WHAT IS BIPOLAR DISORDER?
Bipolar disorder, which is also known as manic-depressive
illness and will be called by both names throughout this
publication--is a mental illness involving episodes of serious
mania and depression. The person's mood usually swings from
overly "high" and irritable to sad and hopeless and then back
again, with periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early
adulthood and continues throughout life. It is often not
recognized as an illness, and people who have it may suffer
needlessly for years or even decades.
Effective treatments are available that greatly alleviate the
suffering caused by bipolar disorder and can usually prevent its
devastating complications. These include marital break-ups, job
loss, alcohol and drug abuse, and suicide.
Here are some facts about bipolar disorder.
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AWARENESS Manic-Depressive Illness Has a Devastating Impact on
Many People. At least 2 million Americans suffer from
manic-depressive illness. For those afflicted with the illness,
it is extremely distressing and disruptive. Like other serious
illnesses, bipolar disorder is also hard on spouses, family
members, friends, and employers. Family members of people with
bipolar disorder often have to cope with serious behavioral
problems (such as wild spending sprees) and the lasting
consequences of these behaviors. Bipolar disorder tends to run
in families and is believed to be inherited in many cases.
Despite vigorous research efforts, a specific genetic defect
associated with the disease has not yet been detected. Bipolar
illness has been diagnosed in children under age 12, although it
is not common in this age bracket. It can be confused with
attention-deficit/hyperactivity disorder, so careful diagnosis
is necessary. D/ART: A National Educational Program The National
Institute of Mental Health (NIMH) has launched the
Depression/Awareness, Recognition, and Treatment (D/ART)
campaign to help people:
Recognize the symptoms of depressive disorders, including
bipolar disorder Obtain an accurate diagnosis Obtain effective
treatments D/ART Also: Encourages and trains health care
professionals to recognize the signs of manic-depressive illness
and utilize the most up-to-date treatment approaches Organizes
citizens' advocacy groups to extend the D/ART program Works with
industry to improve recognition, treatment, and insurance
coverage for depressive disorders
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RECOGNITION
Bipolar disorder involves cycles of mania and depression. Signs
and symptoms of mania include discrete periods of:
Increased energy, activity, restlessness, racing thoughts, and
rapid talking Excessive "high" or euphoric feelings Extreme
irritability and distractibility Decreased need for sleep
Unrealistic beliefs in one's abilities and powers
Uncharacteristically poor judgment A sustained period of
behavior that is different from usual Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping
medications Provocative, intrusive, or aggressive behavior
Denial that anything is wrong Signs and symptoms of depression
include discrete periods of:
Persistent sad, anxious, or empty mood Feelings of hopelessness
or pessimism Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in ordinary activities, including
sex Decreased energy, a feeling of fatigue or of being "slowed
down" Difficulty concentrating, remembering, making decisions
Restlessness or irritability Sleep disturbances Loss of appetite
and weight, or weight gain Chronic pain or other persistent
bodily symptoms that are not caused by physical disease Thoughts
of death or suicide; suicide attempts It may be helpful to think
of the various mood states in manic-depressive illness as a
spectrum or continuous range. At one end is severe depression,
which shades into moderate depression; then come mild and brief
mood disturbances that many people call "the blues," then normal
mood, then hypomania (a mild form of mania), and then mania.
Some people with untreated bipolar disorder have repeated
depressions and only an occasional episode of hypomania (bipolar
II). In the other extreme, mania may be the main problem and
depression may occur only infrequently. In fact, symptoms of
mania and depression may be mixed together in a single "mixed"
bipolar state.
Descriptions provided by patients themselves offer valuable
insights into the various mood states associated with bipolar
disorder:
Depression: I doubt completely my ability to do anything well.
It seems as though my mind has slowed down and burned out to the
point of being virtually useless....[I am] haunt[ed]...with the
total, the desperate hopelessness of it all... Others say, "It's
only temporary, it will pass, you will get over it," but of
course they haven't any idea of how I feel, although they are
certain they do. If I can't feel, move, think, or care, then
what on earth is the point?
Hypomania: At first when I'm high, it's tremendous...ideas are
fast...like shooting stars you follow until brighter ones
appear...all shyness disappears, the right words and gestures
are suddenly there...uninteresting people, things, become
intensely interesting. Sensuality is pervasive, the desire to
seduce and be seduced is irresistible. Your marrow is infused
with unbelievable feelings of ease, power, well-being,
omnipotence, euphoria...you can do anything...but, somewhere
this changes.
Mania: The fast ideas become too fast and there are far too
many...overwhelming confusion replaces clarity...you stop
keeping up with it--memory goes. Infectious humor ceases to
amuse. Your friends become frightened...everything is now
against the grain...you are irritable, angry, frightened,
uncontrollable, and trapped.
Recognition of the various mood states is essential so that the
person who has manic-depressive illness can obtain effective
treatment and avoid the harmful consequences of the disease,
which include destruction of personal relationships, loss of
employment, and suicide.
Manic-depressive illness is often not recognized by the patient,
relatives, friends, or even physicians. An early sign of
manic-depressive illness may be hypomania--a state in which the
person shows a high level of energy, excessive moodiness or
irritability, and impulsive or reckless behavior. Hypomania may
feel good to the person who experiences it. Thus, even when
family and friends learn to recognize the mood swings, the
individual often will deny that anything is wrong. In its early
stages, bipolar disorder may masquerade as a problem other than
mental illness. For example, it may first appear as alcohol or
drug abuse, or poor school or work performance. If left
untreated, bipolar disorder tends to worsen, and the person
experiences episodes of full-fledged mania and clinical
depression.
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TREATMENT Most people with manic depressive illness can be
helped with treatment. Almost all people with bipolar
disorder--even those with the most severe forms--can obtain
substantial stabilization of their mood swings. One medication,
lithium, is usually very effective in controlling mania and
preventing the recurrence of both manic and depressive episodes.
Most recently, the mood stabilizing anticonvulsants
carbamazepine and valproate have also been found useful,
especially in more refractory bipolar episodes. Often these
medications are combined with lithium for maximum effect. Some
scientists have theorized that the anticonvulsant medications
work because they have an effect on kindling, a process in which
the brain becomes increasingly sensitive to stress and
eventially begins to show episodes of abnormal activity even in
the absence of a stressor. It is thought that lithium acts to
block the early stages of this kindling process and that
carbamazepine and valproate act later. Children and adolescents
with bipolar disorder are generally treated with lithium, but
carbamazepine and valproate are also used. Valproate has
recently been approved by the Food and Drug Administration for
treatment of acute mania. The high potency benzodiazepines
clonazepam and lorazepam may be helpful adjuncts for insomnia.
Thyroid augmentation may also be of value. For depression,
several types of antidepressants can be useful when combined
with lithium, carbamazepine, or valproate. Electroconvulsive
therapy (ECT) is often helpful in the treatment of severe
depression and/or mixed mania that does not respond to
medications. As an adjunct to medications, psychotherapy is
often helpful in providing support, education, and guidance to
the patient and his or her family. Constructing a life chart of
mood symptoms, medications, and life events may help the health
care professional to treat the illness optimally. Because
manic-depressive illness is recurrent, long-term preventive
(prophylactic) treatment is highly recommended and almost always
indicated.
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Getting Help Anyone with bipolar disorder should be under the
care of a psychiatrist skilled in the diagnosis and treatment of
this disease.
Other mental health professionals, such as psychologists and
psychiatric social workers, can assist in providing the patient
and his or her family with additional approaches to treatment.
Help can be found at: University- or medical school-affiliated
programs Hospital departments of psychiatry Private psychiatric
offices and clinics Health maintenance organizations Offices of
family physicians, internists, and pediatricians People With
Manic-Depressive Illness Often Need Help To Get Help. Often
people with bipolar disorder do not recognize how impaired they
are or blame their problems on some cause other than mental
illness. People with bipolar disorder need strong encouragement
from family and friends to seek treatment. Family physicians can
play an important role for such referral. If this does not work,
loved ones must take the patient for proper mental health
evaluation and treatment. If the person is in the midst of a
severe episode, he or she may have to be committed to a hospital
for his or her own protection and for much needed treatment.
Anyone who is considering suicide needs immediate attention,
preferably from a mental health professional or a physician;
school counselors and members of the clergy can also assist in
detecting suicidal tendencies and/or making a referral for more
definitive assessment or treatment. With appropriate help and
treatment, it is possible to overcome suicidal tendencies. It is
important for patients to understand that bipolar disorder will
not go away, and that continued compliance with treatment is
needed to keep the disease under control. Ongoing encouragement
and support are needed after the person obtains treatment,
because it may take a while to discover what therapeutic regimen
is best for that particular patient. Many people receiving
treatment also benefit from joining mutual support groups such
as those sponsored by the National Depressive and Manic
Depressive Association (NDMDA), the National Alliance for the
Mentally Ill (NAMI), and the National Mental Health Association.
Families and friends of people with bipolar disorder can also
benefit from mutual support groups such as those sponsored by
NDMDA and NAMI.