What you should know about Bipolar Disorder

Introduction

This information sheet is for people with bipolar disorder, their family members, friends, and anyone interested in learning about the disorder. It is a guide to understanding what bipolar disorder is, how it is recognized and diagnosed, and how it is treated. Bipolar disorder is also known by other terms such as: manic-depressive disorder, manic-depressive illness, bipolar mood disorder, bipolar affective disorder, and, simply bipolar disorder. It is a medical illness that affects more than three million Americans.

Despite impressive progress, two thirds of people with bipolar disorder are not properly diagnosed or treated. With accurate diagnosis, effective medication, and proper support, many people with bipolar disorder can lead normal, productive, and fulfilling lives.

What Is Bipolar Disorder?

First of all, bipolar disorder is a medical illness that affects how people think, feel, and behave. It used to be called manic depression. It is primarily characterized by recurrent episodes of mania (highs) and depression (lows). There are a few people who have only manic episodes and they, too, are considered to have bipolar disorder. On the other hand, people who experience only episodes of depression and not mania have an illness known as major depression, clinical depression, or unipolar disorder -- a condition distinct from manic-depressive disorder.

What Is Mania?

During a manic episode, the mood can be abnormally elevated, euphoric, or irritable. Thoughts race and speech is rapid, sometimes nonstop, often jumping from topic to topic in ways that are difficult for others to follow. Energy level is high, self-esteem inflated, sociability increased, and enthusiasm abounds. There may be very little need for sleep (Aa waste of time@) with limitless activity extending around the clock. During a manic episode, a person may feel Aon top of the world@ and have little or no awareness that the feelings and behaviors are not normal.

Mania comes in degrees of severity and, while a very little amount may be pleasant and productive, even the less severe form known as hypomania can be problematic and cause social and occupational difficulties. A manic episode is more severe than a hypomanic episode with a magnification of symptoms to the extent that there is marked impairment in interpersonal and social interactions and occupational functions. Hospitalization is often necessary. Severe mania can be psychotic -- the person loses contact with reality and may experience delusions (false beliefs), especially of a grandiose (AI am the President@), religious (AI am God@), or sexual nature, and hallucinations (hearing voices or seeing visions). Psychotic mania may be difficult to distinguish from schizophrenia and, indeed, mistaking the former for the latter is not uncommon.

During a manic episode, judgment is often greatly impaired as evidenced by excessive spending, reckless behaviors involving driving, abuse of drugs and alcohol and sexual indiscretion, and impulsive, sometimes catastrophic business decisions.

The manic individual has little insight into the destructive nature of such behavior and may resist the well-intentioned interventions of others with impatience, irritability, and hostility.

The symptoms of a manic episode may vary considerably from person to person and from episode to episode. For example, the diagnosis of mania would apply equally to person A with euphoric mood, heightened self-esteem, increased goal-directed activity, rapid speech, and decreased need for sleep, and person B with irritable mood, distractibility, agitation, racing thoughts, and involvement in dangerous activities.

Some Symptoms of Mania

‚ Elevated, euphoric mood

‚ Irritability, impatience

‚ Grandiosity, inflated self-esteem

‚ Rapid, nonstop speech

‚ Racing thoughts

‚ Decreased need for sleep

‚ Increased energy

‚ Difficulty concentrating

What Is Depression?

During a depressive episode, mood is sad, blue, down-in-the-dumps, unhappy, or irritable. Self -esteem is low, thoughts are negative, and there is loss of interest in usual activities and an inability to experience pleasure. Concentrating is difficult and decision making impaired. Anxiety or agitation are common features of depression, although some individuals are drained of energy and are physically inert. Feelings of hopelessness and helplessness are common with both the present and future looking bleak. Guilt, crying, and social withdrawal are additional features. Suicidal thoughts, plans, and attempts are common and, in fact, suicide is a cause of death in many people with depression. Physical findings associated with depression include sleep disturbance (either insomnia or oversleeping), appetite and weight loss (although overeating and weight gain are not uncommon), fatigue, loss of interest in sex, and bodily pains.

Some Symptoms of Depression

‚ Sad, unhappy, blue, or irritable mood

‚ Loss of interest in usual activities

‚ Inability to experience pleasure

‚ Social withdrawal

‚ Difficulty concentrating

‚ Fatigue, lack of energy

‚ Insomnia or oversleeping

‚ Appetite loss or overeating

‚ Feelings of guilt and worthlessness

‚ Thoughts of death or suicide

What Are Mixed Episodes?

Not all episodes of bipolar disorder are clearly manic or depressed. Some have features of both, making the episode a mixture of manic and depressive symptoms.

Mixed episodes, sometimes known as dysphoric mania, occur in up to 40% of individuals with bipolar disorder and can be particularly troublesome because they may be more difficult to treat.

From the descriptions above, it should be clear that bipolar disorder is a serious medical illness that should not be confused with the happy and sad moods that occur in everyone from time to time. Untreated, bipolar disorder can be devastating with great personal suffering, disruptive relationships, derailing of careers, increased risk of death from suicide and accident, and enormous financial cost to the individual and society. Proper treatment, however, can be effective in returning people to more healthy and productive lives.

Are There Different Types of Bipolar Disorder?

Bipolar I disorder is characterized by the presence of one or more manic or mixed episodes. Depressive episodes usually occur too.

Bipolar II disorder is characterized by highs that are never more severe than hypomania (less severe mania) together with major depressive episodes.

Cyclothymic disorder refers to frequent episodes of hypomania and mild depression occurring over at least a 2-year period.

What Is the Clinical Course of Bipolar Disorder?

Bipolar disorder is a recurrent, episodic illness. It is highly unlikely that a person would have just one episode over the course of a lifetime. Between episodes the individual usually returns to normal or near-normal functioning. Episodes usually last for weeks to months, although sometimes they can be of much shorter duration. The pattern of cycling is quite variable. Episodes may occur at irregular intervals and follow an unpredictable pattern of mania and depression. Sometimes, however, episodes are linked so that mania always follows depression or depression always follows mania. The episodes may follow a seasonal pattern; for example, winter depressions followed by hypomania or mania in the spring. At times the cycles can be continuous with little or no periods of stability separating them. Individuals who have four or more episodes a year are known as Arapid cyclers@ and those who cycle very frequently are said to have Aultra rapid cycling.@ Rapid cycling is considerably more common in women.

The duration of wellness between episodes is also quite variable, but it is usually longer (months or years) early in the course of the illness and grows shorter as the number of episodes increases.

Who Gets Bipolar Disorder?

Bipolar disorder is common -- affecting about 1% of the population or about two million Americans. Men and women are equally affected. While the disorder has been seen in children, the usual age of onset is late adolescence and early adulthood. Mania occasionally appears for the first time in the elderly, and when it does, it is often related to another medical disorder. Bipolar disorder is not restricted to any social or educational class, race, or nationality.

What Causes Bipolar Disorder?

The exact cause of bipolar disorder is not known, but it is believed to result from imbalances of certain brain chemicals known as neurotransmitters. Heredity or genetic factors also play a role -- the risk of developing the illness is higher in close relatives of someone with the disorder than in the general population. Researchers are currently working on identifying the gene or genes responsible for bipolar disorder. Developmental factors and current psychosocial stressors may interact in predisposed individuals to determine if and when an episode occurs. Sometimes a stressful life event such as loss of a job, marital difficulties, or a death in the family may trigger an episode of mania or depression. At other times, episodes occur for no apparent reason.

How Is Bipolar Disorder Diagnosed?

Obtaining a thorough present and past history is the key to the diagnosis of bipolar disorder. While the patient is usually the main source of information, contributions from family members and other involved persons can be helpful. The diagnosis may be missed if the patient presents for treatment during a depressive episode unless care is taken to uncover a history of prior manic or hypomanic episodes. Since some of the symptoms of severe mania and schizophrenia may be similar, distinguishing the two may be difficult unless a detailed history is obtained of the entire clinical course of the illness. While there are no laboratory tests that diagnose bipolar disorder, certain tests may be helpful in excluding medical disorders that can mimic mania or depression.

How Do Alcohol and Street Drugs Relate to Bipolar Disorder?

There is a high incidence of alcohol and other substance abuse in people with bipolar disorder. This may represent an ill-advised form of self-medication or be part of the social expansiveness associated with a manic episode. Regardless of the cause, the use of alcohol and/or street drugs can worsen the symptoms of mania and depression, create diagnostic difficulties, and interfere with what might otherwise be effective treatment. In addition, these substances can have unhealthy interactions with the medicines used to treat bipolar disorder.

Is Bipolar Disorder Treatable?

Fortunately, the answer to this question is Ayes.@ Treatment in the form of medications and counseling can be effective for most people with bipolar disorder. For many, this means returning to a more normal, satisfying, and productive life. On the other hand, if not diagnosed and not treated, the impact of the illness can be devastating to the individual, significant others, and society in general.

Medications form the core of treatment for bipolar disorder. Without them, the likelihood of treatment success is slim. At the same time, medications alone are insufficient; without psychotherapy and support, a comprehensive treatment program would be incomplete.

In addition, treatment must effectively deal with stressors that may precipitate or aggravate episodes and with the psychosocial complications of the episodes themselves.

With proper treatment, most people with bipolar disorder can achieve the mood stability that will allow them to lead more fulfilling and productive lives.

How Does a Person Get Help?

If you suspect that you, a family member, or a friend has bipolar disorder, you should consult a mental health professional. This can be done directly or through your family physician, your health maintenance organization, or your community mental health center. The self-help and support organizations listed below can also be helpful.

Since proper diagnosis is essential for effective treatment, see someone who is knowledgeable about bipolar disorder. Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental illness. In addition to providing counseling, they are the only mental health professionals who can prescribe medication (in certain states, clinical nurse specialists have become able to prescribe). Clinical psychologists and clinical social workers can also diagnose and provide counseling and psychotherapy. Mental health counselors can be useful sources of counseling, support, and education. The best treatment is sometimes provided by several professionals working together to address the varied needs of an individual.

Is Counseling Useful for Treating Bipolar Disorder?

Counseling plays an important adjunctive role in the treatment of bipolar disorder. Therapy issues include dealing with the psychosocial stressors that may precipitate or worsen manic and depressive episodes and dealing with the individual, interpersonal, social, and occupational consequences of the disorder itself. Counseling can also help ensure better compliance with medication. While there are many forms of counseling available to people with bipolar disorder, they all include support and education. Therapy programs are further refined to meet the particular needs of the individual and may include individual psychotherapy, couples therapy, family therapy, or group therapy.

What Are Self-Help and Support Groups?

Associating with one or more of the following organizations can be of enormous benefit to individuals with bipolar disorder and their families. These groups provide information, educational material, and support.

Additional reading materials can also be obtained from these support groups.

Please call or write for information:

‚ Depression and Bipolar Support Alliance is specifically for people who have bipolar disorder and their relatives. The DBSA has 35,000 members and 250 chapters. Its address is 730 North Franklin Street, Suite 501, Chicago, IL 60610; phone 312-642-0049 or 1-800-82-NDMDA; fax 312-642-7243.

‚ The National Alliance for the Mentally Ill (NAMI) has about 140,000 members and 1,000 chapters. Their address is 200 North Glebe Road, Suite 1015, Arlington, VA 22203-3754; phone 703-524-7600, or call the NAMI Helpline at 1-800-950-NAMI.

‚ The National Mental Health Association (NMHA) has more than 300 chapters. Its address is 1021 Prince Street, Alexandria, VA 22314-2971; phone 703-684-7722.

‚ The Alliance for the Mentally Ill

NAMI of Greater Chicago

1536 West Chicago Ave, Chicago, IL 60622

Phone: 312-563-0445

namigc@aol.com