Program & Services

Bipolar Disorder

Bipolar disorder is also known as manic-depressive illness. It is a brain disorder and causes extreme shifts in a person's mood. It also causes shifts in a person's energy and ability to do things. Bipolar disorder is different from the normal ups and downs we all have. The symptoms are severe. They can result in the following:

• Damaged relationships
• Poor job or school performance
• Suicide

Bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than two million American adults have bipolar disorder. About one percent of people 18 and older have this illness. It usually develops in early adulthood. Some people can have their first symptoms when they are a child. Others develop symptoms late in life. Bipolar disorder is a long-term illness, and it must be managed with care for a person's entire life.

What are the symptoms?

Bipolar disorder causes extreme mood swings. People with bipolar disorder can be very high and/or irritable. Then they can be very sad and hopeless before they swing back again to high. There are often periods of normal mood in the middle. They also have severe changes in energy and behavior. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

• 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. It must be with three or more of the abovesymptoms. These symptoms have to occur most of the day, nearly every day. They also must occur for one week or longer. If the elevated mood is irritable, four more symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

• 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 are found. They need to last most of the day and need to happen nearly every day, for two weeks or longer.

A mild to moderate level of mania is called hypomania. The person may feel good in this state. They may feel they are doing well and are extra productive. Family and friends may learn to notice the mood swings as possibly being bipolar disorder. The person may deny that anything is wrong. This can become severe mania in some people if not treated. I can also switch into depression.

Sometimes severe episodes of highs or lows include symptoms of psychosis. Common symptoms are hearing, seeing or feeling things not really there. Other symptoms include delusions - false, strongly held beliefs without logical thought. These symptoms are usually in the extreme mood state. For example, a person may believe he or she is the president or have special powers. He or she may feel extreme guilt or worthlessness during depression. People with these symptoms are sometimes not diagnosed correctly.

It may be helpful to think of the various mood states in bipolar disorder as a continuous range:

• Severe depression
• Moderate depression
• Mild low mood ("the blues" when it doesn't last long and "dysthymia" when it is chronic)
• Normal mood
• Hypomania (mild to moderate mania)
• Severe mania

Some people may have symptoms of mania and depression that occur at the same time. This is called a mixed bipolar state. Symptoms of a mixed state often include the following:

• Agitation
• Trouble sleeping
• Significant change in appetite
• Psychosis
• Suicidal thinking

A person may have a very sad, hopeless mood, but at the same time they may be feeling very energized.

What is the course of bipolar disorder?

People usually have high and low events all their life. Most people have no symptoms between the highs and lows. Usually about one-third of people have some symptoms that continue. Others continue to have symptoms that never go away even when treated.

People can lead healthy and productive lives when treated. With no treatment they will get worse. Over time, a person may suffer more and more severe episodes. In most cases, good treatment can help reduce the amount and severity of episodes. Treatment will help people keep a good quality of life.

Can children and young adults have bipolar disorder?

Yes, both children and young adults can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Adults tend to have symptoms that are more clearly defined. Younger people often have very fast mood swings. These mood swings also happens many times a day. Children with mania are more likely to be irritable. They are prone to bad tantrums more than being overly happy. Mixed symptoms also are common in children. Young adults who develop the illness may have more adult-type episodes and symptoms.

What causes bipolar disorder?

Scientists are still learning about the causes of bipolar disorder. Most scientists agree that there is no single cause and think there are many factors acting together. Because this illness tends to run in families, they have been searching for specific genes. Scientists are also looking at cells that influence how the body and mind work and grow. They think they are passed down through generations and that they may increase a person's chance of getting the illness.

How is bipolar disorder treated?

Most people are helped with good treatment. However, bipolar disorder never goes away, which makes long-term treatment very important. It is best to combine medication and multiple forms of treatment for the mind and body to manage this illness over time.

Usually bipolar disorder is controlled better if treatment goes on continuously. It is not good to start and stop, but even when there are no breaks in treatment, mood changes can occur. Report any changes to the doctor right away. The doctor may be able to prevent a full-blown episode. He or she will make adjustments to the treatment plan.

Medications

Medicine is prescribed by special doctors. These are medical doctors with expertise in mental disorders, called psychiatrists. Regular doctors who do not specialize in mental disorders may also prescribe these medicines. However, it is recommended that people with bipolar disorder see a special doctor.

Treatment of bipolar depression

Research has shown that people with bipolar disorder are at risk of having symptoms if they take medicine for depression. Therefore, "mood-stabilizing" medicine generally is required, alone or in combination with medicine for depression, to protect people with bipolar disorder from the side effects of medicines for depression.

Psychosocial treatments

As well as medicine, certain forms of "talk" therapy are helpful. It helps support, educate and guide people. It also helps their families. Studies have shown that this therapy can lead to better mood stability and can lead to fewer visits to the hospital. A special doctor is usually seen or a social worker or counselor can also be seen. They often work together to monitor progress. The number and type of sessions should be based on the needs of each person.

A long-term illness that can be effectively treated

Bipolar disorder is a long-term illness. There currently is no cure. Staying on treatment at all times is important as it can help keep the disorder under control. It can also help stop the episodes from getting worse and happening more often.