Bipolar Disorder

Bipolar disorder, previously known as manic-depressive illness, is a complex psychiatric disorder that involves sudden and dramatic mood swings between mania and depression. An episode may last for hours, days, weeks or months and symptoms may be severe, sometimes resulting in dangerously impulsive or self-destructive behavior and sometimes leading to depression so deep it results in suicide.

Causes of Bipolar Disorder

It is known that individuals with bipolar disorder have physiological changes in their brains. Although precipitating factors have been researched, precise causes for the changes have not been pinpointed. The following genetic and environmental factors appear to play important roles in the development of bipolar disease:

Imbalances in brain chemicals called neurotransmitters
Hormonal imbalances
Heredity, having a blood relative with a psychiatric disorder
Environmental stress
Childhood abuse
Trauma

Types of Bipolar Disorder

There are three different types of bipolar disorder, characterized by the severity of the disease:

Bipolar I
Bipolar II
Cyclothymic disorder or cyclothymia

Patients with bipolar I typically suffer manic or depressive episodes lasting for a week or more. The episodes, though they may be alleviated with medication, are frequently severe enough to require hospitalization. Bipolar II is a less severe variety of the disorder. Patients with bipolar II may have noticeably elevated or depressed moods, though these are less severe, and last for shorter periods, than those of patients with bipolar I. Cyclothymic disorder is a milder form of bipolar disorder characterized by mood swings more extreme than those of the average person, but not disabling.

There are other variations in bipolar disorder in which symptoms may differ in specific ways, such as:

Seasonal changes in mood
Rapid-cycling bipolar disorder
Bipolar disorder with psychotic symptoms
Bipolar disorder in children
Mixed state bipolar disorder
Hypomania

Symptoms of Bipolar Disorder

The symptoms of bipolar disorder are extreme versions of the emotional states all individuals experience. In patients with this disorder, however, the emotional states are not only exaggerated, but often seem to have no relation to experienced events. Beyond that, the symptoms start and stop abruptly, and are extreme enough to interfere with normal functioning.

Symptoms of Mania

Symptoms of a manic episode have a wide range. While some symptoms are similar to those experienced during a period of joy, many topple over into a kind of chaos. Symptoms of mania may include:

Euphoria

Inflated self-esteem

Rapid speech and racing thoughts

Increased physical activity

Agitation, irritation or aggression

Heightened sexual desire

Impulsive or risky behavior (including spending)

Distractibility

Decreased appetite or need for sleep

Substance abuse

Sometimes a person is treated for depression with an anti-depressant and then develops some of the symptoms above. This is called "activation" and can be a clue that the person actually has bipolar disorder, and not a unipolar depression.
Symptoms of Depression

Depressive episodes of bipolar disorder differ from simple sadness since they frequently are not reactions to a sad event and since they can reach a deep level of despair. Symptoms of a depressive episode may include:

Anxiety

Hopelessness

Dissociation

Feelings of guilt

Sleep disturbances

Decreased or increased appetite

Extreme fatigue or lack of energy

Inactivity

Loss of interest in sex and other pleasurable activities

Inexplicable chronic pain

Suicidal thoughts

Symptoms of bipolar disorder can be exacerbated by many things, including hormonal changes, physical illnesses, traumatic events, substance use, and ongoing abusive treatment.

Diagnosis of Bipolar Disorder

Bipolar disorder is a complex psychiatric illness, diagnosed by a careful evaluation of symptoms by a qualified psychiatrist. Everyone experiences mood swings to a greater or lesser degree, but the mood swings of patients with bipolar disorder are more exaggerated and intense and often interfere with normal activities. Psychiatrists diagnose bipolar disorder by taking a thorough history of symptoms and through personal observation of behavior patterns.

Patients' symptoms are assessed using criteria formulated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Observable or reported symptoms of mania alternating with depression over an extended period of time are clues to the existence of the disorder. Since there is a genetic component to the disorder, a thorough family history will also be taken to assist in diagnosis.

Treatment of Bipolar Disorder

Bipolar disorder is treated with several different types of medications, as well as with psychotherapy designed to help the patient cope with the underlying disease. Medications administered to treat bipolar disorder include mood stabilizers, antidepressants, anti-seizure medications, anti-psychotics and anti-anxiety medications.

Balancing medications is difficult even for highly experienced psychiatrists since small changes in dosage can make substantive changes in mood and behavior, and since medications may have to be altered as moods shift. Hospitalization is often necessary for patients with severe bipolar disorder, particularly when they are in the throes of a severe episode. Usually such hospitalizations are brief, necessary only until the patient is stabilized on medication.

Risks of Bipolar Disorder

If left untreated, bipolar disorder is life-threatening and eventually can lead to suicide. The condition is not curable at the present time, but ongoing treatment can keep the patient stabilized. Once a patient with bipolar disorder has achieved an emotional balance with treatment, normal functioning is possible. Long-term treatment, during which the patient learns to recognize and report symptoms of mania and depression as soon as they appear, can help make this potentially life-threatening disease manageable.

Suzanne Watson MD, MDiv, MEd

Del Mar Psychiatry

Patient Education