Bipolar disorder

Bipolar disorder, formally known as manic depression, is classified as a type of affective disorder or mood disorder that goes beyond ordinary ups and downs. It is a serious medical condition characterized by episodes of mania with or without depression and affecting approximately 1 percent of the general population. Suicide rates are exceptionally high, with some recent estimates of 11-19 percent of patients with bipolar disorder having committed suicide, and approximately 50 percent of patients having experienced at least one suicide attempt.

The hallmark of mania is extreme elation, elevated mood or irritability. It is often accompanied by impulsive behavior that can have significant negative consequences. Many individuals with bipolar disorder also have symptoms of depression that manifest as sad mood and feelings of hopelessness.

Manic symptoms may include:

• Euphoric or irritable mood
• Inflated self-esteem
• Decreased need for sleep
• Excessive involvement in pleasurable activities that may result in negative consequence; this may include provocative, aggressive or destructive behavior
• Increased talkativeness
• Racing thoughts
• Increased sex drive
• Increased energy level

Other symptoms that may indicate depressive disorder include:

• Persistent sad, anxious or empty mood
• Loss of interest in activities once previously enjoyed
• Excessive crying
• Increased restlessness and irritability
• Decreased ability to concentrate and make decisions
• Decreased energy
• Thoughts of death or suicide, or suicide attempts
• Increased feelings of guilt, helplessness and/or hopelessness
• Weight and/or appetite changes due to overeating or undereating
• Changes in sleep patterns
• Social withdrawal
• Physical symptoms unrealized by standard treatment (e.g., chronic pain, headaches)

Bipolar disorder affects men and women equally. It usually appears between ages 15 and 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder, suggesting that genetic factors contribute to the development and onset of the illness. Environmental stressors, such as major life changes, certain medications, illicit drugs, and significant shifts in routine and/or sleep may also contribute to illness onset.

Individuals with symptoms of bipolar I disorder have had at least one manic episode. Individuals with bipolar I disorder may also have episodes of depression. Some individuals have unusual experiences while in a manic or depressive episode including perceptual disturbances and/or false/fixed beliefs. These are called psychotic symptoms.

Individuals with symptoms of bipolar II disorder experience episodes of both hypomania and depression. Hypomania is a less intense euphoric state than mania. During periods of hypomania, individuals are often highly productive but also likely to engage in impulsive behaviors.

A mild form of bipolar disorder called cyclothymia indicates mood swings with alternating periods of hypomania and depression. These mood swings are unlike short-lived emotions experienced in reaction to stressful situations.

Treatment of bipolar disorder involves taking medications and going to mental health counseling (psychotherapy). Different types of medications can help control symptoms of bipolar disorder. Medication treatment of bipolar disorder is provided according to established treatment guidelines and the best available research evidence. Treatments are tailored to meet the individual needs of each patient as not everyone responds to medications in the same way.

Several different medications trials might be needed before finding ones that work best for each individual patient. The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics, and antidepressants.