Bipolar Disorder

Bipolar disorder was formerly called manic depression. It is a form of major affective disorder, or mood disorder, defined by manic or hypomanic episodes (changes from one's normal mood accompanied by high energy states). Bipolar disorder is a serious condition. Mania often involves sleeplessness, sometimes for days, along with hallucinations, psychosis, grandiose delusions, or paranoid rage. In addition, depressive episodes can be more devastating and harder to treat than in people who never have manias or hypomanias.

What Is Bipolar Disorder?

Bipolar disorder is a complex disorder that likely stems from a combination of genetic and non-genetic factors. The mood episodes associated with it involve clinical depression or mania (extreme elation and high energy) with periods of normal mood and energy in between episodes. The severity of mood episodes can range from very mild to extreme, and they can happen gradually or suddenly within a timeframe of days to weeks. When discrete mood episodes happen four or more times per year, the process is called rapid cycling. Rapid cycling should not be confused with very frequent moment-to-moment changes in mood, which can sometimes occur in people with bipolar disorder or other conditions such as borderline personality disorder.

Along with manic or depressive episodes, patients with bipolar disorder may have disturbances in thinking. They may also have distortions of perception and impairment in social functioning.

What Causes Bipolar Disorder?

Like with other mood disorders, the causes of bipolar disorder are not known. What is known is that bipolar disorder involves dysregulation of brain functioning and sometimes has a genetic component (it can run in families).

At What Age Is Bipolar Disorder Usually Diagnosed?

Bipolar disorder usually appears between ages 15 and 24 and persists through a lifetime. It's rare that newly diagnosed mania is seen in children or in adults over age 65.

Severity of symptoms varies with individuals who have bipolar disorder. While some people have a few symptoms, others have many that impair their ability to work and live a normal life.

Marked by relapses and remissions, bipolar disorder has a high rate of recurrence if untreated. Patients with severe mania usually require hospitalization to keep them from risky behaviors. Those who are severely depressed also might need hospitalization to keep them from acting on suicidal thoughts or psychotic symptoms (delusions, hallucinations, disorganized thinking).

About 90% of individuals with bipolar I disorder, which is the more serious form, have at least one psychiatric hospitalization. Two out of three will have two or more hospitalizations in their lifetime.

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What Are the Depression Symptoms of Bipolar Disorder?

The clinical depression symptoms seen with bipolar disorder are the same as those seen in major depressive disorder and include:

  • Decreased appetite and/or weight loss, or overeating and weight gain
  • Difficulty concentrating, remembering, and making decisions
  • Fatigue, decreased energy, being "slowed down"
  • Feelings of guilt, worthlessness, helplessness
  • Feelings of hopelessness, pessimism
  • Insomnia, early-morning awakening, or oversleeping
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
  • Persistently sad, anxious, or "empty" moods
  • Restlessness, irritability
  • Thoughts of death or suicide, suicide attempts

What Are the Signs of Mania in Bipolar Disorder?

The signs of mania in bipolar disorder include:

  • Disconnected and very fast (racing) thoughts
  • Grandiose beliefs
  • Inappropriate elation or euphoria
  • Inappropriate irritability
  • Inappropriate social behavior
  • Increased sexual desire
  • Increased talking speed or volume
  • Markedly increased energy
  • Poor judgment
  • A decreased need for sleep due to high energy

What Is Bipolar II Disorder?

While mania is the main characteristic of bipolar I disorder, bipolar II has milder periods of elation known as hypomania. It also has episodes of major depression. According to the DSM-5, the diagnostic manual published by the American Psychiatric Association, the difference between mania and hypomania is "the degree of severity" as well as an absence of psychosis (delusions or hallucinations) in hypomania and no negative impact from "high" symptoms in work and social functioning.

What Are Signs of Hypomania in Bipolar II Disorder?

Signs of hypomania in bipolar II disorder include:

  • Decreased need for sleep
  • Extreme focus on projects at work or at home
  • Exuberant and elated mood
  • Increased confidence
  • Increased creativity and productivity
  • Increased energy and libido
  • Reckless behaviors
  • Risky pleasure-seeking behaviors

How Is Bipolar Disorder Diagnosed?

As with most mood disorders, there is no laboratory test or brain imaging method to diagnose bipolar disorder. After performing a physical exam, your doctor will evaluate your signs and symptoms. Your doctor will also ask you about your personal medical history and family history. Lab tests may be done to rule out other medical illnesses that can affect mood.

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In addition, your doctor may want to talk with family members to see if they can identify times when you were elated and over-energized. Because elation may feel good or even normal when compared to depression, it's often hard for a person with bipolar disorder to know if the mood was too high. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. So early diagnosis and effective treatment is very important with bipolar disorder.

How Is Bipolar Disorder Treated?

Treatment for bipolar disorder may include the use of mood stabilizers such as lithium. Certain anticonvulsants, antipsychotics, and benzodiazepines may also be used to stabilize mood. Sometimes antidepressants are given in combination with mood stabilizers to boost the depressed mood, although antidepressants are often not as effective as some mood stabilizers or certain atypical antipsychotics for treating depression in bipolar disorder.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on February 27, 2016

Sources

SOURCES:

National Institute of Mental Health: "What is Depression?" and "What are the different forms of depression?"

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Fieve, R. Bipolar II, Rodale Books, 2006.

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