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Information about Bipolar disorder

Treatments for Bipolar Disorder

Bipolar disorder requires lifelong treatment. A number of medications and psychotherapies are effective for manic, hypomanic, depressed and mixed episodes.

Left untreated, bipolar disorder can increase a person’s risk of suicide, accidents, heart disease, obesity, diabetes and other medical conditions, unemployment, divorce, social isolation, financial difficulties, alcoholism and drug abuse.

Timely diagnosis and treatment of bipolar disorder can minimize these risk. Helpful information about specific medications can be found at www.medlineplus.gov (click on "Drugs and Supplements").

Bipolar Disorder (Manic Depression)

Bipolar disorder is a complex, yet treatable illness that affects an individual’s ability to regulate mood and behavior. People with bipolar disorder experience a variety of intense mood swings. These mood swings may include elation and grandiosity, explosiveness and irritability, and extreme sadness and low energy. Moods can be very brief, or they can last for months or years.

Evidence suggests that genes may play a role in bipolar disorder. Environmental influences, such as stress (such as trauma or loss), hormonal changes, substance abuse, sleep disorders, or a medical illness, may also activate the illness. A person who suffers from bipolar disorder may have a difficult time with work, school, relationships, social activities, sports, hobbies and parenting. Individuals with bipolar disorder also frequently suffer from anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and problems with drugs and alcohol.

For most people with bipolar disorder, the illness is characterized by the presence of at least one of the following mood episodes: manic, hypomanic, or mixed. Only one of these episodes needs to occur in a person’s lifetime in order for the person to be diagnosed with bipolar disorder. These mood episodes commonly alternate with periods of relative wellness and with depressive episodes. It is also possible for a person with bipolar disorder to experience a chronic disordered mood state rather than discrete episodes.

Manic episodes (also called mania) are distinct periods of persistently elevated or expansive mood (feeling abnormally “high”), or irritable mood, lasting at least one week (or less if hospitalization is required). The mood is also accompanied by at least three of the following symptoms (four if a person feels irritable but is not experiencing an abnormal mood elevation): inflated self-esteem or grandiosity; a decreased need for sleep; pressured speech (excessive talkativeness); flight of ideas (racing thoughts); distractibility/poor concentration; increased involvement in goal-directed activities (socially, at work, at school, or sexually) or psychomotor agitation (feeling restless, keyed-up, fidgety); and excessive involvement in pleasurable and high-risk activities (such as excessive spending sprees, impulsive business investments, or indiscriminate, promiscuous, impulsive or unsafe sexual liaisons). Manic episodes usually require immediate treatment.

Hypomanic episodes are distinct periods of persistently elevated, expansive, or irritable mood lasting at least four days. The mood is also accompanied by additional symptoms, such as: inflated self-esteem or grandiosity; a decreased need for sleep; pressured speech; flight of ideas; distractibility; increased involvement in goal-directed activities or psychomotor agitation; and excessive involvement in pleasurable and high-risk activities. In contrast to a manic episode, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

Mixed episodes are characterized by a period of time in which a person experiences both a manic episode and a major depressive episode nearly every day for at least a week. The individual may experience rapidly alternating moods (sadness, irritability, euphoria) accompanied by symptoms of a manic episode and a major depressive episode. Mixed episodes are serious conditions that usually require immediate treatment.

Depressive episodes (also called depression) are a frequent problem for people who have bipolar disorder. (For a description of depression, refer to the previous section.) If their depression is untreated, individuals with bipolar disorder may experience disabling depressive symptoms between 30 and 50 percent of the time. For most people with bipolar disorder, depression is much more common than mania or hypomania.

When a person suffers a depressive episode, a trained treatment professional must carefully evaluate whether bipolar disorder is present. It is important to obtain the correct diagnosis, since the treatments for people with bipolar depression differ from the treatments for people who have depression but do not have bipolar disorder. For individuals with bipolar disorder who experience depressive symptoms, doctors commonly prescribe an anti-manic treatment together with an antidepressant to minimize the risk that the antidepressant will cause manic symptoms. While antidepressants do not "cause" bipolar disorder, they can unmask or intensify manic symptoms. Helpful information about specific medications can be found at www.medlineplus.gov (click on "Drugs and Supplements").

There are three general types of bipolar disorder, called bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified (BP-NOS). Bipolar I disorder is diagnosed when a person has had a manic or mixed episode. Bipolar II disorder is diagnosed when a person has had a hypomanic episode and depressive episodes. BP-NOS is diagnosed when a person has symptoms of bipolar disorder but does not meet the specific diagnostic guidelines for either bipolar I or II.

People with bipolar I disorder generally experience depressive symptoms for up to a third of the time; and manic or mixed symptoms less frequently. People with bipolar II disorder generally experience depressive symptoms for up to half of the time, rarely have hypomanic symptoms, and never have manic episodes. People with BP-NOS may experience manic or hypomanic symptoms and depressive symptoms, but these mood episodes may last for only a few days.

Bipolar disorder may look different in young people than it does in adults. Children with bipolar disorder often have mood swings that shift rapidly over hours or even minutes, while adults’ mood swings typically shift over days to weeks. Whereas adults with bipolar disorder generally have separate times when they are depressed, and separate times when they are manic, children with bipolar disorder are more likely to have moods that are not as well defined. Children who develop the disorder very young are particularly likely to experience chronic irritability and frequent mood shifts rather than separate periods of mania and depression.