Bipolar disorder, formerly called “manic-depression”, is a chronic illness affecting more than 2 out of every 100 people. In bipolar disorder, people experience extreme mood swings that are much more dramatic than what we usually call “moodiness.” There will be periods of depression, alternating with periods of mania, which is an intensely “high” or extremely irritable mood.
These mood swings are not for just a few hours, which may occur when we are “moody.” The depression or mania will usually last for at least a week, up to several months. These highs and lows are more extreme than those experienced by most people. The mood swings can often worsen performance in work or school, and damage relationships with family and friends.
The depressive periods may seem at first to be the more common form of depression, with sadness, lack of energy and hopelessness, including suicidal thinking. People with bipolar disorder are often mis-diagnosed as having simple or “unipolar” depression when they first come to treatment. Only later, when a manic or hypomanic (a little bit manic) episode occurs, will the diagnosis of bipolar disorder be more clear.
The manic periods may include agitation and surges of energy where the person is extremely active and often impulsive and overly confident. They may have racing thoughts, rapid speech, and feel little need for sleep. Friends and family may observe a dramatic personality change. They may witness an increase in foolish or risk-taking behavior, such as sexual promiscuity, or very excessive spending. The person may appear delusional; they may express odd ideas, or develop a sudden preoccupation with religion or other topics unusual for them.
Everyone with bipolar disorder will experience symptoms that are somewhat different. Some people’s mood swings are much more extreme than others. Many people experience primarily depression, with manic periods being few and far between.
Because its forms are so varied, bipolar disorder is often hard to diagnose. It can begin at any time of life, though most commonly between ages 15 and 25. People may attribute their symptoms to stress, drug or alcohol use, or life circumstances. As a result, many people go 10 years or more before being diagnosed.
We are not certain about the causes of bipolar disorder. Studies have suggested that the disease can be inherited, so that if others in your family have been diagnosed with bipolar disorder, your chances of developing it are greater. The illness also may be triggered by stress, including unexpected loss, illness, relationship or financial problems, or drug abuse.
Bipolar disorder is chronic and can be disabling, and can get worse without treatment. Treatment can help people get control of their mood swings. In psychotherapy they can learn to make careful lifestyle choices (with attention to regular sleep and nutrition), manage stress more successfully, avoid alcohol and drug use, and to develop a good support system.
In addition, medications are usually very helpful in keeping mood swings to a minimum. Often, different medications must be tried before one or a combination of several medications are found that work well for the individual.
Usually one medication will be a mood stabilizer such as lithum, a mineral which has been used for over 50 years for the stabilization of bipolar mood swings; or an anticonvulsant drug such as valproic acid (Depakote), lamotrigine (Lamictal) or carbamazepine (Tegretol). Antidepressants and/or antipsychotics are often used in combination with mood stabilizers.
These medications should be managed by a psychiatrist or psychiatric nurse practitioner, who is experienced in helping people with bipolar disorder, and will know how to help them manage side effects and other complications.
Finally, alternative treatments such as fish oil (omega-3 fatty acids) have been found to be helpful. To learn about effective dosing of these supplements, which are available over the counter, it is best to talk with your psychiatric provider.
If you have further questions about the treatment of Bipolar or Manic Depression, please feel free to contact us.