Bipolar disorder is a condition in which a person has periods of depression and periods of being extremely happy or being cross or irritable.
Manic depression; Bipolar affective disorder
Causes, incidence, and risk factors
Bipolar disorder affects men and women equally. It usually starts between ages 15 and 25. The exact cause is not known. But it occurs more often in relatives of people with bipolar disorder.
In most people with bipolar disorder, there is no clear cause for the periods (episodes) of extreme happiness (mania) or depression. The following may trigger a manic episode:
Medicines such as antidepressants or steroids
Periods of not being able to sleep (insomnia)
Recreational drug use
The manic phase may last from days to months. It can include these symptoms:
Little need for sleep
Poor temper control
Reckless behavior and lack of self control such as drinking, drug use, sex with many partners, spending sprees
Very elevated, expansive or irritable mood, such as racing thoughts, talking a lot, false beliefs about self or abilities
Very involved in activities
The depressive episode may include these symptoms:
Daily low mood or sadness
Difficulty concentrating, remembering, or making decisions
Eating problems such as
loss of appetite and weight loss, or overeating and weight gain
Fatigue or lack of energy
Feeling worthless, hopeless, or guilty
Loss of pleasure in activities once enjoyed
Loss of self-esteem
Thoughts of death or suicide
Trouble getting to sleep or sleeping too much
Pulling away from friends or activities that were once enjoyed
Persons with bipolar disorder are at high risk of suicide. They may abuse alcohol or other substances. This can make the symptoms and suicide risk worse.
Episodes of depression are more common than episodes of mania. The pattern is not the same in all persons with bipolar disorder:
Depression and mania symptoms may occur together. This is called a mixed state.
Symptoms may also occur right after each other. This is called rapid cycling.
Signs and tests
To diagnose bipolar disorder, the health care provider may do some or all of the following:
Ask whether other family members have bipolar disorder.
Ask about your recent mood swings and for how long you have had them.
Perform a thorough exam and order lab tests to look for other illnesses that may be causing the symptoms that resemble bipolar disorder.
Talk to family members about your symptoms and overall health.
Ask about any health problems you have and any medications you take.
Watch your behavior and mood.
The main goal of treatment is to:
Make the mood episodes less frequent and severe
Help you function well and enjoy your life at home and at work
Prevent self-injury and suicide
Medicines are a key part of treating bipolar disorder. Most often, the first medicines used are called mood stabilizers They help you avoid mood swings.
With medicines, you may begin to feel better. For some, symptoms of mania may feel good. Or side effects from the medicines may occur. As a result, you may be tempted to stop taking your medicine or change the way you are taking them. But stopping your medicines or taking them in the wrong way can cause symptoms to come back or become much worse.
Family members or friends can help you take medicines the correct way. They can also help to make sure that episodes of mania and depression are treated as early as possible.
Other medicines, such as antipsychotics or antidepressants, may be tried.
Regular visits with a psychiatrist to talk about your medicines and side effects are needed. Blood tests are often needed also.
Patients who are in the middle of a severe manic or depressive episode may need to stay in a hospital until their mood is stable and their behavior is under control.
SUPPORT PROGRAMS AND TALK THERAPY
Many people with bipolar disorder do not recognize when they are becoming more depressed or more manic. Joining a support group may help you and your loved ones. Involving family members and caregivers in your treatment programs may help reduce the chance of symptoms returning in the patient.
Important skills that may be learned at such programs include:
Coping with symptoms that are present even while taking medications
Getting enough sleep and staying away from recreational drugs
Taking medicines correctly and how to manage side effects
Watching for the return of symptoms, and knowing what to do when they return
Finding out what triggers the mood episodes and how to avoid these triggers
Talk therapy with a mental health provider may be helpful for people with bipolar disorder.
Periods of depression or mania return in most patients, even with treatment. Patients may also have issues with alcohol or drug abuse. They may also have problems with relationships, school, work, and finances.
Suicide is a very real risk during both mania and depression. People with bipolar disorder who think or talk about suicide need emergency attention right away.
Calling your health care provider
Seek help right way for:
Symptoms of mania
You feel the urge to hurt yourself or others
You are feeling hopeless, scared, or overwhelmed
You are seeing things that are not really there
You feel you cannot leave the house
You are not able to care for yourself
Call the treating health care provider if:
Symptoms are getting worse
Side effects of medicines
Medicines are not being taken the right way
Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. J Psychopharmacol. 2009; 23(5):574-591.
Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 404.
Perlis RH. Bipolar disorder. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Elsevier Mosby; 2008:chap 30.
David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.