Bipolar Disorder

Bipolar disorder...
also known as manic-depressive illness,
is a brain disorder that causes unusual shifts
in a person's mood, energy, and ability to function.

Different from the normal ups and downs
that everyone goes through

The symptoms of bipolar disorder are severe.
they can result in damaged relationships, poor job
or school performance, and even suicide.
But there is good news:
bipolar disorder can be treated
and people with this illness
can lead full and productive lives.

More than 2 million American adults have bipolar disorder.
Bipolar disorder typically develops in late adolescence
or early adulthood.
However, some people have their first symptoms
during childhood, and some
develop them late in life.
It is often not recognized as an illness,
and people may suffer for years
before it is properly diagnosed and treated.
Like diabetes or heart disease,
bipolar disorder is a long-term illness
that must be carefully managed
throughout a person's life.

Symptoms

What Are the Symptoms of Bipolar Disorder
Bipolar disorder causes dramatic mood swings-
from overly "high" and/or irritable
to sad and hopeless, and then back again,
often with periods of normal mood in between.
Severe changes in energy and behavior
go along with these changes in mood.
The periods of highs and lows are called
episodes of mania and depression.

Signs and symptoms of mania include:

Increased energy, activity, and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast,
jumping from one idea to another
Distractibility, can't concentrate well
Little sleep needed
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine,
alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
A manic episode is diagnosed if elevated mood
occurs with 3 or more
of the other symptoms most of the day, nearly every day,
for 1 week or longer

Signs and symptoms of depression

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed,
Decreased energy, a feeling of fatigue or of being
"slowed down"
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can't sleep
Change in appetite with unintended weight loss or gain
Chronic pain or other persistent bodily symptoms
that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if 5 or more of these symptoms
last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania.

Hypomania may feel good to the person who experiences it and
may even be associated with good functioning and enhanced productivity
Even when family and friends learn to recognize the mood swings
as possible bipolar disorder, the person may deny that anything is wrong.
Without proper treatment, however, hypomania can become severe mania
in some people or can switch into depression.

Sometimes, severe episodes of mania or depression can include symptoms of psychosis.
Common psychotic symptoms are hallucinations...
hearing, seeing, or sensing the presence of things not actually there
or delusions...
believing something that isn't realistically possible
It may be helpful to think of the various mood states
At one end is severe depression ranging to severe mania.
Bipolar disorder may appear to be a problem other than mental illness-for instance,
alcohol or drug abuse.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder
cannot yet be identified physiologically,
by a blood test or a brain scan.
A diagnosis of bipolar disorder is made on the basis of symptoms,
course of illness, and, when available, family history.

Suicide

Some people with bipolar disorder become suicidal.
Anyone who is thinking about committing suicide needs immediate attention
, preferably from a mental health professional or a physician.
Anyone who talks about suicide should be taken seriously.
Risk for suicide appears to be higher earlier in the course of the illness.
Therefore, recognizing bipolar disorder early and learning how best to manage it
may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

talking about feeling suicidal or wanting to die
feeling hopeless, that nothing will ever change or get better
feeling helpless, that nothing one does makes any difference
feeling like a burden to family and friends
abusing alcohol or drugs
putting affairs in order such as organizing finances or giving away possessions to prepare for one's death
writing a suicide note
putting themselves in dangerous situation where deathly injury is possible

What Is the Course of Bipolar Disorder

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience
chronic unremitting symptoms despite treatment.

People with bipolar disorder can lead
healthy and productive lives when the illness
is effectively treated
Without treatment,however,
bipolar disorder tends to worsen.

Can Children and Adolescents Have Bipolar Disorder

Both children and adolescents can develop bipolar disorder.
It is more likely to affect the children of parents who have the illness.

Bipolar disorder in children and adolescents
can be hard to tell apart from other problems
that may occur in these age groups.
While irritability and aggressiveness can indicate bipolar disorder,
it also can be symptoms of attention deficit hyperactivity disorder,
conduct disorder, oppositional defiant disorder
or other types of mental disorders more common among adults such as
major depression or schizophrenia
. Drug abuse also may lead to such symptoms.

As in any illness, however, effective treatment depends on appropriate diagnosis.
Children or adolescents with emotional and behavioral symptoms
should be carefully evaluated by a mental health professional.
Any child or adolescent who has suicidal feelings, talks about suicide,
or attempts suicide should be taken seriously and should receive immediate help
from a mental health specialist.

What Causes Bipolar Disorder

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies.
Most scientists now agree that there is no single cause for bipolar disorder-
rather,many factors act together to produce the illness.

How Is Bipolar Disorder Treated

Most people with bipolar disorder-
even those with the most severe forms
can achieve substantial stabilization of their mood swings
and related symptoms
with proper treatment
Because bipolar disorder is a recurrent illness,
long-term preventive treatment is strongly recommended
A combination of medication and psychosocial treatment is best
for managing the disorder over time.
Any changes in symptoms should bereported immediately to your doctor.
The doctor may be able to prevent a full-blown episode
by making adjustments to the treatment plan

Medications

Medications for bipolar disorder are prescribed by psychiatrists
While primary care physicians who do not specialize in psychiatry
also may prescribe these medications
it is recommended that people with bipolar disorder
see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed
to help control bipolar disorder
Several different types of mood stabilizers are available
Other medications are added when necessary,
to treat episodes of mania or depression
that break through despite the mood stabilizer.

Lithium, the first mood-stabilizing medication approved
by the U.S. Food and Drug Administration for treatment of mania,
is often very effective in controlling mania and preventing
the recurrence of both manic and depressive episodes.
Anticonvulsant medications, also can have mood-stabilizing effects
and may be especially useful for difficult-to-treat bipolar episodes
Anticonvulsant medications may be combined with lithium,
or with each other, for maximum effect.

Children and adolescents with bipolar disorder
generally are treated with lithium.
Women with bipolar disorder who wish to conceive
, or who become pregnant,face special challenges
due to the possible harmful effects
of existing mood stabilizing medications
on the developing fetus and the nursing infant
Therefore, the benefits and risks of all available treatment options
should be discussed with a physcian skilled in this area.
New treatments with reduced risks during pregnancy and breast feeding
are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder
are at risk of switching into mania or hypomania,
or of developing rapid cycling during treatment
with antidepressant medication.
Mood-stabilizing medications generally are required,
alone or in combination with antidepressants,
to protect people with bipolar disorder from this switch.
Lithium and valproate are the most commonly
used mood-stabilizing drugs today.
Lithium levels in the bloodstream must be monitored
by blood tests at intervals dictated by the physcian
Otherwise toxic levels can be attained and cause significant
mental and physical symptoms
Research studies continue to evaluate
the potential mood-stabilizing
effects of newer medications.

Medication Side Effects

Before starting a new medication for bipolar disorder,
always talk with your psychiatrist and/or pharmacist
about possible side effects.
Depending on the medication, side effects may include
weight gain, nausea, tremor,reduced sexual drive or performance,
anxiety, hair loss, movement problems, or dry mouth.
Be sure to tell the doctor about all side effects you notice during treatment.
He or she may be able to change the dose or offer
a different medication to relieve them.
Your medication should not be changed or stopped
without the psychiatrist's guidance.

Psychosocial Treatments

As an addition to medication,
psychotherap are helpful in providing support, education,
and guidance to people with bipolar disorder and their families.
Studies have shown that psychosocial interventions
can lead to increased mood stability,fewer hospitalizations,and improved
functioning in several areas
A licensed psychologist, social worker, or counselor
typically provides these therapies and often works together
with the psychiatrist to monitor a patient's progress.
The number, frequency, and type of sessions should be based
on the treatment needs of each person.

A Long-Term Illness That Can Be Effectively Treated
Even though episodes of mania and depression naturally come and go, it is important
to understand that bipolar disorder is a long-term illness that currently has no cure.
Staying on treatment, even during well times, can help keep the disease under control
and reduce the chance of having recurrent, worsening episodes.

Do Other Illnesses Co-occur with Bipolar Disorder

Alcohol and drug abuse are very common among people with bipolar disorder.
Research findings suggest that many factors may contribute to these substance
abuse problems, including self-medication of symptoms, mood symptoms either
brought on or perpetuated by substance abuse, and risk factors that may influence
the occurrence of both bipolar disorder and substance use disorders
Treatment for co-occurring substance abuse, when present, is an important part
of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder,
also may be common in people with bipolar disorder.
Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder,
or they may require separate treatment.

How Can Individuals and Families Get Help for Bipolar Disorder

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in
the diagnosis and treatment of this disease. Other mental health professionals,
such as psychologists, psychiatric social workers, and psychiatric nurses, can assist
in providing the person and family with additional approaches to treatment.

Help can be found at:

University-or medical school-affiliated programs
Hospital departments of psychiatry
Private psychiatric offices and clinics
Health maintenance organizations (HMOs)
Offices of family physicians, internists, and pediatricians
Public community mental health centers
People with bipolar disorder may need help to get help.
Often people with bipolar disorder do not realize how impaired they are.
A person with bipolar disorder may need strong encouragement
from family and friends to seek treatment.
Family physicians can play an important role in providing
referral to a mental health professional.
A person who is in the midst of a severe episode
may need to be hospitalized for his or her own protection and treatment.
There may be times when the person must be hospitalized against his or her wishes.
Ongoing encouragement and support are needed after a person obtains treatment.

Like other serious illnesses, bipolar disorder is also hard on
spouses, family members, friends, and employers.
Family members of someone with bipolar disorder often have to cope with the
person's serious behavioral problems.
Many people with bipolar disorder and their families benefit from joining support groups.

What About Clinical Studies for Bipolar Disorder

Some people with bipolar disorder receive medication and/or psychosocial therapy
by volunteering to participate in clinical studies (clinical trials). Clinical studies involve
the scientific investigation of illness and treatment of illness in humans. Clinica
l studies in mental health can yield information about the efficacy of a medication
or a combination of treatments, the usefulness of a behavioral intervention or type
of psychotherapy, the reliability of a diagnostic procedure, or the success of a
prevention method. Clinical studies also guide scientists in learning how illness develops,
progresses, lessens, and affects both mind and body. Millions of Americans diagnosed
with mental illness lead healthy, productive lives because of information discovered
through clinical studies. These studies are not always right for everyone, however.
It is important for each individual to consider carefully the possible risks and benefits
of a clinical study before making a decision to participate.