Bipolar (Manic-Depressive) Disorder

What is bipolar disorder?

This disorder used to be called manic-depressive disorder. Bipolar disorder 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.

How does it occur?

Bipolar disorder usually begins with either a manic episode followed by a depressed period or the other way around. About 1% of people develop bipolar disorder. It usually begins during the teenage or young adult years. About as many men as women get bipolar disorder.

The exact causes of the disorder is 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.

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 jumping between different ideas.
• Be very restless and hyperactive.
• Go for days with little or no sleep and not feeling 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 bad manic episode, you may also have psychotic 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 pain in your back or abdomen, or get headaches.
• Think often about death or suicide.

These symptoms may last for days or weeks.

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 health care 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. There are no lab tests that directly diagnose bipolar disorder.

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

Your health care provider will carefully consider your symptoms and history to choose the best medicine for you. Lithium carbonate (Lithium), valproic acid (Depakote) and carbamazepine (Tegretol) are the most commonly used medicines. Sometimes you may need other drugs. Your health care provider might also prescribe an antidepressant, an antipsychotic, or an antianxiety medication for best results.

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. Psychotherapy also helps you get control over your mood swings more quickly.

Natural Remedies and Alternative Treatments

No herbal or natural remedies are effective in treating bipolar disorder. St. John's wort is effective for mild depression but not for bipolar disorder.

Controlling stress and being more relaxed may help with manic or depressive episodes. Treatments that might help with this include biofeedback, art therapy, and massage therapy. They do not directly treat bipolar disorder.

How long will the effects last?

Bipolar disorder is a lifelong problem that may require treatment throughout your life. There is some evidence that as people age their episodes become more frequent. This makes it important to follow your prescribed treatment every day.

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 is likely to bring about episodes.
• Watch yourself for the beginning signs of a manic or depressive episode. Ask others around you to also watch closely.
• Maintain routines, even when you travel, of getting enough sleep and exercise every day.
• Check with the health care provider treating you for your bipolar disorder before you start taking 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 National Mental Health Association (NMHA) for information and support.
  • DBSA's toll-free telephone number is 1-800-826-3632. Its Web site address is http://www.dbsalliance.org.
  • NAMI's toll-free helpline number is 1-800-950-NAMI. NAMI's Web site address is http://www.NAMI.org.
  • NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's Web site address is http://www.NMHA.org.

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. Most of the time, you will feel much better after a few weeks of treatment.

If you have had a past episode of depression or mania and begin to feel one coming again, get professional help quickly. Episodes can come back with very little warning.

When to get immediate help

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