What is bipolar disorder?
Bipolar disorder, sometimes referred to as manic depressive illness, is a severe brain disorder that affects between 1% and 5.5% of adults (by comparison, about 21% of women and 12% of men in the U.S will experience an episode of depression at some point in their lifetime).
Bipolar disorder affects men and women in equal percentages, and is usually diagnosed in early adulthood. Although the symptoms of bipolar disorder and their severity vary from patient to patient, the impact the disease on individuals and those around them is almost always significant.
The term bipolar disorder actually refers to two different disorders – bipolar I disorder and bipolar II disorder. Sometimes they are referred to as “bipolar spectrum disorder.”
- Bipolar I disorder is characterized by episodes of mania (an extreme elevation of mood) and depression
- Bipolar II disorder is characterized by episodes of hypomania (a milder form of mood elevation) and depression
Patients with bipolar disorder experience extreme variations in mood (commonly referred to as “mood swings,” ranging from episodes of depression to episodes of mania or intense elevations of mood). These swings can be frightening for those suffering from bipolar disorder, and for their friends and family members, because they are often associated with high-risk behaviors including substance abuse, sexual promiscuity, excessive spending, and even violence. During manic episodes, patients can transiently lose the ability to empathize with others or to know how their words and actions affect others. They sleep less, and their relationships are often strained. They may get into trouble with the law or with colleagues at work.
What causes bipolar disorder?
As is the case with depression, bipolar disorder is caused by complex changes in brain chemistry. There appears to be a genetic or inherited component to the disease as well. Scientists are still working to unlock the secrets of exactly how and why these imbalances arise. They do know that people with bipolar disorder are more sensitive to both physical and emotional stress. Thus, anything from travel across time zones to a profound lack of sleep to drug use to a stressful interaction with another person can trigger an episode.
What are the symptoms of bipolar disorder?
During depressive episodes, the symptoms are identical to those encountered during unipolar depression, impacting an individual’s feelings, thoughts, behaviors and physical condition, including:
- Angry outbursts
- Loss of interest in friends, family or favorite activities, including sex
- Trouble concentrating
- Trouble making decisions
- Trouble remembering
- Delusions and/or hallucinations
- Thoughts of harming yourself
- Withdrawing from people
- Substance abuse
- Missing work, school or other commitments
- Attempts to harm yourself
- Tiredness or lack of energy
- Unexplained aches and pains
- Changes in appetite
- Weight loss
- Weight gain
- Changes in sleep – sleeping too little or too much
- Sexual problems
During manic or hypomanic episodes, some or all of the following symptoms may be present:
- Extreme agitation or Irritability
- Trouble concentrating or paying attention
- Racing thoughts
- Trouble sleeping or needing less sleep
- Speaking more, or more rapidly, than usual
- Changes in appetite
- Unrealistic thinking or beliefs, including thoughts of superiority over others, or an unrealistically high opinion of oneself
- Poor judgment and/or reckless behavior
- An increase in achievement and in goal-directed activities
- Delusions or hallucinations
During a hypomanic episode, the same symptoms occur, but may be less severe and cause fewer problems, though still having a negative impact on a person’s ability to function. In fact, during a hypomanic episode, an individual may actually feel better and more productive than usual. Unfortunately, this can cause someone to think that medication is no longer needed, when the opposite is true: hypomania cannot usually be maintained, and is often followed by either a manic or depressive episode.
Finally, individuals with bipolar disorder may experience what is referred to as a mixed episode, when both mania and depression are present at the same time. Because these individuals experience both heightened energy and/or agitation and the symptoms of depression, this is the most disturbing and dangerous state, presenting the greatest risk of harm to the individual affected or others.
How is bipolar disorder diagnosed?
When diagnosing bipolar disorder, healthcare professionals must rely on a careful analysis of an individual’s symptoms over time, in order to identify the presence of both the depressive and manic episodes. The following criteria, as indicated by the American Psychiatric Association’s guidelines, are helpful in understanding how a diagnosis is made.
A major depressive episode is commonly present when at least five of the following symptoms arise during a two-week period, with at least one being either a depressed mood or loss of interest or pleasure:
- A depressed mood most of the day, nearly every day
- A diminished interest in pleasure in all or nearly all daily activities nearly every day
- Significant weight loss (when not dieting) or weight gain, or a change in appetite nearly every day
- Sleeping too little or too much nearly every day
- Being very agitated, including experiencing severe anxiety and restlessness in the body, or slowing down significantly, to a degree that is noticeable to others
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Trouble concentrating or indecisiveness nearly every day
- Recurring thoughts of death or suicide, or evidence of planning or attempting suicide
A manic episode is characterized by a period of abnormally and persistently elevated or irritable mood, lasting at least one week. During this period of mood disturbance, at least three of the following symptoms are present and persistent to a significant degree:
- An inflated sense of self-esteem or grandiosity
- A decreased need for sleep (feeling rested after no more than three hours of sleep)
- Appearing more talkative than usual or exerting pressure to continue talking
- Experiencing racing thoughts and ideas
- Being easily distracted, particularly by unimportant or irrelevant things
- An increased focus on achievement and on goal-oriented activities (including social, academic, career, or sexual activities)
- Experiencing severe anxiety, restlessness in the body or agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (such as unrestrained buying sprees, sexual indiscretions, or foolish business investments)
How is bipolar disorder treated?
The good news is that there are multiple options for treatment. “Mood stabilizing” medications including lithium and anticonvulsant medications as well as antipsychotics can be effective in preventing episodes of either depression or mania. Psychotherapy is employed along with medications to help patients cope with stressful life experiences that can bring about episodes. Exercise and nutrition are valuable tools, and the support of family members, friends and co-workers is crucial. For most patients with bipolar disorder, indefinite treatment is required to continually monitor and adjust medications and manage symptoms.