfold
greater risk tha a o ide tical twi .
| Studies of adopted twi s (where a child whose biological pare t had the ill ess is raised
i a adoptive family u touched by the ill ess) has helped researchers lear more about
the ge etic causes vs. e viro me tal a d life eve ts causes.

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Bipolar disorder is primarily a biological disorder that occurs i a specific area of the brai a d is
due to the dysfu ctio of certai eurotra smitters, or chemical messe gers, i the brai . `hese
chemicals may i volve eurotra smitters like orepi ephri e, seroto i a d probably ma y
others. ’s a biological disorder, it may lie dorma t a d be activated o its ow or it may be
triggered by exter al factors such as psychological stress a d social circumsta ces.

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| ’ life eve t may trigger a mood episode i a perso with a ge etic dispositio for bipolar
disorder.
| ve without clear ge etic factors, altered health habits, alcohol or drug abuse, or
hormo al problems ca trigger a episode.
| ’mo g those at risk for the ill ess, bipolar disorder is appeari g at i creasi gly early
ages. `his appare t i crease i earlier occurre ces may be due to u derdiag osis of the
disorder i the past. `his cha ge i the age of o set may be a result of social a d
e viro me tal factors that are ot yet u derstood.
| ’lthough substa ce abuse is ot co sidered a cause of bipolar disorder, it ca worse the
ill ess by i terferi g with recovery. Use of alcohol or tra quilizers may i duce a more
severe depressive phase.

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Medicatio s such as a tidepressa ts ca trigger a ma ic episode i people who are susceptible to


bipolar disorder. `herefore, a depressive episode must be treated carefully i those people who
have had ma ic episodes. Because a depressive episode ca tur i to a ma ic episode whe a
a tidepressa t medicatio is take , a a tima ic drug is also recomme ded to preve t a ma ic
episode. `he a tima ic drug creates a ³ceili g,´ partially protecti g the perso from
a tidepressa t-i duced ma ia.

áertai other medicatio s ca produce a ³high´ that resembles ma ia. ’ppetite suppressa ts, for
example, may trigger i creased e ergy, decreased eed for sleep a d i creased talkative ess.
’fter stoppi g the medicatio , however, the perso retur s to his ormal mood.

Substa ces that ca cause a ma ic-like episode i clude:

| Illicit drugs such as cocai e, ³desig er drugs´ such as cstasy a d amphetami es.
| xcessive doses of certai over-the-cou ter drugs, i cludi g appetite suppressa ts a d
cold preparatio s.
| No psychiatric medicatio s, such as medici e for thyroid problems a d corticosteroids
like pred iso e.
| xcessive caffei e (moderate amou ts of caffei e are fi e).

If a perso is vul erable to bipolar disorder, stress, freque t use of stimula ts or alcohol, a d
lack of sleep may prompt o set of the disorder. áertai medicatio s also may set off a depressive
or ma ic episode. If you have a family history of bipolar disorder, otify your physicia so as to
help avoid the risk of a medicatio -i duced ma ic episode.

People ofte have commo questio s about the basics of ma ic depressio . `hese are some of
the most commo ly asked questio s ² a d their a swers ² about ma ic depressio (also
k ow as bipolar disorder):

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áurre tly, o test ca tell a perso if he is at risk of developi g bipolar disorder. It is u likely
that a si gle ge e will be discovered that is respo sible for the ill ess i all people with bipolar
disorder.

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áertai co ditio s mimic mood disorders, i cludi g bipolar disorder. áommo o es are:

| thyroid co ditio s
| eurological diseases, such as multiple sclerosis, brai tumors, stroke or epilepsy
| i fectio s of the brai from co ditio s such as HIV i fectio , syphilis, sleep ap ea a d
lyme disease
| deficie cies of certai vitami s, such as vitami B12
| corticosteroid use, especially i high doses
| medici e used to preve t diseases like tuberculosis a d ’IDS
`elli g your doctor about your medical history a d the medicatio s that you are curre tly taki g
ca help her determi e the cause of your co ditio .

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Jamily members may wa t to express their co cer by describi g the specific behaviors to that
perso i a o udgme tal fashio . `he perso with the disorder is less able to dismiss the
observatio if there is a co se sus amo g frie ds or family members that a disti ctive patter
has emerged.

’t the work site, violatio s of safety codes or eglige ce may eed to be reported to supervisors
so that the perso ca receive a medical evaluatio before i ury or disability occurs.

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Not ecessarily. However, patie ts are e couraged to stay o medicatio i defi itely if a
episode was very frighte i g or associated with great risk to their health, fi a ces or family
relatio ships.

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   !

Yes. Jirst, lear all you ca about your ill ess by readi g books, goi g to lectures a d talki g to
your doctor. Get support from others who also have the ill ess. `he Depressive a d Ma ic-
Depressive ’ssociatio is a good place to look for a support group i your area. I these groups,
you ca hear how others face the challe ges of life a d ma age their mood a d treatme t
medicatio s. Jor helpful hi ts for ma agi g your ill ess, see áopi g îith Bipolar Disorder.

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Lack of a co siste t routi e a d disrupted sleep ca trigger a mood episode. áhoosi g work a d
leisure activities that allow proper sleep a d rest is vital to healthy emotio al fu ctio i g.
Jamilies ca support good me tal hygie e by goi g to bed a d getti g up at the same time each
day.

îe recomme d checki g out further o li e resources


for bipolar disorder that have bee reviewed by Psych áe tral. You may also wa t to check out
our thrivi g o li e bipolar
support group, where you¶ll meet frie dly people who are also grappli g with this issue.

Me tal Health ’merica


(formerly the Natio al Me tal Health ’ssociatio )
2000 N. Beauregard Street, 6th Jloor
’lexa dria, V’ 22311
`elepho e: 703-684-7722; 1-800-969-NMH’ (6642)

îebsite: http://www. mha.org


Natio al Depressive a d Ma ic Depressive ’ssociatio
730 Jra kli Street, Suite 501
áhicago, IL 60610
`elepho e: 312-642-0049; 1-800-826-3632
J’X: 312-642-7243
îebsite: http://www. dmda.org

Natio al ’llia ce for the Me tally Ill


áolo ial Place `hree
2107 îilso Blvd., Suite 300
’rli gto , V’ 22201-3042
`elepho e: 703-524-7600; 1-800-950-N’MI (6264)
J’X: 703-524-9094
îebsite: http://www. ami.org

`he I ter atio al Jou datio for Research a d ducatio o Depressio


îebsite: http://www.depressio .org

áauses

Symptoms

`ests & diag osis

`reatme t

Prog osis

áomplicatio s

îhe to co tact a doctor

Refere ces

U.S. Natio al Library of Medici e

Ji d this co te t a d more from trusted sources.


Overview

Bipolar disorder i volves periods of excitability (ma ia) alter ati g with periods of depressio .
`he "mood swi gs" betwee ma ia a d depressio ca be very abrupt.

’lter ative Names

Ma ic depressio ; Bipolar affective disorder

áauses

Bipolar disorder affects me a d wome equally. It usually appears betwee ages 15 - 25. `he
exact cause is u k ow , but it occurs more ofte i relatives of people with bipolar disorder.

Bipolar disorder results from disturba ces i the areas of the brai that regulate mood.

`here are two primary types of bipolar disorder. People with bipolar disorder I have had at least
o e fully ma ic episode with periods of maor depressio . I the past, bipolar disorder I was
called ma ic depressio .

People with bipolar disorder II seldom experie ce full-fledged ma ia. I stead they experie ce
periods of hypoma ia (elevated levels of e ergy a d impulsive ess that are ot as extreme as the
symptoms of ma ia). `hese hypoma ic periods alter ate with episodes of maor depressio .

’ mild form of bipolar disorder called cyclothymia i volves periods of hypoma ia a d mild
depressio , with less severe mood swi gs. People with bipolar disorder II or cyclothymia may be
misdiag osed as havi g depressio alo e.

Symptoms

`he ma ic phase may last from days to mo ths a d ca i clude the followi g symptoms:

| ’gitatio or irritatio
| levated mood
Y| Hyperactivity
Y| I creased e ergy
Y| Lack of self-co trol
Y| Raci g thoughts
| I flated self-esteem (delusio s of gra deur, false beliefs i special abilities)
| Little eed for sleep
| Over-i volveme t i activities
| Poor temper co trol
| Reckless behavior
Y| Bi ge eati g, dri ki g, a d/or drug use
Y| Impaired udgme t
Y| Sexual promiscuity
Y| Spe di g sprees
| `e de cy to be easily distracted

`hese symptoms of ma ia are see with bipolar disorder I. I people with bipolar disorder II,
hypoma ic episodes i volve similar symptoms that are less i te se.

`he depressed phase of both types of bipolar disorder i volves very serious symptoms of maor
depressio :

| Difficulty co ce trati g, rememberi g, or maki g decisio s


| ati g disturba ces
Y| Loss of appetite a d weight loss
Y| Overeati g a d weight gai
| Jatigue or listless ess
| Jeeli gs of worthless ess, hopeless ess a d/or guilt
| Loss of self-esteem
| Persiste t sad ess
| Persiste t thoughts of death
| Sleep disturba ces
Y| xcessive sleepi ess
Y| I ability to sleep
| Suicidal thoughts
| îithdrawal from activities that were o ce e oyed
| îithdrawal from frie ds

`here is a high risk of suicide with bipolar disorder. îhile i either phase, patie ts may abuse
alcohol or other substa ces, which ca worse the symptoms.

Sometimes there is a overlap betwee the two phases. Ma ic a d depressive symptoms may
occur simulta eously or i quick successio i what is called a mixed state.

`ests & diag osis

’ diag osis of bipolar disorder i volves co sideratio of ma y factors. `he health care provider
may do some or all of the followi g:

| ’sk about your family medical history, particularly whether a yo e has or had bipolar
disorder
| ’sk about your rece t mood swi gs a d for how lo g you've experie ced them
| Observe your behavior a d mood
| Perform a thorough exami atio to ide tify or rule out physical causes for the symptoms
| Request laboratory tests to check for thyroid problems or drug levels
| Speak with your family members to discuss their observatio s about your behavior
| `ake a medical history, i cludi g a y medical problems you have a d a y medicatio s
you take

Note: Use of recreatio al drugs may be respo sible for some symptoms, though this does ot
rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

`reatme t

Jor the ma ic phase of bipolar disorder, a tipsychotic medicatio s, lithium, a d mood stabilizers
are typically used. Jor the depressive phase, a tidepressa ts are sometimes used, with or without
the ma ic phase treatme t.

`here is very little lo g-term evide ce suggesti g that a y medicatio has great success i the
mai te a ce phase. However, i studies that followed patie ts for 2 years, lithium a d some
a tipsychotics were fou d to be moderately successful.

’ tipsychotic drugs ca help a perso who has lost touch with reality. ’ ti-a xiety drugs, such
as be zodiazepi es, may also help. `he patie t may eed to stay i a hospital u til his or her
mood has stabilized a d symptoms are u der co trol.

lectroco vulsive therapy (á`) may be used to treat bipolar disorder. á` is a psychiatric
treatme t that uses a electrical curre t to cause a brief seizure of the ce tral ervous system
while the patie t is u der a esthesia. Studies have repeatedly fou d that á` is the most
effective treatme t for depressio that is ot relieved with medicatio s.

Getti g e ough sleep helps keep a stable mood i some patie ts. Psychotherapy may be a useful
optio duri g the depressive phase. Joi i g a support group may be particularly helpful for
bipolar disorder patie ts a d their loved o es.

Prog osis

Mood-stabilizi g medicatio ca help co trol the symptoms of bipolar disorder. However,


patie ts ofte eed help a d support to take medici e properly a d to e sure that a y episodes of
ma ia a d depressio are treated as early as possible.

Some people stop taki g the medicatio as soo as they feel better or because they wa t to
experie ce the productivity a d creativity associated with ma ia. ’lthough these early ma ic
states may feel good, disco ti ui g medicatio may have very egative co seque ces.

Suicide is a very real risk duri g both ma ia a d depressio . Suicidal thoughts, ideas, a d
gestures i people with bipolar affective disorder require immediate emerge cy atte tio .

áomplicatio s

Stoppi g or improperly taki g medicatio ca cause your symptoms to come back, a d lead to
the followi g complicatio s:
| ’lcohol a d/or drug abuse as a strategy to "self-medicate"
| Perso al relatio ships, work, a d fi a ces suffer
| Suicidal thoughts a d behaviors

`his ill ess is challe gi g to treat. Patie ts a d their frie ds a d family must be aware of the
risks of eglecti g to treat bipolar disorder.

îhe to co tact a doctor

áall your health provider or a emerge cy umber right way if:

| You are havi g thoughts of death or suicide


| You are experie ci g severe symptoms of depressio or ma ia
| You have bee diag osed with bipolar disorder a d your symptoms have retur ed or you
are havi g a y ew symptoms