Bipolar disorder (manic-depressive illness) is a mood disorder, which means that the symptoms are disturbances or abnormalities of mood. Major depression is a more common illness, the symptoms of which are mainly those of 'low' mood. Bipolar disorder involves episodes of both serious mania and depression. The person's mood swings from excessively 'high' and irritable, to sad and hopeless, and then back again, with periods of normal mood in between. Different from normal mood states of happiness and sadness, symptoms of manic-depressive illness can be severe and life threatening. However, because many artists, musicians and writers have suffered from bipolar illness, the effect of the illness has sometimes been trivialized, and regarded in some way as beneficial for artistic creativity. In fact, for those afflicted with the illness, it is extremely distressing and disruptive.
Bipolar disorder is the third most common mood disorder after major depression and dysthymic disorder. It affects about 1% of adults during their lifetime. Symptoms typically begin during adolescence or early adulthood, and continue to recur throughout life. Men and women are equally likely to develop this disabling illness. The consequences of the illness can be devastating, and may include marital break-ups, unemployment, alcohol and drug abuse. Bipolar illness is often complicated by co-occurring alcohol or substance abuse. Without effective treatment, bipolar illness leads to suicide in nearly 20% of cases.
Effective treatments are available that greatly reduce the suffering caused by bipolar disorder, and can usually prevent its devastating complications. However, bipolar disorder is often not recognized by the patient, relatives, friends, or even physicians. People with bipolar disorder may suffer needlessly without proper treatment, for years or even decades. Also, many patients do not respond to at least one drug, and many show no response to several. This means that combination treatment is often the rule because a combination of different drugs with different methods of action can be more effective without increasing the risk of side effects. Lithium is still the most used drug overall in mania, but mood stabilizing anticonvulsant are also widely used.
Causes of bipolar disorder
Bipolar disorder tends to run in families, and is believed to be inherited in many cases. More than two-thirds of people with manic-depressive illness have at least one close relative with the disorder, or with major depression. This suggests that genetic factors are important, and it is likely that susceptibility to the illness is related to several genes. However, the specific genes involved have not yet been conclusively identified. Once this is achieved it is hoped that it will be possible to better treatments and prevention strategies aimed at the underlying illness process.
Sensitisation (kindling)
It may be that the development of bipolar disorder is due to a process of sensitisation (kindling). This idea suggests that the first episodes of illness are triggered by stressful life events, but that each episode of illness causes changes in the brain which make the next episode more likely, and eventually episodes occur spontaneously. This process was first describes as an explanation for epilepsy, and may explain why certain antiepileptic drugs are also effective in the treatment of bipolar disorder.
Neurotransmitters
Neurotransmitters are the molecules that enable the transmission of nerve impulses from one nerve to the next. Since it is thought that faulty nerve transmission may be one cause of bipolar disorder, it is possible that these molecules are involved. Examples include dopamine, serotonin (5-HT; 5-hydroxytryptamine), acetylcholine, GABA and glutamate.
Introduction | Symptoms and diagnosis | Causes of bipolar disorder | Treatment | The role of family and friends
Symptoms and diagnosis
Bipolar disorder involves cycles of mania and depression. These two mood states can be thought of as opposite ends of a range. At one end is severe depression; then moderate depression; mild and brief mood disturbances (that many people call 'the blues'); normal mood; hypomania (a mild form of mania); and at the other extreme is mania.
Some people with untreated bipolar disorder have repeated depressive episodes 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.
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 (destruction of personal relationships, loss of employment, and suicide).
Signs and symptoms of mania include periods of:
Excessively 'high' or euphoric feelings
Increased energy, activity, restlessness, racing thoughts, and increased talkativeness
Overly-inflated self-esteem
Extreme irritability and distractibility
Reduced need for sleep
Unrealistic beliefs in one's abilities and powers
Uncharacteristically poor judgement
A sustained 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
Signs and symptoms of depression include periods of:
Persistent sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of inappropriate guilt, worthlessness, or helplessness
Loss of interest or pleasure in ordinary activities, including sex
Loss of energy, a feeling of fatigue or of being 'slowed down'
Difficulty thinking or concentrating, remembering, making decisions
Restlessness or irritability
Difficulties sleeping, or oversleeping
Loss of appetite and weight, or weight gain
disease
Repeated thoughts of death or suicide; suicide attempts
An early sign of manic-depressive illness may be hypomania, in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences it, so even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong. In its early stages, bipolar disorder may appear to be a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
Severe depression or mania may be accompanied by periods of psychosis. Psychotic symptoms include: hallucinations (hearing, seeing, or otherwise sensing things which do not exist) and delusions (false beliefs that illogical, held despite evidence to the contrary).
Symptoms of mania and depression may be present at the same time ( mixed state). The symptoms often include agitation, trouble sleeping, a significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Symptoms (mania, depression, or mixed state) are usually limited to distinct episodes of illness. These episodes are separated by periods during which the person suffers few to no symptoms. Some episodes can be as long as 1 year whereas others may be as short as several hours, depending on the patient. With time, episodes become more frequent. When four or more episodes of illness occur within a 12-month period, the person is said to have manic-depressive illness with rapid cycling. In most patients, the number of episodes experienced in a lifetime is approximately 8-10, but many patients experience more. In rapid-cycling bipolar disorder, 4 or more episodes can occur in each yearlong period.
Introduction | Symptoms and diagnosis | Causes of bipolar disorder | Treatment | The role of family and friends
The role of family and friends
Like other serious illnesses, bipolar disorder is hard on spouses, family members, friends, and employers. Family 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. If symptoms cause an individual to become aggressive, or unable to fulfil their responsibilities, family members may well become angry with the individual. Family members often experience feelings of extreme guilt after the individual is diagnosed. They are concerned about having had angry or hateful thoughts, and many wonder whether they somehow caused the illness by being un-supportive or short-tempered, although this is not the case.
People with bipolar disorder should be cared for by a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists and psychiatric social workers, can assist in providing the patient and his or her family with additional approaches to treatment.
Often people with bipolar disorder do not recognize how ill they are, or blame their problems on some cause other than mental illness. They often need encouragement from family and friends to seek treatment; the family physician can make the first assessment. If the person is in the middle of a severe episode, he or she may have to be committed to a hospital for his or her own protection and for much needed treatment. Anyone who is considering suicide needs immediate attention from a family doctor or mental health specialist. With appropriate help and treatment, it is possible to overcome suicidal tendencies.
It is important for patients to understand that bipolar disorder will not go away, and that continued treatment is needed to keep the disease under control. Encouragement and support are equally as important after the person begins treatment, because it may take some time to decide what treatment regimen is best for that particular person.
8:38 a.m. - 2003-09-17
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