Understanding Bipolar Disorder

Today, approximately 5.7 million U.S. adults in the U.S. have bipolar disorder, a serious mental illness.  Also known as manic-depressive disorder, the illness is characterized by extreme mood swings.

Bipolar disorder typically develops during an individual’s late teen or early adult years, with half of all cases emerging before age 25.

Symptoms

Bipolar disorder is characterized as one of several types, depending upon the cluster of symptoms:

• Bipolar I— requires at least one full manic episode, with or without depressive episodes.
• Bipolar II – features cycles of depression and elevated moods (often referred to as hypomanic episodes) that do not reach the level of a full mania.
• Bipolar Disorder Not Otherwise Specified (BP-NOS) — does not fully meet criteria for Bipolar I or II or follow a fixed pattern.
• Cyclothymia – exhibits much milder symptoms of the disorder.

An estimated 10-20% of affected individuals also experience rapid cycling, characterized by at least four episodes in one year.

Manic symptoms include excessive excitement, restlessness, increased energy, racing thoughts, irritability, sleeplessness, and a tendency to engage in reckless and impulsive actions.

Depressive symptoms include sadness, crying episodes, weight loss or gain, feelings of hopelessness or helplessness, decreased energy, loss of interest in daily activities, and thoughts of death or suicide.

Sometimes psychotic symptoms may also be present, such as hallucinations or delusions; e.g., “I am the wealthiest person in the world.”

Causes

While the causes of bipolar disorder are not completely understood, several risk factors may influence its development.

An individual whose parent or sibling has the disorder is up to six times more likely to develop the illness.  Researchers are seeking specific genes that play a causative role.  MRIs have shown structural changes in the brains of affected individuals. Imbalances in neurotransmitters, important brain chemicals, may be another culprit, as well as hormone imbalances.

Trauma or extreme stress may influence the development of the disorder or trigger episodes.

Treatment

Without treatment, bipolar disorder often worsens over time. Treatment is usually a combination of medication and psychotherapy.

Common medications used include:

• Mood stabilizers, including Lithium and various anticonvulsants.
• Atypical antipsychotics, such as Zyprexa or Abilify.
• Antidepressants, usually in combination with a mood stabilizer.
• Symbyax, FDA-approved specifically for bipolar disorder.
• Benzodiazepines, such as Klonopin or Ativan for anxiety and sleep disturbance.

Medication may be a lifetime commitment for a person with bipolar disorder.

Psychotherapy can help individuals learn to cope with the effects of the illness and avoid situations which might trigger episodes.  Cognitive behavioral therapy (CBT) teaches individuals to change negative patterns of behavior and thought, while interpersonal and social rhythm therapy focuses on improvement of relationships and more stable daily routines.  Psychoeducational approaches provide information to increase understanding and assist in recognition of warning signs.

Therapists also work with entire families or with groups of individuals with bipolar disorder.  Family-focused therapy helps families with communication, symptom recognition, and more effective coping skills.  Group therapy allows individuals to learn from others with the disorder, while practicing better interpersonal skills.

For individuals who have been resistant to other treatment methods, electroconvulsive therapy (ECT) has offered some benefit.

While there is no permanent cure for bipolar disorder, effective treatment can lead to better illness management and allow individuals to live normal lives.