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Bipolar Disorder: Ask the Expert

Bipolar disorder is often misunderstood. To help, WebMD’s health team takes your questions to leading experts on bipolar disorder. Bookmark this page and check back. We’ll be adding more of your questions and finding expert answers.
  • Q: Is there a cure for bipolar disorder, or do I need to stay on medications for the rest of my life?
  • Answer:

    A:  “The short answer is no -- there is no 'cure' for bipolar disorder,” says David Kahn, MD, a clinical professor of psychiatry at Columbia University and author of Treatment of Bipolar Disorder: A Guide for Patients and Families. “Years of research tells us that after a person has a single manic episode, there is roughly a 90% chance that there will be future episodes. After two or three episodes, the likelihood of more goes up to nearly 100%. 

    Medications reduce the frequency and severity of episodes for most patients. In fact, about one-third of people with bipolar disorder eliminate almost all episodes of mania on an uncomplicated medication schedule. For example, this might include lithium or divalproex (Depakote) as a mood stabilizer, sometimes in conjunction with an antidepressant.

    Prolonged relief with medication does not cure the illness, however, and stopping successful medication even after many years can result in a relapse.

    One exception: There are people who have single manic episodes related to general medical conditions -- for example, substance abuse or steroid use during an inflammatory illness. These people will not go on to have future episodes if they steer clear of the substance that caused the manic episode.”

  • Q: How stable should my moods be when I'm on medications? I don't feel like I'm improving much.
  • Answer:

    A:  “Complete remission is our goal with treatment for bipolar disorder, but it can take some time and a lot of trial and error,” says David Kahn, MD, a clinical professor of psychiatry at Columbia University and author of Treatment of Bipolar Disorder: A Guide for Patients and Families. “We use sequential trials of treatments, based on medication but also supplemented by psychotherapy and lifestyle changes, such as stress reduction and getting enough sleep. 

    It's really important not to give up. There are many medication combinations to work through in expert hands. Keep in mind that as new medications are tried, you may need to stop older medications you've been taking for a long time, in order to try and 'clear the decks.' Continuing on older medications as you try new ones can sometimes backfire and prolong the cycling phases of the illness, or cause sedation, weight gain, or other unpleasant side effects.”

  • Q: How can I tell if I'm going into a depression cycle, or I'm just in a bad mood?
  • Answer:

    A:  David Kahn, MD, a clinical professor of psychiatry at Columbia University and author of Treatment of Bipolar Disorder: A Guide for Patients and Families, says to watch for these symptoms:

    “To be considered a formal episode of depression, sad mood or profound loss of pleasure has to last at least two weeks, and be accompanied by at least four of the following symptoms:

    •   Marked weight and appetite change
    •   Marked sleep change
    •   Feeling either very agitated or very lethargic
    •   Fatigue
    •   Feeling worthless or very guilty
    •  Trouble concentrating
    •  Having suicidal thoughts and feelings

    However, in bipolar disorder, especially in someone who’s being treated for the condition, the full range of symptoms might not develop, or might be briefer than the official two week cut-off. 

    So, the key is whether your bad mood happens a lot more often than it does to other people, if it lasts longer than it would for other people, or if it occurs without apparent environmental triggers. These are admittedly pretty subjective, but may be clues to having residual depressive problems that would benefit from more vigorous treatment.”

  • Q: I think someone I know has bipolar disorder. How can I tell? What should I do?
  • Answer:

    A:  “There are many clues that can lead you to wonder if someone you care about has bipolar disorder,” says David Kahn, MD, a clinical professor of psychiatry at Columbia University and author of Treatment of Bipolar Disorder: A Guide for Patients and Families. “Just a few examples are:

    • A change in personality that is sustained over a period of weeks, or frequent changes that last days at a time and happen quite often
    • Irritability or social withdrawal that persists and becomes out-of-character compared to the what that person used to be like
    • Long bouts of either high energy or low energy that you can clearly observe 
    • Complaints by the person of feeling down, bored, or flat
    • Expressions of either abnormally high hopes and unrealistic expectations, or of hopelessness and pessimism

    Of course, there are lots of reasons for people acting sad or irritable, so you cannot be sure. The goal is to get your friend of relative to have a proper medical evaluation. If you have a good relationship, you could ask the person if he or she would like to talk about it or get some help.  If you don't know the person well and don't feel comfortable approaching the subject, you could try and speak to a friend or relative who does and whom you can trust not to alienate the person you're worried about.

    If someone you know is talking about killing himself or herself, then you really ought to talk to them about getting help. Offer them help in getting to a doctor, an employee health program, or even to an emergency room. If a person is truly agitated and violent or out of control, then you would need the help of police or professional safety officers.”

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on May 22, 2012

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