Bipolar Disorder

What is bipolar disorder?

Bipolar disorder, also known as manic-depressive illness, is a psychiatric disease that causes extreme mood swings. At times a person who has bipolar disorder may feel very happy, full of energy and able to do anything. The person may not even want to rest when he or she feels this way. This feeling is called "mania". At other times, a person who has bipolar disorder may feel very sad and depressed. The person may not want to do anything when he or she feels this way. This is called "depression". People with bipolar disorder can go quickly from mania to depression and back again.

What causes bipolar disorder?

Bipolar disorder is known to run in families. If you have a parent who has bipolar disorder, you have a greater chance of having it.

What are the symptoms?

Bipolar disorder causes wide mood swings - from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. Signs and symptoms of mania (or a manic or "up" episode) include:

• Increased energy, activity and restlessness
• Excessively "high," overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can't concentrate well
• Little sleep needed
• Unrealistic beliefs in one's abilities and powers
• Poor judgment, spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medication
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.

Signs and symptoms of depression (or a depressive or "down" episode) include:

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feeling of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, a feeling of fatigue or of being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much or can't sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts.

A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

What are the risk factors?

• Both men and women can have bipolar disorder
• People of all ages can have bipolar disorder
• People with a family history of bipolar disorder have an increased risk for the disease.
• Having certain medical conditions or taking certain medications may increase your risk for a manic syndrome.

How is it diagnosed?

• Bipolar disorder is diagnosed on the basis of symptoms that occur during a manic episode, a history of previous episodes, and family history.
• A person's Health Care Provider will have to rule out the possibility that the symptoms are a result of an underlying medical or drug-related condition.

How is it treated?

It is recommended that a Mental Health Care Provider monitor and prescribe treatment for bipolar disorder. Treatment usually includes:

• Medication: Mood-stabilizing medications are usually prescribed to help control bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Other medications may be added as necessary to provide short-term treatment for episodes of manic and depressive episodes that break through despite the mood stabilizer.
• Psychotherapy OR "Talk Therapy": In psychotherapy, you talk with your Health Care Provider about things that are going on in your life. The focus may be on your thoughts and beliefs or on your relationships. The focus may also be on your behavior and how it is affecting you and what you can do differently.
• Electroconvulsive Therapy (ECT): Electroconvulsive therapy is a common treatment for depression that is normally used for people who don't respond to medications and for those most likely to commit suicide. It is generally safe and effective. In this therapy you are given a light general anesthesia and a muscle relaxant. An electrical current is then passed through your brain for 1 to 3 seconds. This stimulation to your brain will cause a controlled seizure, which usually lasts for 20 to 90 seconds. You will wake up in 5 to 10 minutes and rest for about an hour. Most people require 6 to 10 treatments.

What can I do to prevent it?

Because bipolar disorder tends to run in families, you may not be able to prevent it, but there are some things you can do. Once treatment for bipolar disorder begins, you will still have to manage on a day-to-day basis. You will need to do the following:

• See your Health Care Provider regularly: Your Provider can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
• Take your medications: Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medications as prescribed.
• Don't become isolated: Try to participate in normal activities. Share talking and listening time with a friend often, especially during difficult times. Participate in fun and creative activities.
• Take care of yourself:
• Eat a healthy diet: Avoid caffeine, sugar and heavily salted foods.
• Get the right amount of sleep: Keep a regular sleep schedule.
• Exercise regularly: Do exercises that help you relax, focus and reduce stress. Take a daily walk regardless of the weather. It will help keep you in touch with the elements and connects you to the world around you.
• Try to maintain a calming, safe environment. Seek opportunities to be exposed to light. Record your thoughts and feelings in a journal. When confronted with troubling circumstances, stop analyze your situation and make a positive choice.
• Limit alcohol and avoid illegal drugs:
• Abuse of alcohol and drugs will slow or prevent your recovery.

Questions to ask your health care provider

• What's the name of my medication and how will it help me?
• What dosage(s) of medication do I need to take?
• At what times of the day should I take them? Do I need to take them with food?
• Do I need to avoid any specific foods, medications, supplements (vitamins, herbs) or activities while taking this medication?
• What should I do if I forget to take my medication?
• What side effects might I have? What can I do about them?
• How can I reach you in an emergency?
• How long will it take for me to feel better? What type of improvement should I expect?
• Are there any special risks I should worry about? How can I prevent them? How can I recognize them?
• If my medication needs to be stopped for any reason, how should I do it? (Never stop taking your medication without talking to your Mental Health Provider.)
• Should I have "talk" therapy? What type do you recommend? Is it possible that I could be treated with talk therapy and no medication?
• Is there anything I can do to help my treatment work better, such as changing my diet, physical activity, sleep pattern, or lifestyle?
• If my current treatment isn't helpful, what are my alternatives? What is my next step?
• What risks do I need to consider if I want to become pregnant?
• How can I spot my warning signs?

There are two key people on your health care team, you and your health care provider. You are just as important as your provider in directing your health care. The first step you should take in becoming an active team member of your health care team is to understand what you are being treated for and why. Continue to ask questions until you understand the answer. By paying attention to your health and maintaining your own records, you will become an active, informed decision maker in your health care.