Bipolar (Manic-Depressive) Disorder

What is bipolar disorder?

Bipolar disorder used to be called manic-depressive disorder. It causes extreme changes in mood, thinking, and behavior. In the manic phase you feel highly energized and are very active. In the depressed phase you are very depressed. Most people with bipolar disorder have these severe mood swings many times during their lives. Some people have mostly manic phases. Others may have mostly depressed phases.

How does it occur?

About 1% of people develop bipolar disorder. It usually begins during the young adult years. About as many men as women get bipolar disorder.

The exact causes of the disorder are unclear. However, it does run in families. If you have relatives with bipolar disorder, you are more likely to have it.

Parts of the brain may not work normally during manic and depressive episodes. But exactly what triggers these switches is unclear.

If you are a woman, episodes may be more likely right before your monthly period or after the birth of a child.

What are the symptoms?

During a manic episode you may:

• Have a very high sense of self-worth and a feeling of being "on top of the world."
• Be very talkative and talking fast, maybe so fast that others have trouble following what you are saying.
• Have racing thoughts and ideas to the point of being disorganized and muddled.
• Have trouble concentrating and jump between different ideas.
• Be very restless and hyperactive.
• Have more anxiety and panic.
• Go for days with little or no sleep and not feel tired.
• Be very irritable and get into fights with others.
• Have bursts of high interest in sex and sexual activity.
• Be too active and act recklessly. For example, you might spend all your money and go into debt, or take sudden trips.

If you have a very intense manic episode, you may also have symptoms like confusion, delusions (ideas that aren't true), or hallucinations.

A manic episode may be followed by a period of normal mood and behavior or a period of depression.

During a period of depression, you may:

• Be irritable.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Notice changes in your appetite and weight, either up or down.
• Notice changes in energy level, usually down but sometimes feeling overexcited.
• Lose sexual desire and function.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained physical symptoms.
• Think often about death or suicide.

These symptoms may last for days or weeks. Rapid cycling patterns are defined by 4 or more mood disturbances (major depressive, mixed, manic, or hypomanic episodes) in a year.

You may also have what is called a mixed episode. A mixed episode is mania with depressed symptoms at the same time. In a mixed episode you may be overly active, withdraw from others, feel worthless, and cry often.

How is it diagnosed?

Your healthcare provider or mental health therapist will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical problems such as hormone imbalances.

How is it treated?

Medicines are the most effective treatment for bipolar disorder. If an episode is severe, you may need to spend some time in a hospital.

Medicines

Several types of mood stabilizing medicines can help treat bipolar disorder. Your healthcare provider will work with you to carefully select the best one for you.

Sometimes you may need other medicines. For example an antidepressant, an antipsychotic, or an antianxiety medicine may give you the best results. However, it is possible that symptoms may become worse if you take antidepressants.

There are no nonprescription medicines for bipolar disorder.

Psychotherapy

Counseling and psychotherapy are usually very helpful. They help you learn how to maintain a positive lifestyle and attitude, which can reduce your episodes.

Natural Remedies and Alternative Treatments

Omega-3 fatty acids may help to reduce bipolar symptoms. No herbal or natural remedies are effective in treating bipolar disorder.

Controlling stress, keeping to a regular sleep schedule, having friends or family to support you, and being more relaxed may help manage manic or depressive episodes.

How long will the effects last?

Bipolar disorder may last a lifetime. Symptoms may also become more frequent as people age. Follow the treatment prescribed. Bipolar disorder can be managed even if it is not cured.

What can I do to help myself or my loved one?

• Take your medicines every day, even if you are feeling well. Stopping your medicines when you feel well may bring about episodes.
• Watch yourself for the beginning signs of a manic or depressive episode. Ask others around you to also watch closely.
• Stick to regular sleep and exercise routines even when you travel.
• Eat a healthy diet.
• Do not abuse drugs or alcohol.
• Do not drink too much caffeine.
• Check with the healthcare provider treating you for bipolar disorder before you take other medicines to make sure there is no conflict with your bipolar medicines.
• Contact organizations such as the Depression and Bipolar Support Alliance (DBSA), the National Alliance for the Mentally Ill (NAMI), and the Mental Health America (formerly the National Mental Health Association or NMHA) for information and support.

When should I seek help?

If you are showing the signs of either a manic or depressive episode, seek professional help quickly. Do not try to treat your illness by yourself. Professional treatment is necessary. If bipolar disorder is not treated, it tends to get worse. The mania and depression can be more severe and episodes happen more often. Most of the time, you will feel much better after a few weeks of treatment.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others. Also get emergency help if manic behavior becomes so wild that it endangers you or others.

For further information, see:
Resource List: Bipolar Disorder
Depression: Its Many Forms
Depression: Its Symptoms and Treatment