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Bipolar Disorder

 

What is Bipolar Disorder?
Awareness
Recognition
Treatment
For further information contact:

WHAT IS BIPOLAR DISORDER?

Bipolar disorder--which is also known as manic-depressive illness and will be called by both names throughout this publication--is a mental illness involving episodes of serious mania and depression. The person's mood usually swings from overly "high" and irritable to sad and hopeless, and then back again, with periods of normal mood in between.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people who have it may suffer needlessly for years or even decades.

Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These include marital break-ups, job loss, alcohol and drug abuse, and suicide.

Here are some facts about bipolar disorder.

 

AWARENESS

Manic-depressive illness has a devastating impact on many people.

bulletAt least 2 million Americans suffer from manic-depressive illness. For those afflicted with the illness, it is extremely distressing and disruptive.
bulletLike other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
bulletFamily members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.
bulletBipolar disorder tends to run in families and is believed to be inherited in many cases. Despite vigorous research efforts, a specific genetic defect associated with the disease has not yet been detected.
bulletBipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. It can be confused with attention deficit/hyperactivity disorder, so careful diagnosis is necessary.

RECOGNITION

Bipolar disorder involves cycles of mania and depression.

Signs and symptoms of mania include discrete periods of:
bulletIncreased energy, activity, restlessness, racing thoughts, and rapid talking
bulletExcessive "high" or euphoric feelings
bulletExtreme irritability and distractibility
bulletDecreased need for sleep
bulletUnrealistic beliefs in one's abilities and powers
bulletUncharacteristically poor judgment
bulletA sustained period of behavior that is different from usual
bulletIncreased sexual drive
bulletAbuse of drugs, particularly cocaine, alcohol, and sleeping medications
bulletProvocative, intrusive, or aggressive behavior
bulletDenial that anything is wrong

Signs and symptoms of depression include discrete periods of:
bulletPersistent sad, anxious, or empty mood
bulletFeelings of hopelessness or pessimism
bulletFeelings of guilt, worthlessness, or helplessness
bulletLoss of interest or pleasure in ordinary activities, including sex
bulletDecreased energy, a feeling of fatigue or of being "slowed down"
bulletDifficulty concentrating, remembering, making decisions
bulletRestlessness or irritability
bulletSleep disturbances
bulletLoss of appetite and weight, or weight gain
bulletChronic pain or other persistent bodily symptoms that are not caused by physical disease
bulletThoughts of death or suicide; suicide attempts

It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania.

Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single "mixed" bipolar state.

Descriptions provided by patients themselves offer valuable insights into the various mood states associated with bipolar disorder:

Depression:

I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless....[I am] haunt[ed]...with the total, the desperate hopelessness of it all... Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?

Hypomania:

At first when I'm high, it's tremendous...ideas are fast...like shooting stars you follow until brighter ones appear...all shyness disappears, the right words and gestures are suddenly there...uninteresting people, things, become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria...you can do anything...but, somewhere this changes.

Mania:

The fast ideas become too fast and there are far too many...overwhelming confusion replaces clarity...you stop keeping up with it--memory goes. Infectious humor ceases to amuse. Your friends become frightened...everything is now against the grain...you are irritable, angry, frightened, uncontrollable, and trapped.

Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment, and suicide.

 

Manic-depressive illness is often not recognized by the patient, relatives, friends, or even physicians.

bulletAn early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior.
bulletHypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.
bulletIn its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.
bulletIf left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.

TREATMENT

Most people with manic-depressive illness can be helped with treatment.

bulletAlmost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.
bulletOne medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
bulletMost recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.
bulletSome scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.
bulletChildren and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
bulletValproate has recently been approved by the Food and Drug Administration for treatment of acute mania.
bulletThe high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia.
bulletThyroid augmentation may also be of value.
bulletFor depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.
bulletElectroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
bulletAs an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
bulletConstructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.
bulletBecause manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.

FOR FURTHER INFORMATION CONTACT:

National Institute of Mental Health
Information Resources and Inquiries Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Telephone: 301-443-4513
FAX: 301-443-4279
TTY: 301-443-8431
FAX4U: 301-443-5158
Website: http://www.nimh.nih.gov
E-mail: nimhinfo@nih.gov
National Depressive and Manic Depressive Association
730 Franklin Street, Suite 501
Chicago, IL 60610
Telephone: 312-642-0049; 1-800-826-3632
FAX: 312-642-7243
Website: http://www.ndmda.org
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Telephone: 703-524-7600; 1-800-950-NAMI (6264)
FAX: 703-524-9094
Website: http://www.nami.org
National Foundation for Depressive Illness, Inc.
P.O. Box 2257
New York, NY 10116
Telephone: 212-268-4260; 1-800-239-1265
FAX: 212-268-4434
Website: http://www.depression.org
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
Telephone: 703-684-7722; 1-800-969-NMHA (6642)
FAX: 703-684-5968
TTY: 1-800-433-5959
Website: http://www.nmha.org

 

 

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