Bipolar disorder, historically known as manicdepressive disorder, is a serious disease of the brain and a form of mental illness. People with the disorder experience dramatic mood swings, fluctuating between mania (the “high” phase) and depression (the “low” phase). They often have “normal” moods in between. It is also known as bipolar affective disorder.

The exact causes of bipolar disorder are unknown, but the tendency may run in families. Genes that affect nerve cells in the brain may be responsible, but those specific genes have not been identified. Bipolar disorder can affect children and adults, both male and female, though it most often strikes young adults 15–25 years old. Bipolar disorder can affect people of all races, cultures and income levels. More than 2 million people in the United States have bipolar disorder.

In most people with bipolar disorder, there is no clear trigger for each phase, though life changes such as childbirth, medications such as antidepressants or steroids, periods of sleeplessness or recreational drug use may trigger a manic episode.

The manic phase may last from days to months. Symptoms include distractibility, hyperactivity, euphoria, high energy, impulsivity, racing thoughts, talking a lot and high esteem of self or abilities. The person may have little need for sleep and experience agitation, poor judgment, lack of temper control, reckless behavior and lack of self-control manifested in binge eating, alcohol and drug use, promiscuity and spending sprees.

Daily low mood or sadness and difficulty concentrating, remembering or making decisions are characteristics of the depressed phase. The person may experience eating problems (loss of appetite and weight loss, or overeating and weight gain); fatigue or lack of energy; feelings of worthlessness, hopelessness or guilt; isolation from friends or family; and thoughts of death or suicide.

Sometimes the two phases overlap, with manic and depressive symptoms occurring together or quickly one after the other in what is called a mixed state. There is also a high risk of suicide in bipolar disorder. Abusing alcohol or other substances can worsen the symptoms and increase suicide risk.

The main goal of treatment is to decrease the number of episodes and their severity and thus avoid the need for a hospital admittance, improve function between episodes and prevent self-injury and suicide.

Before recommending treatment, a health care provider will try to determine if there are triggers for the mood episodes and identify medical or emotional problems that may affect treatment. After a physical assessment, including a mental health history and appropriate lab tests, medication therapy is initiated with a mood stabilizer such as lithium. Other treatments may include antiseizure, antipsychotic, antidepressant or anti-anxiety medications. People with bipolar disorder who take antidepressants are more likely to have manic or hypomanic episodes and should simultaneously take mood stabilizers.

ECT (electroconvulsive therapy) may treat manic or depressive phases if they do not respond to medication. ECT uses an electrical charge to cause a brief seizure while the patient is under anesthesia. TMS (transcranial magnetic stimulation), which is usually used after ECT, targets affected areas of the brain with high-frequency magnetic pulses.

Coping with bipolar disorder can be challenging. Learning about your condition can empower you and motivate you to stick to your treatment plan. Also educate your family and friends about what you’re going through. Support groups can help you connect to others facing similar challenges and shared experiences.

Treatment for bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings. Explore healthy ways to channel your energy such as hobbies, exercise and recreational activities. Yoga, tai chi or meditation can help you relax and manage stress.

There’s no sure way to prevent bipolar disorder. However, some strategies can help prevent minor episodes from becoming full-blown mania or depression. Pay attention to warning signs. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs. Symptoms are more likely to return if you drink alcohol or use street drugs, so avoid their use. Take your medications as directed. When you feel better, you may be tempted to stop treatment, but this can have immediate consequences; you may become depressed, feel suicidal or go into a manic episode. If you think you need to make a change, call your doctor. Check with your doctor before taking other medications since they may trigger episodes or interfere with your treatment.

Weblinks

National Alliance on Mental Illness

National Institute of Mental Health

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment.
Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.