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Definition
Bipolar disorder is a disorder characterized by extreme swings in mood, energy, and 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. Bipolar disorder can be treated; contact your doctor if you think you may have this condition.
The two extremes of the illness are mania (when energy peaks, mood may be overly euphoric or irritable) and depression (when lethargy takes over, mood may be very blue). Severe episodes of mania or depression may sometimes be associated with psychotic symptoms such as hallucinations, delusions, or disorders of thought.
There are three forms of this condition: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Bipolar I disorder involves recurrent episodes of mania and depression. Bipolar II disorder involves milder episodes of mania (called hypomania) that alternate with episodes of depression. Cyclothymic disorder may be diagnosed in patients who experience frequent depressive symptoms and hypomania for at least two years and who have been without symptoms for no more than two months.
CausesThe cause of bipolar disorder is not known. This condition tends to run in families. Specific genes may play a role, but bipolar disorder is not caused by one single gene. Rather, many different genes likely act together. Medications such as corticosteroids and medical conditions, such as thyroid disease and multiple sclerosis , may be accompanied with features of bipolar disorder. The diagnosis of bipolar disorder is made only when none of these causes are present. The BrainBipolar disorder may be a result of genetic and environmental influences on the brain. 2008 Nucleus Medical Art, Inc. Risk FactorsA risk factor is something that increases your chance of getting a disease or condition. Having family members with bipolar disorder increases your chance of developing this condition. If you have a family member with bipolar disorder, tell your doctor. Symptoms Symptoms include: Dramatic mood swings, ranging from elated excitability to hopeless despondencyPeriods of normal mood in between ups and downsExtreme changes in energy and behavior Periods of highs are called mania. Signs and symptoms of mania include: Persistent and inexplicable elevation in moodIncreased energy and effort toward goal-directed activitiesRestlessness and agitationRacing thoughts, jumping from one idea to anotherRapid speech or pressure to keep talkingTrouble concentratingDecreased need for sleepOverconfidence or inflated self-esteemPoor judgment, often involving spending sprees and sexual indiscretions Periods of lows are called depression. Signs and symptoms of depression include:
Prolonged sad, hopeless, or empty moodFeelings of guilt, worthlessness, or helplessnessLoss of interest or pleasure in activities once enjoyed, including sexDecreased energy or fatigueTrouble concentrating, remembering, and/or making decisionsRestlessness or diminished movementsAgitationSleeping too much or too littleUnintended weight loss or gainThoughts of death or suicide with or without suicide attempts Diagnosis Your doctor will ask about your symptoms and medical history and will usually perform a physical exam. In some cases, laboratory tests are ordered to rule out other causes of mood and behavior symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on: Presence of symptoms over time Absence of other causes, such as some medications, thyroid disease, or Parkinson's diseaseFamily history of bipolar disorderAn episode of mania is diagnosed if elevated mood is accompanied by three or more of the mania symptoms listed above during most of the day, nearly every day, for one week or longer. If the mood is irritable, not elevated, four symptoms must be present for a diagnosis of mania.A depressive episode diagnosis requires that five or more of the depressive symptoms listed above last for most of the day, nearly every day, for a period of two weeks or longer.
TreatmentTalk with your doctor about the best treatment plan for you. Treatment options include: Medications The following medications may be used to treat bipolar disorder (many patients are treated with a combination of two or more of these medications): Lithiuma mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)Valproate (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal), topiramate (Topamax)antiseizure medications, also used as mood stabilizers instead or in combination with lithiumBenzodiazepines (clonazepam [Klonopin] or lorazepam [Ativan]) can be used to treat agitation or insomniaZolpidem (Ambien)used to treat insomniaAntidepressants (serotonin reuptake inhibitors or bupropion [Wellbutrin])used to treat depression Antipsychotic medicationsused for acute manic or mixed episodes and maintenance treatment Classic antipsychotic medications (eg, haloperidol [Haldol]) are not often used because of risks of tardive dyskinesia (uncontrollable movements). Atypical antipsychotic medications (eg, risperidone, olanzapine, aripiprazole, ziprasidone, and quetiapine) are more effective with less risk of tardive dyskinesiaTreatment may need to be continued for prolonged periods or indefinitely, depending on the pattern of the illness, to prevent significant mood swings.
Psychotherapy Psychotherapy may include: Cognitive-behavioral therapyCounselingFamily therapyInterpersonal and social rhythm therapy, a form of therapy designed to treat bipolar disorder Electroconvulsive TherapyElectroconvulsive therapy may be effective for both mania and depression when medications fail. PreventionThere are no guidelines for preventing bipolar disorder. RESOURCES: Child and Adolescent Bipolar Foundationhttp://www.bpkids.org Depression and Bipolar Support Alliancehttp://www.dbsalliance.org National Institute of Mental Healthhttp://www.nimh.nih.gov/index.shtml CANADIAN RESOURCES: Canadian Psychiatric Associationhttp://www.cpa-apc.org Mood Disorder Association of Canadahttp://www.mooddisorderscanada.ca/index.htm References: Belmaker R. Medical progress: bipolar disorder. N Eng J Med . 2004;351:476-486. Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/bipolar.cfm . Accessed November 10, 2005. Hirschfeld RMA. Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder . 2nd ed. Arlington, VA: American Psychiatric Association; 2005. Available at: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm . Accessed January 20, 2007.
Hirschfeld RMA, Bowden CL, Gitlin MJ, et al. Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision). American Psychiatric Association; 2002. Available at: http://www.psych.org/psych_pract/treatg/pg/Practice%20Guidelines8904/BipolarDisorder_2e.pdf . Accessed on January 20, 2007. Last reviewed January 2008 by Janet H. Greenhut, MD, MPHPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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