About Bipolar Disorder

Bipolar Disorder is a common psychiatric illness and brain disorder that affects between 1-2% of the world’s population. It is the same as manic depressive illness which is simply an older name. People with bipolar disorder alternate between the two extreme mood states of mania and depression. These states are much more severe than the usual ups and downs of daily life and can cause significant suffering and impairment.

Mania

When manic, someone may experience elation and euphoria, racing thoughts and rapid speech. They may feel filled with energy, start many new projects and work long hours. They may have so much energy that they don’t feel the need for sleep and may work all night or sleep only a few hours a night for days at a time. People with mania may have grandiose ideas about their abilities, their importance or what they can accomplish. They also may spend large amounts of money on frivolous or unnecessary things, or engage in a variety of risky behaviors. Alternatively, sometime they may feel irritable and angry instead of elated and still have the racing thoughts and high energy. In its extreme stages, they may become psychotic, lose touch with reality and have hallucinations such as hearing voices or having visions. Delusional, unrealistic ideas or fears may also develop.

Depression

Depression is in many ways the opposite of mania. Someone may feel sad or blue for and complain of fatigue or lack of energy. They may lose their usual motivation and interest in things, and may find nothing enjoyable. Insomnia is common, though some people may sleep excessively. People who are depressed may also lose their appetite and experience significant weight loss or sometimes weight gain. They may have difficulty concentrating, remembering things and making decisions. Most seriously, they may have thoughts about suicide.

Mixed States

A frequently under-recognized aspect of bipolar disorder is that sometimes the two states of mania and depression may occur at the same time. Though this may seem contradictory, it is actually quite common. There are many different manifestations of this making difficult to recognize. For example, a person may feel depressed, but at the same time have racing thoughts and excessive energy. Or someone may feel elated and energized but have suicidal thoughts.

Suicide

Thoughts about death or suicide are common in bipolar disorder. Unfortunately, many people with Bipolar Disorder may attempt suicide or actually kill themselves. Thoughts about suicide can occur in both the depressed and mixed phases of the illness. If you or someone you know is having thoughts about suicide, they should seek professional help immediately.

Classification

Bipolar Disorder is usually classified into two different forms. People who have more severe forms of mania where psychosis occurs, hospitalization is necessary or who have significant impairment in functioning have bipolar I disorder. Those who have milder forms of mania, termed hypomania, have bipolar II disorder. People with hypomania have the same symptoms as mania, but because it is milder they are not impaired and do not require hospitalization.

Treatment

Fortunately there are many effective treatments for bipolar disorder. The mainstay of treatment is a class of medications called mood stabilizers. These include lithium, and a number of drugs developed first for epilepsy including valproate (Depakote®), carbamazepine (Tegretol®), and lamotrigine (Lamictal®). There are several other drugs where the evidence for their effectiveness is not as strong, but they nevertheless may be useful for some people. These include: gabapentin (Neurontin®), topiramate (Topamax®) or levetiracetam (Keppra®).

Antipsychotic medications may be used when someone has symptoms of psychosis such as hearing voices or having delusions. However, newer antipsychotic drugs, termed atypical antipsychotics, have also been shown to be effective as mood stabilizers as well. Some of these medications include: olanzapine (Zyprexa®), quetiapine (Seroquel®), risperidone (Risperdal®), aripiprizole (Abilify®) and others.

Antidepressant medications may also be used for the depressed phase of illness. However, their effectiveness is a topic of debate amongst doctors. Several recent studies suggest that they are not helpful, and may actually in some cases make people worse by triggering mania, rapid cycling or mixed states. A doctor’s advice should be followed in deciding whether antidepressants are indicated for an individual patient.

The key to treatment is preventing episodes by regular use of one of the mood stabilizing medications. Not all medications work well for every person and finding the right medication is frequently a trial and error process. However, a medication that works can almost always be found and warrants patience through this trial and error process. As almost all patients with Bipolar Disorder will have multiple episodes during their lives, staying on medication is usually recommended and is the key to success.

In addition to medication treatment, people with Bipolar Disorder can benefit from a number of other treatments. Education about the illness, how to recognize early symptoms and manage stress is important. Psychotherapy, either individual or in a group, is invaluable in learning to manage mood changes. Learning to maintain regular daily rhythms of sleep and activity is also very helpful. For some people with seasonal forms of the illness, bright light treatment can also be quite effective.

With appropriate preventive treatment, most people with bipolar disorder can manage their illness, prevent episodes and lead normal productive lives.