Suppose one day you wake up feeling oddly energized and pumped for anything. The world is at your feet. You can do whatever you set your mind to and nothing could possibly go wrong. In fact, you're so full of energy that you decide you don't need to sleep. Days, perhaps even weeks, go by -- nothing gets you down and nothing slows you down. But then, without warning, this feeling starts to wane. For no reason at all, you begin to feel bogged-down, depressed or even suicidal. Life is joyless and meaningless. For weeks you feel absolutely hopeless. And then, one day you wake up -- ready for anything.
This cycle is characteristic of people who suffer from bipolar disorder. According to the National Institute of Mental Health (NIMH), bipolar disorder, also known as manic-depressive disorder, affects approximately 5.7 million adults in the U.S. (2.6 percent of the 18 and up population) [source: NIMH]. The disorder causes intense, alternating episodes of mania and depression that go far beyond normal mood swings. Children and adolescents can develop the disorder as well, though their mood swings usually happen far more rapidly.
People who have bipolar disorder face several obstacles as a result of the illness. In addition to the stress it can place on families and interpersonal relationships, a bipolar patient is 40 percent less likely to have a job [source: Cox]. Someone with bipolar disorder is also 10 times more likely than the general population to abuse alcohol or drugs, which is unfortunate since alcohol and drugs have the potential to trigger episodes of the disorder [source: UPMC]. Perhaps the most terrifying fact is that about 15 percent of bipolar patients succeed in committing suicide, out of 25 percent to 50 percent who attempt it [source: psychlaws].
What do scientists know and what don't they know about this disorder? Keep reading to learn the signs and symptoms of manic and depressive episodes.
The mood swings a bipolar patient experiences are more intense than the natural mood swings of a healthy person. The disorder typically shows up between the ages of 15 and 25 in both men and women and is characterized by periods of mania and periods of depression [source: Healthline].
The National Institute of Mental Health (NIMH) lays out the symptoms that are common to a manic episode. These include:
- Feeling a "high" and an unusually good mood
- Excessive energy
- Feeling restless
- Talking faster than usual
- Unusually fast thoughts and ideas
- Risky decisions (spending sprees, risky investments)
- Easily distracted
- Needing little sleep
- Inflated ideas of one's abilities or importance
- Increased sexual appetite
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a certain number of manic symptoms must be present for at least a week for those symptoms to add up to a manic episode. Manic episodes can affect people differently. For some, euphoric symptoms make it a wonderful, desirable experience. For others, mania makes them extremely irritable and easily angered. A less severe kind of mania is called hypomania, which may include a less intense form of any of the above symptoms. Hypomania does not interfere with one's daily life and relationships as much as a regular manic episode [source: MedicineNet]. If left untreated, hypomania could progress into mania.
The following is the NIMH's list of depressive episode symptoms:
For these symptoms to add up to a depressive episode, a certain number of these symptoms must persist for at least two weeks.
It is possible for bipolar patients to actually experience manic and depressive symptoms at the same time. When this happens for at least a week, it is referred to as a mixed episode [source: DBSA]. In addition, some may experience rapid cycling which is characterized by a year of at least four episodes of mania, hypomania or depression [source: DBSA]. During a more severe manic or depressive episode, a bipolar patient can experience psychotic symptoms. These can include delusions (false beliefs) and hallucinations (false sensations) [source: NIMH]. Because these symptoms are usually associated with schizophrenia, doctors can easily misdiagnose these bipolar patients.
The kinds of episodes patients experience determines the type of bipolar disorder they are diagnosed with. Classifications for the disorder include:
- Bipolar I Disorder: This is the most severe form of the disorder. It includes at least one manic or mixed episode and at least one depressive episode [source: DBSA].
- Bipolar II Disorder: Patients have had at least one depressive episode and at least one hypomanic episode. With this type, a patient could experience periods of normal moods as well.
- Bipolar Disorder Not Otherwise Specified (NOS): This classification is used for cases in which bipolar patients experience patterns that don't fall into the I or II categories.
- Cyclothymia: This is the least severe form of the disorder. It includes two years of episodes of hypomania and milder depression.
Now that we can more easily recognize the disorder and what bipolar patients experience, let's take a look at what people think might cause this mysterious illness.
Causes of Bipolar Disorder
Researchers don't know exactly what causes bipolar disorder. Most likely, there's no single factor but rather multiple factors that cause bipolar disorder to develop. Genetics do play a role and increase the likelihood that someone will develop the disorder. But you can't always determine who will get it based on genetics. For example, although the disorder does run in families, one twin may develop the disorder while the other twin never does. Statistics show that the children of bipolar patients have a higher risk than the general population of developing it. Attempts to find the specific genes that lead to the disorder have failed, but research is ongoing [source: NIMH].
Environmental factors might actually contribute to the development of the disorder in someone who is genetically predisposed. For instance, stressful periods and major life-altering events -- both good and bad -- can trigger the disorder. Other environmental factors have the potential to cause specific manic and depressive episodes in bipolar patients. These include drug and alcohol abuse, seasonal changes and even antidepressants [source: Helpguide.org].
Chemicals in the brain could also predispose people to bipolar disorder [source: CCI]. Researchers suspect that the levels of neurotransmitters dopamine, serotonin, norepinephrine, and GABA (gamma aminobutyric acid) might be involved in the disorder. Because cocaine and amphetamine, which release dopamine, can instigate mania, it is possible that high dopamine levels could lead to a manic episode [source: Davies]. This theory is supported by the evidence that manic and psychotic symptoms correlate with increased dopamine levels [source: Frank]. In addition, researchers have found low serotonin activity during manic and depressive episodes [source: Frank]. Also, hypomania often correlates with increased norepinephrine levels. Compared to healthy patients, bipolar patients have lower levels of an enzyme used in the transfer of GABA in the brain. It is thought this plays a role in causing the disorder because anticonvulsant drugs, which are effective in combating bipolar disorder, increase the levels of GABA [source: Frank].
The more scientists find out about the causes of the condition, the more progress they can make toward finding effective treatments. Luckily, many bipolar patients benefit from existing medications. Next, we'll take a look at the most common medications used to treat bipolar disorder.
Medication for Bipolar Disorder
Because the cause of bipolar is largely unknown, the search for effective treatments is difficult. Though certain medications, such as lithium, prove helpful for many bipolar patients, scientists don't know why. Doctors have found that bipolar disorder is a long-term illness that requires consistent, long-term treatment. This usually includes taking prescribed medications even during periods of healthy moods.
Because patients respond differently to the various drugs used to treat the disorder, adjusting the dosage or the kind of medication is often necessary to find the best treatment for an individual. The following is a list of the most popular medications used for bipolar disorder.
Lithium: In the 1970s, the Food & Drug Administration (FDA) approved lithium for treating bipolar disorder, and it is still one of the first lines of treatment for the condition. Lithium is a mood stabilizer, effective against both depressive and manic episodes. After starting on lithium, patients have to visit the doctor for frequent blood tests to monitor lithium levels. After finding a healthy dosage, patients won't have to take the blood tests as often.
Anticonvulsants: Like lithium, anticonvulsants are also mood stabilizers. Anticonvulsants work by stabilizing the overactive parts of the brain. They also are commonly used to prevent seizures in epileptic patients. Different anticonvulsants work in different ways. Some work by increasing levels of the GABA neurotransmitter [source: Frank]. Used alone or with lithium, anticonvulsants can be effective for many bipolar patients.
Atypical Antipsychotics: For people who don't respond to lithium and anticonvulsants, doctors may prescribe atypical antipsychotics, such as clozapine. These kinds of drugs, which are also used to treat schizophrenia, work by affecting the levels of certain neurotransmitters in the brain, such as dopamine.
Benzodiazepines (Anti-Anxiety Drugs): If a bipolar patient is having sleeping problems, benzodiazepines can help promote healthy sleeping routines. These should be used with caution, however, and usually for only a short period because of the possibility of addiction [source: NIMH].
Antidepressants: Because they can trigger manic episodes, antidepressants are not prescribed to treat bipolar disorder as commonly as they used to be [source: MayoClinic]. Depending on the kind, antidepressants work by adjusting levels of serotonin or norepinephrine in the brain. To learn more about them, read How Antidepressants Work.
In addition to the normal potential for side effects, it is dangerous for pregnant or nursing mothers to take certain mood-stabilizing drugs. Lithium isn't likely to harm a fetus in the womb, but certain anticonvulsants can cause birth defects [source: NAMI]. Changing medications too much during pregnancy can cause negative effects as well [source: NAMI]. Because unexpected pregnancy can make the choice difficult, it's best to discuss the options with a doctor.
Medications are not the only option for fighting bipolar disorder. The National Institute of Mental Health maintains that the best treatment incorporates both medicines like those listed above and psychosocial treatment [source: NIMH]. In the next section, we'll explore these and other kinds of treatments.
Other Treatments for Bipolar Disorder
Various therapies have proven helpful for bipolar patients as a supplement to medicinal treatment. Taking part in any of the following can lessen the severity and give the patient more control over symptoms:
- Cognitive Behavioral Therapy: Used for various disorders, this therapy aims to change the patient's perceptions and habits. By changing how bipolar patients think about the illness and encouraging positive attitudes, cognitive behavioral therapy can make effective improvements. This therapy also usually involves learning more about bipolar disorder, which helps patients become more confident and knowledgeable about how to treat it.
- Family Therapy: The patient's family participates in this therapy with the patient. By identifying sources of stress and conflicts, the family can learn to better address them and thereby offer the patient a better and more encouraging environment.
- Group Therapy: This therapy offers an opportunity for several people with bipolar disorder to gather in a group led by a psychologist. In the group sessions, the members discuss their experiences with the illness and offer feedback for one another.
- Interpersonal and Social Rhythm Therapy: As the name implies, the purpose of this therapy is to improve relationships and encourage habits of regular routine (such as a sleep schedule). Both of these factors have a large impact on moods. Studies show that this therapy helps prevent relapse of bipolar disorder that might have been brought on by unhealthy relationships and irregular habits [source: Kupfer].
- Electroconvulsive Therapy (ECT): Though it still carries a stigma, ECT is an effective treatment and is much safer than it used to be. Using ECT, doctors induce seizures in patients, which last up to a minute long [source: MayoClinic]. After repeated treatment, ECT is effective against many mental disorders. It works by altering the behavior of chemicals in the brain. However, scientists don't quite know how or why it works.
In addition to these therapies, it's a good idea to avoid drugs and alcohol, as they can potentially trigger an episode.
As we've seen, just learning more about the disorder might provide comfort and hope. Bipolar patients should realize that they are not alone and that it is a treatable condition. Various kinds of research and advancements in technology that allow for more precise studies of the brain offer promising signs that the disorder will continue to get more manageable. To learn more about related subjects, such as the brain and how it is studied, read the links on the next page.
Other Great Links
- American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders: DSM-IV." American Psychiatric Pub., Inc. 1994. (Feb. 28, 2008) http://books.google.com/books?id=3SQrtpnHb9MC&printsec=frontcover&dq=dsm-iv&source=gbs_summary_r
- BBC. "The Secret Life of the Manic Depressive: Bipolar Stories." British Broadcasting Company. (March 4, 2008) http://www.bbc.co.uk/health/tv_and_radio/secretlife_bipolarstories.shtml
- Bloch, Jon P. "The Everything Health guide to Adult Bipolar Disorder." Adams Media. 2006. (March 6, 2008). http://books.google.com/books?id=mbYD87izKHYC&printsec=frontcover&dq=The+Everything+Health+Guide+to+Adult+Bipolar+Disorder&ei=IiDQR5X4A5eQiQHD8bCrBQ&sig=o-6WMmJuvu29AxhA5d1dRpQXc8s
- CCI. "What causes bipolar disorder?" Centre for Clinical Interventions. (March 4, 2008) http://www.cci.health.wa.gov.au/docs/Info-What%20causes%20bipolar%20disorder.pdf
- Cox, Lauren, Support or Stigma? Bipolar in the Workplace." ABC News. March 3, 2008. (March 5, 2008)
- Davies, Martin. "The Blackwell Encyclopedia of Social Work." Blackwell Publishing. 2000. (March 4, 2008). http://books.google.com/books?id=w5XEVCcF8qkC&pg=PP1&dq=The+Blackwell+Encyclopaedia+of+Social+Work&ei=gc7NR7C8FZmYiwGWudGZBA&sig=jc_NAk7PNM5fM98HVLamMMUbxrM
- Encyclopædia Britannica. "Bipolar disorder ." 2008. Encyclopædia Britannica Online. (March 3, 2008)
- Encyclopedia Britannica. "Kraepelin, Emil." 2008. Encyclopedia Britannica Online.
- Frank, Ellen. "Treating Bipolar Disorder." Guilford Press. 2007. (Mar 4, 2008) http://books.google.com/books?id=v8lsjOoHP3oC&printsec=frontcover&dq=Treating+Bipolar+Disorder:+A+Clinician%27s+Guide&ei=cdPNR7_YFJn2iwHOzvGOBA&sig=sWegawyiGNPgENl_FnVkOMzRiU4
- Depression and Bipolar Support Alliance."Types of Bipolar Disorder." (March 4, 2008) http://www.dbsalliance.org/site/PageServer?pagename=about_bipolar_types
- Healthline. "Bipolar disorder." (March 5, 2008) http://www.healthline.com/adamcontent/bipolar-disorder
- Helpguide.org. "Understanding Bipolar Disorder." (March 4, 2008) http://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm
- Johnson, Sheri L., Robert L. Leahy. "Psychological Treatment of Bipolar Disorder." Guillford Press. 2003. (March 6, 2008) http://books.google.com/books?id=wvPHQSGaMNgC&printsec=frontcover&dq=%22untreated+bipolar%22&lr=&source=gbs_summary_r
- Kuo, Irving, MD. "Bipolar Disorder -- How Best to Treat Lactating Women." Viguera AC, Newport J, Ritchie J, et al. Am J Psychiatry. 2007;164:342-345. Medscape Today. (March 5, 2008) http://www.medscape.com/viewarticle/556690
- Kupfer, David J. et al. "Interpersonal and social rhythm therapy proven to be effective treatment for bipolar disorder." Medical News Today. Sept. 7, 2005 (March 5, 2008)
- Maj, Mario. "Bipolar Disorder." John Wiley and Sons. 2002. (March 5, 2008) http://books.google.com/books?id=9kKUii2sy4kC&printsec=frontcover&dq=Bipolar+Disorder+maj&source=gbs_summary_r
- Manji, Husseini K., Charles L. Bowden, Robert H. Belmaker. "Bipolar Medications: Mechanisms of Action. American Psychiatric Pub, Inc. 2000. (March 6, 2008) http://books.google.com/books?id=xCmN3g9ht4EC&dq=Bipolar+Medications&lr=&source=gbs_summary_s&cad=0
- MayoClinic. "Bipolar disorder." MayoClinic.com. (March 3, 2008) http://www.mayoclinic.com/print/bipolar-disorder/DS00356/DSECTION=all&METHOD=print
- MayoClinic. "Electroconvulsive therapy (ECT): Treating severe depression and mental illness." July 14, 2006. (Feb. 28, 2008)
- Mental Health Today. "Famous People with Bipolar Disorder." (March 6, 2008) http://www.mental-health-today.com/bp/famous_people.htm
- Mitchell, Steve. "Blood test could reveal bipolar disorder." MSNBC.com. Feb. 25, 2008. (March 6, 2008) http://www.msnbc.msn.com/id/23337532/
- NAMI. "Managing Pregnancy and Bipolar Disorder." National Alliance on Mental Illness. (March 6, 2008) http://www.nami.org/Template.cfm?Section=bipolar_disorder&template=/ContentManagement/ContentDisplay.cfm&ContentID=17899
- NIMH. "Bipolar Disorder." National Institute of Mental Health. (March 3, 2008)http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-publication.shtml
- Patient Health International. "The Mad Genius: Fact or Fiction." Sept. 27, 2004. (March 6, 2007) http://www.patienthealthinternational.com/features/3118.aspx
- Pscyhlaws. "Briefing Paper."Suicide: One of the Consequences of Failing to Treat Severe Mental Illnesses." Psychlaws.org. (March 5 2008) http://www.psychlaws.org/BriefingPapers/BP6.pdf
- UPMC. "Anticonvulsant Drug Cuts Drinking in Bipolar Alcoholics, Shows University of Pittsburgh Research." Jan. 3, 2005. University of Pittsburgh (March 5, 2008)
- WebMD. "Bipolar Disorder Treatment Overview." WebMD. (March 6 2008) http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-treatment-overview