The exact causes of bipolar disorder are unknown. While genes and life stress may contribute to it, experts believe that symptoms may arise from a problem with nerve signals in the brain that control emotion, thinking, and behavior.
The best treatment for bipolar disorder is a combination of medication and counseling. Other treatments such as electroconvulsive therapy (ECT) are often successful for people who don't respond to traditional therapy or who can't take the medications.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
Taken together, these factors...
Doctors often treat the mania symptoms of bipolar disorder with one set of drugs and the depression symptoms with another set of drugs, although some mood-stabilizing drugs are effective at treating both kinds of symptoms. Certain drugs are also used for "maintenance" -- to maintain a steady mood. Antidepressants are usually not used alone because they sometimes cause manic attacks in depressed patients, and they may be less effective for treating bipolar depression.
Most people respond well to medications for bipolar disorder. For many others, the symptoms do not completely disappear despite therapy. The moods may become less intense and more manageable, however.
Remember, getting your diagnosis should come as a relief. Now you know what the problem has been and you're on the road to getting the right treatment.
Mania in Bipolar Disorder
If you are suffering from bipolar mania, your doctor at first may treat you with an anti-manic mood stabilizer plus an antipsychotic drug and/or a benzodiazepine to quickly control hyperactivity, sleeplessness, hostility, and irritability.
Mood stabilizers treat manias or depressions without causing symptoms to swing the other way. Some also may help to reduce the risk of suicide. They are usually taken for a long time, commonly for many years. Examples include lithium and certain anticonvulsant drugs such as Depakote, Lamictal, or Tegretol.
Treating bipolar mania often requires hospitalization because there is high risk for unpredictable, reckless behavior and noncompliance with treatment. For people with extreme mania, pregnant women with mania, or those people whose mania can't be controlled with mood stabilizers, doctors sometimes also recommend electroconvulsive therapy (ECT).
If mania occurs while you are on maintenance therapy, your doctor may simply change your medication dose. Or you may start taking an antipsychotic drug or a second mood stabilizer to lessen symptoms.
Non-drug treatments, such as psychotherapy and establishing a well-ordered routine, may help patients in their maintenance phase. This is often suggested along with medication, but non-drug treatments are usually not effective alone.
Depression in Bipolar Disorder
Treating bipolar depression is controversial and challenging. Studies have shown that antidepressants may be ineffective to treat bipolar depression, and using antidepressants alone may trigger a manic or hypomanic episode. Antidepressants alone also may lead to or prolong rapid cycling. In rapid cycling, a person may recover more quickly from depression, but may experience mania and then another episode of depression. And antidepressants can increase the risk of suicidal thoughts and attempts in children and adolescents with any form of depression.