Bipolar disorder, sometimes called manic depression, is a disorienting condition that causes extreme shifts in mood. Like riding a slow-motion roller coaster, patients may spend weeks feeling like they're on top of the world before plunging into a relentless depression. The length of each high and low varies greatly from person to person. In any given year, bipolar disorder affects more than 2% of American adults.
Depressive Phase Symptoms
Without treatment, a person with bipolar disorder may experience intense episodes of depression. Symptoms include sadness, anxiety, loss of energy, hopelessness, and difficulty concentrating. Patients may lose interest in activities that were once pleasurable. They may gain or lose weight, sleep too much or too little, and contemplate suicide.
Manic Phase Symptoms
During a manic phase, patients tend to feel euphoric and may believe they can accomplish anything. This can result in inflated self-esteem, agitation, reduced need for sleep, being more talkative, being easily distracted, and a sense of racing thoughts. Reckless behaviors, including spending sprees, sexual indiscretions, fast driving, and substance abuse, are common. Having three or more of these symptoms nearly every day for a week may indicate a manic episode.
Bipolar I vs. Bipolar II
People with bipolar I disorder have manic episodes or mixed episodes and often have one or more depressive episodes. People with bipolar II have major depressive episodes with less severe mania; they experience hypomania, a condition that is less intense than mania or lasting less than a week. Patients may seem like the "life of the party" -- full of charm and humor. They may feel and function fine, even if family and friends can see the mood swing. However, hypomania can lead to mania or depression.
People with mixed episode experience depression and mania at the same time. This leads to unpredictable behavior, such as sadness while doing a favorite activity or feeling very energetic. It's more common in people who develop bipolar disorder at a young age, particularly during adolescence. But some estimates suggest up to 70% of bipolar patients experience mixed episodes.
Causes of Bipolar Disorder
Doctors aren't exactly sure what causes bipolar disorder. A leading theory is that brain chemicals fluctuate abnormally. When levels of certain chemicals become too high, the patient develops mania. When levels drop too low, depression may result.
Bipolar Disorder: Who's at Risk?
Bipolar disorder affects males and females equally. In most cases, the onset of symptoms is between 15 and 30 years old. People are at higher risk if a family member has been diagnosed, especially if it's a first degree relative, but doctors don't think the disorder kicks in based on genetics alone. A stressful event, drug abuse, or other unknown factor may trigger the cycle of ups and downs.
Bipolar Disorder and Daily Life
Bipolar disorder can disrupt your goals at work and at home. In one survey, 88% of patients said the illness took a toll on their careers. The unpredictable mood swings can drive a wedge between patients and their co-workers or loved ones. In particular, the manic phase may scare off friends and family. People with bipolar disorder also have a higher risk of developing anxiety disorders.
Bipolar Disorder and Substance Abuse
About 60% of people with bipolar disorder have trouble with drugs or alcohol. Patients may drink or abuse drugs to relieve the uncomfortable symptoms of their mood swings. This is especially common during the reckless manic phase.
Bipolar Disorder and Suicide
People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without the illness. Warning signs include talking about suicide, putting affairs in order, and inviting death with risky behavior. Anyone who appears suicidal should be taken very seriously. Do not hesitate to call one of the suicide hotlines: 1-800-SUICIDE (1-800-784-2433) and 1-800-273-TALK (1-800-273-8255). If you have a plan to commit suicide, go to the emergency room for immediate treatment.
Diagnosing Bipolar Disorder
A crucial step in diagnosing bipolar disorder is to rule out other possible causes of extreme mood swings. These may include brain infection or other neurological disorders, substance abuse, thyroid problem, HIV, ADHD, side effects of certain medications, or other psychiatric disorders. There is no lab test for bipolar disorder. A psychiatrist usually makes the diagnosis based on a careful history and evaluation of the patient's mood and other symptoms.
Medications for Bipolar Disorder
Medications are key in helping people with bipolar disorder live stable, productive lives. Mood stabilizers can smooth out the cycle of ups and downs. Patients may also be prescribed antipsychotic drugs and anticonvulsant drugs. Between acute states of mania or depression, patients typically stay on maintenance medication to avoid a relapse.
Talk Therapy for Bipolar Disorder
Talk therapy can help patients stay on medication and cope with their disorder's impact on work and family life. Cognitive behavioral therapy focuses on changing thoughts and behaviors that accompany mood swings. Interpersonal therapy aims to ease the strain bipolar disorder may place on personal relationships. Social rhythm therapy helps patients develop and maintain daily routines.
Lifestyle Tips for Bipolar Disorder
Establishing firm routines can help manage bipolar disorder. Routines should include sufficient sleep, regular meals, and exercise. Because alcohol and recreational drugs can worsen the symptoms, these should be avoided. Patients should also learn to identify their personal early warning signs of mania and depression. This will allow them to get help before an episode spins out of control.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy can help some people with bipolar disorder. ECT uses an electric current to cause a seizure in the brain. It is one of the fastest ways to ease severe symptoms. ECT is usually a last resort when a patient does not improve with medication or psychotherapy.
Educating Friends and Family
Friends and family may not understand bipolar disorder at first. They may become frustrated with the depressive episodes and frightened by the manic states. If patients make the effort to explain the illness and how it affects them, loved ones may become more compassionate. Having a solid support system can help people with bipolar disorder feel less isolated and more motivated to manage their condition.
When Someone Needs Help
Many people with bipolar disorder don't realize they have a problem or avoid getting help. If you're concerned about a friend or family member, here are a few tips for broaching the subject. Point out that millions of Americans have bipolar disorder, and that it is a treatable illness -- not a personality flaw. There is a medical explanation for the extreme mood swings, and effective treatments are available.
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National Alliance on Mental Illness.
National Institute of Mental Health.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.