Bipolar Disorder: Signs, Symptoms and Treatment

Bipolar Disorder: Signs, Symptoms and Treatment
What is bipolar disorder?
Bipolar disorder (formerly known as manic-depression) is a condition in which a person typically experiences dramatic "mood swings" from periods of extremely elevated moods (mania) to extremely low moods (depression). In most cases, bipolar disorder first appears in young adults, but children and adolescents might also suffer from this disorder.

What are the signs and symptoms of bipolar disorder?Bipolar disorder is characterized by two extremes - the polar opposites that give the condition its name.

Signs and symptoms of the manic phase (Bipolar I):

• euphoria, feeling "high"
• agitation, edginess, irritability, restlessness
• racing thoughts, talkativeness
• increased energy, sleeplessness
• inflated self-esteem; grandiosity; poor judgment
• reckless spending sprees or other activities with high potential for painful consequences
• delusions or hallucinations
• drug or alcohol use
• increased sexual drive
• aggressive behavior
• inability to concentrate well
• Hypomania (Bipolar II) refers to an episode with less extreme symptoms than full-blown mania.
• Although bipolar disorder can be diagnosed from just a manic episode, most persons with this disorder also experience the other extreme, depression.

Signs and symptoms of the depressive state:

• abnormally low mood
• sadness and hopelessness
• excessive feelings of guilt and worthlessness
• difficulty concentrating or making decisions
• changes in appetite or weight (increase or decrease)
• fatigue; changes in sleep patterns (increase or decrease)
• loss of self-esteem
• diminished interest in daily activities
• withdrawal from others
• drug or alcohol use
• suicidal thoughts, plans or attempts.
• A person diagnosed with a Bipolar III condition is identified as "unipolar." He or she experiences recurrent episodes of depression only, but has a family history of mania or hypomania.

What is the typical course of bipolar disorder?There is no standard presentation for bipolar disorder. Some people have relatively few or mild episodes. Others may experience rapid cycling (four or more episodes within a year). People can also experience a mixed state, where symptoms of both mania and depression are present at the same time.

What causes bipolar disorder?
Abnormalities in the brain
The cause of bipolar disorder is under investigation, but there are strong indications that it is a brain-based disorder. It seems that several factors act together to produce the illness. Possibilities include:

• an imbalance of neurotransmitters
• a genetic disorder
• a dysfunction in the mitochondria (see link "Cellular Bipolar Breakdown Lane")
• Other triggers

When an individual is predisposed to bipolar disorder, an episode can be triggered by:

• a major life event
• stress in large doses
• an antidepressant medication
• seasonal fluctuations in light (mania is more prevalent in summer, depression in spring, fall and winter)
• sleep loss

How is bipolar disorder diagnosed?There is no specific diagnostic test for bipolar disorder. It is identified by behaviors often first noticed in adolescence and early adulthood. Symptoms of bipolar disorder may be similar to those of other conditions, such as schizophrenia, other anxiety or depressive disorders, or alcohol or drug abuse.

In children, bipolar disorder may appear similar to temper tantrums, ADHD, or oppositional or conduct disorders. A psychiatrist is the most likely medical doctor to determine the correct diagnosis.

An accurate diagnosis is important because the use of the wrong medication sometimes can lead to more serious symptoms. A medical evaluation should include an assessment of thyroid and kidney function.

How is bipolar disorder treated?
The good news about bipolar disorder is that it is treatable. Proper treatment can help reduce the frequency and severity of episodes and can help people who have the disorder maintain a good quality of life. Without treatment by a psychiatrist experienced with this condition, however, the symptoms can become more severe. But each person is unique. A treatment that works for someone else may not work for you. Although this can lead to heartbreaking rounds of hit-or-miss therapy, there are so many treatments and combinations to choose from that there is bound to be something that is right for you.

Medications may not be the total answer, but they can get you on your feet again and help prevent relapses. It is best to view them as one part of the treatment and wellness equation.

Treatment of bipolar disorder usually includes a combination of approaches, such as:

• medication (mood stabilizers, anti-depressants, and/or anti-anxiety medications)
• cognitive behavioral therapy (to challenge and change negative thought patterns and inappropriate behaviors)
• psychoeducation (learning about the illness and its treatment; recognizing and preventing relapse)
• family therapy (to help family members cope with and manage the stress of bipolar disorder)
• social rhythm therapy (to improve interpersonal relationships and to regularize daily routines, to avoid manic episodes)
• ECT (electro-convulsive therapy, sometimes used when other treatments are unsuccessful, to "re-set" the brain's electrical system)
• nutritional supplements (under investigation to determine if they can help alleviate or prevent bipolar episodes)

One challenge in treating bipolar disorder is that the person often enjoys the excitement of the hypomanic or even the manic state, and does not want to give up those feelings to a medication that will level off moods and may have troublesome side effects. In addition, many people are in denial of the problem, or feel stigmatized about having a "mental illness" and refuse to acknowledge the need for treatment. Education about the cause, consequences, and treatment for bipolar disorder can help these individuals:

• come to terms with the condition
• recognize symptoms when they appear.
• Practical suggestions from families
• Encourage the person with bipolar disorder to maintain a strong support system of family members and friends and to use it whenever he or she needs help.
• Be a loving, caring family member or friend yourself.
• Help the individual find ways to distract or engage him- or herself when the red flags of depression go up, e.g. play a sport, work out, go to a movie, visit a friend.
• Try to convince the individual to stay on medication and point out symptoms as they begin to emerge.