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Bipolar Disorder

(Manic-Depressive Illness; Manic Depression; Manic Disorder; Manic Affective Disorder)

Definition

Bipolar disorder is a mental health condition marked by extreme swings in mood, energy, and the ability to function. The mood changes of bipolar disorder are more dramatic than normal ups and downs. They can hurt relationships and cause poor job or school performance.
The two mood extremes of bipolar disorder are mania and depression. In mania, one of the defining symptoms is an increase in energy and a decreased need for sleep. The mood may be overly happy or irritable. In depression , a down mood with fatigue takes over, often accompanied by irritability.
There are four forms of this condition:
  • Bipolar I disorder—Recurrent episodes of mania often immediately followed by depression; episodes can be severe.
  • Bipolar II disorder—Episodes of less severe mania (called hypomania) that alternate with episodes of major depression.
  • Bipolar disorder not otherwise specified (BP-NOS)—The person has symptoms of bipolar disorder, but the symptoms do meet the specific criteria for bipolar I or bipolar II disorder
  • Cyclothymia—Episodes of hypomania that alternate with episodes of mild depression that last for at least two years

Causes

The cause of bipolar disorder is unknown. This condition tends to run in families. Specific genes may play a role. It is most likely many different genes that act together.
The Brain
Color coded brain
Bipolar disorder may be a result of genetic influences on the brain.
Copyright © Nucleus Medical Media, Inc.

Risk Factors

A family history of the disorder increases your chance of developing it. Tell your doctor if you have a family member with bipolar disorder.

Symptoms

Symptoms include:
  • Dramatic mood swings—This can range from elated excitability, unrealistic goal setting, and an exaggerated sense of self to feelings of hopelessness.
  • Periods of normal mood in between ups and downs
  • Extreme changes in energy and behavior
Mania may cause:
  • A mood that is extremely "high" or overly good
  • Increased energy and effort toward goal-directed activities
  • Restlessness and agitation
  • Racing thoughts, jumping from one idea to another
  • Rapid speech or pressure to keep talking
  • Trouble concentrating
  • Decreased need for sleep
  • Overconfidence or inflated self-esteem
  • Poor judgment, often involving spending sprees and sexual indiscretions
Depression may cause:
  • Prolonged sad, hopeless, or empty mood
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy or fatigue
  • Trouble concentrating, remembering, and/or making decisions
  • Restlessness or diminished movements
  • Agitation
  • Sleeping too much or too little
  • Unintended weight loss or gain
  • Thoughts of death or suicide with or without suicide attempts
Severe episodes of mania or depression may sometimes be associated with psychotic symptoms, such as:
  • Hallucinations
  • Delusions
  • Disorders of thought

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. In some cases, lab tests are ordered to rule out other causes of your symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on:
  • Presence of certain symptoms over time
  • Absence of other causes, such as some medications and certain conditions
  • Family history of bipolar disorder
Mania is diagnosed if:
  • Mood is elevated and there are three or more manic symptoms (listed above)
    • If the mood is irritable, not elevated, four symptoms must be present for a diagnosis of mania
  • Symptoms last for most of the day, nearly every day, for one week or longer
  • Symptoms cause problems in day-to-day functioning
A depressive episode is diagnosed if:
  • There are five or more of the depressive symptoms (listed above)
  • Symptoms last for most of the day, nearly every day, for a period of two weeks or longer
  • Symptoms cause problems in day-to-day functioning

Treatment

Talk with your doctor about the best plan for you. Options may include:

Medications

The primary treatment is with medications called mood stabilizers. There are many different types and combinations of medications, which must be tailored by your doctor to target your symptoms. Examples of common medications used to treat bipolar disorder include:
  • Mood stabilizers
  • Antiseizure medications
  • Benzodiazepines
  • Antidepressants
  • Antipsychotics
The plan is based on the pattern of the illness. Treatment may need to be continued indefinitely. It should prevent significant mood swings.

Psychotherapy

Psychotherapy is often an integral component of a comprehensive treatment plan. Therapy may include:

Electroconvulsive Therapy

Electroconvulsive therapy may be effective when medications fail. It can be used for both mania and depression.

Prevention

There are no current guidelines to prevent bipolar disorder. Taking your daily medications and following your treatment plan can help prevent future mood swings.

RESOURCES

Depression and Bipolar Support Alliance http://www.dbsalliance.org

National Institute of Mental Health http://www.nimh.nih.gov

CANADIAN RESOURCES

Canadian Psychiatric Association http://www.cpa-apc.org

Mood Disorder Association of Canada http://www.mooddisorderscanada.ca

References

Bipolar disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 15, 2013. Accessed September 4, 2013.

Bipolar disorder fact sheet. National Alliance on Mental Illness website. Available at: http://www.nami.org/factsheets/bipolardisorder%5Ffactsheet.pdf . Updated April 2013. Accessed September 4, 2013.

Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml . Updated 2008. Accessed September 4, 2013.

DSM-5. American Psychiatric Association website. Available at: http://www.psychiatry.org/dsm5 . Accessed September 4, 2013.

4/29/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Nivoli AM, Colom F, Murru A, et al. New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord. 2011;129(1-3):14-26.

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