Bipolar disorder, also known as manic-depressive illness, is a mental illness that causes unusual shifts in a person’s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe.
The disease typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness or may be mistaken for (unipolar) depression, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.
There are two main forms of bipolar disorder: type 1 and type 2. The difference is based mostly on the "high high's." Bipolar disorder type 1 has manic episodes. Type 2 has hypomanic episodes which never reach the full intenisty of true mania. For the individual with bipolar type 2, the depressive episodes are the real problem as those tend to be more frequent and more severe.
Dramatic mood swings - from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood.
The periods of highs and lows are called episodes of mania and depression. In total there are four types of mood episodes that a person with bipolar disorder can cycle thru: manic/hypomanic episodes, depressive episodes, mixed episodes, and periods of normal moods.
Signs and symptoms of a manic episodeEdit
- Increased energy, activity, and restlessness
- Excessively “high,” overly good, euphoric mood
- Extreme irritability
- Racing thoughts and talking very fast, jumping from one idea to another
- Distractibility, can’t concentrate well
- Little sleep needed
- Unrealistic beliefs in one’s abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of a depressive episodeEdit
- Lasting sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue or of being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can’t sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
- Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
Mixed episodes have signs and symptoms of both mania and depression. These can be very dangerous for one simple reason: the person can have the high energy from mania and the suicidal thoughts from depression. With the increase in energy, they could be more likely to suceede in killing themselves.
Only manic episodes—and in theory hypomanic episodes—are required for the diagnosis. A doctor can only suspect bipolar disorder if a patient just has depressive episodes but no manic ones yet; this commonly happens when there is a family history of the disorder.
Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.
Because bipolar disorder tends to run in families, researchers have been searching for specific genes inside all cells that influence how the body and mind work and grow that may increase a person’s chance of developing the illness.
Treatment for bipolar disorder focuses on three things: reducing frequency of mood episodes, reducing severity of mood episodes, and reducing duration of mood episodes. This is accomplished mostly by medication but is also supplemented by and greatly helped with psychotherapy and behaviour-cognitive therapy.
Medication for bipolar disorder is almost always required and usually consists of a cocktail of 2 or more different types of medicines.
- The most popular combination is mood stabilizer + antidepressant. The mood stabilizer covers the manic/hypomanic episodes and the cycling while the antidepressants treat the depressive episodes. Many mood stabilizers are actually antiseizure medicines and are also used to treat epilepsy.
- Another common option is atypical antipsychotic + antidepressant. Two atypical antipsychotics have recently been approved to treat (unipolar) depression as an adjunct to an antidepressant as well as bipolar disorder.
- Sometimes people only take a mood stabilizer without an antidepressant as their disorder responds fine without it.
- A select few can be treated with just an antidepressant. However this is very uncommon, and treating someone with bipolar disorder with only an antidepressant is strongly adviced aganist. Antidepressants can trigger severe manic episodes in people with any form of bipolar disorder, including those with bipolar disorder type 2.
Bipolar disorder is a chronic, lifelong condition that needs to be carefully managed and treated.
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness.
Signs and symptoms that may accompany suicidal feelings include:
- talking about feeling suicidal or wanting to die
- feeling hopeless, that nothing will ever change or get better
- feeling helpless, that nothing one does makes any difference
- feeling like a burden to family and friends
- abusing alcohol or drugs
- putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
- writing a suicide note
- putting oneself in harm’s way, or in situations where there is a danger of being killed