Bipolar Disorder

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KEY POINTS

• Bipolar disorder causes extreme changes in mood, thinking, and behavior, such as feeling highly energized and very active, and then feeling sad, hopeless, and low energy.
• Treatment may include medicines, therapy, and learning ways to manage stress. In severe cases, you may need to be treated in the hospital.
• 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.

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What is bipolar disorder?

Bipolar disorder is a condition that causes extreme changes in mood, thinking, and behavior. There are usually two "mood phases," a manic phase and a depressed phase. In the manic phase you feel highly energized and are very active. In the depressed phase you are very sad, hopeless, and just don’t care about anything.

Bipolar disorder may last a lifetime. Symptoms tend to get worse if not treated. Bipolar disorder can be managed even if it is not cured.

What is the cause?

The exact cause of the disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals. What causes the switch between moods is not known.
• Bipolar disorder tends to run in families. Stress also plays a part.
• People with this disorder may have physical changes in their brain. These changes may mean that some parts of the brain are more active or less active than in other people.
• Some medicines can cause depression or manic symptoms. These include some blood pressure medicines, diet pills, and steroids such as prednisone.
• Alcohol and drug abuse can trigger symptoms.

Bipolar disorder is not very common. It usually starts during the young adult years. 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 an unrealistic belief that you are unusually smart, creative, and can do amazing things
• Be very talkative and talk so fast that others have trouble following what you are saying
• Have racing thoughts
• Have trouble concentrating and jump between different ideas
• Take on lots of new projects often without finishing any of them
• Have more feelings of anxiety and panic
• Go for days with little or no sleep and not feel tired
• Be very irritable
• Get into fights with others
• Be more interested in sex
• Be extremely active and act recklessly, such as going on spending sprees or having unsafe sex

When you’re having a manic episode, you may think that you’re fine, but that other people around you are causing problems.

If you have a very intense episode, you may also have symptoms like confusion; hearing, seeing, or feeling things that others do not; or believing things that are not true.

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:

• Feel sad and uninterested in things you usually enjoy
• 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
• Feel very tired or low energy
• Lose sexual desire
• Feel worthless and guilty
• Not be able to concentrate or remember things
• Feel hopeless or just not care about anything
• Have physical symptoms, such as headaches and joint pain
• Think often about death or suicide

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, have racing thoughts, withdraw from others, feel worthless or very irritable, and cry often.

Symptoms may last for days or weeks. Some people have rapid cycling patterns and can have 4 or more extreme mood changes in a year.

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

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 better after a few weeks of treatment. Bipolar disorder can be treated effectively even if it is not cured.

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 medicines can help treat bipolar disorder. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine.

Therapy

Combining medicines with therapy is often the best approach. Cognitive behavioral therapy (CBT) is a form of therapy that helps you identify and change thought processes. Replacing negative thoughts with more positive ones can help you learn how to manage your symptoms.

Family therapy is often very helpful. Family therapy treats the family as a whole rather than focusing on just you.

Interpersonal therapy can help you work on one or two problem areas, such as relationships with friends and family. Learning about the disorder and how to manage symptoms also helps.

Other treatments

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. No known herbal or natural remedies are effective in treating bipolar disorder. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe. Talk with your healthcare provider before you use any of these products.

How can I take care of myself?

• Take your medicines every day, even if you are feeling well. Bipolar disorder is a lifelong illness. Stopping your medicines when you feel well may bring on episodes.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Exercise according to your healthcare provider's instructions.
• Avoid alcohol and drugs.
• Check your medicines. 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.
• Get support. Talk with family and friends. Watch yourself for the beginning signs of a manic or depressive episode. Ask others around you to also watch closely.

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 more information, contact:

• Depression and Bipolar Support Alliance
  800-826-3632
  http://www.dbsalliance.org
• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/