Bipolar Disorder

Bipolar disorder is a complex psychiatric disorder which usually involves episodes of mania and depression over the course of a person’s lifetime. However, a single episode of mania or hypomania in the absence of any depressive episodes can occur in bipolar disorder. Depressive episodes without any manic or hypomanic episodes, on the other hand, are insufficient for a diagnosis of bipolar disorder.

Bipolar disorder, like schizophrenia, is considered a life-long disorder. Currently, there is no cure for this illness. The severity of the illness can vary greatly. In most cases, mood episodes do recur. They may last for only a few days or as long as several months. The disorder may appear in childhood, but typically first appears in one’s teens or early twenties.

Symptoms of bipolar disorder

Manic episodes

In a nutshell, someone who is manic can look very similar to a person on speed. Symptoms of mania may include:

  • An elevated, very happy mood; a negative, angry, irritable mood; or an “expansive” mood, in which the person shows no restraint in expressing his/her emotions. This mood must last at least one week
  • Inflated sense of importance or self-worth
  • Increased talkativeness; speech is often very rapid and pressured
  • Little need for sleep without feeling tired
  • Agitated movement and behavior
  • An increased need to engage in various activities (e.g., more frequent sexual activity, taking on more projects at work, multiple social engagements)
  • Racing thoughts; the person’s thoughts rapidly move from one topic to the next
  • Easily distracted
  • Engaging excessively in activities which bring pleasure, but which can also have serious consequences (e.g., going on a major shopping sprees, having sex with multiple partners, taking foolish business or investment risks)

The manic episode must also do one or more of the following:

  • seriously impact the person’s life, such as his/her job or relationships
  • require hospitalization
  • include psychosis (e.g. hallucinations or delusions)

Major depressive episodes

An episode of depression may include a combination of the following symptoms; the symptoms are experienced most of the time for at least 2 weeks:

  • Depressed or sad mood
  • Loss of energy; feelings of fatigue
  • Feelings of restlessness or agitation, or feeling as if one is slowed down
  • Lack of interest in things or activities which normally interest the person
  • Difficulties making decisions or concentrating
  • Appetite changes (increase or decrease), or changes in weight (not due to dieting)
  • Sleep changes (insomnia or sleeping excessively)
  • Feelings of hopelessness
  • Inappropriate or extreme feelings of guilt; feelings of worthlessness
  • Suicidal thoughts or frequent thoughts of death
  • The depressive episode must cause the person significant distress or seriously impact his/her functioning in one or more areas of life (e.g., relationships or work).
  • Mixed episodes (Mixed episodes occur when there are both manic symptoms and depressive symptoms occurring simultaneously)

Bipolar I vs. Bipolar II

In bipolar I disorder, the person has had at least one manic or mixed episode. In bipolar II disorder, the person has had at least one hypomanic episode, but no manic or mixed episode.

Hypomanic episode

A hypomanic episode is less severe than a manic episode, must last at least 4 days, is noticeable by others but causes less impairment, and never includes psychotic features.

Treatment for Bipolar Disorder

Treatment for bipolar disorder typically involves medication. Mood stabilizers, such as lithium, divalproex (brand name Depakote), and carbamazepine, are often used to treat bipolar disorder. Additional medications such as antidepressants or antipsychotics may also be used, depending on the symptoms. Antidepressant medications pose special risks for individuals who have bipolar disorder or who are predisposed to developing bipolar disorder. This is because, if used alone (i.e., without the addition of a mood stabilizer), they may trigger a manic or hypomanic episode.

Hospitalization may be indicated to stabilize a manic or mixed episode, or to treat a severe depressive episode. Psychotherapy can help the person understand the disorder, learn ways to manage it, and deal with related issues.

written by Dr. Cheryl Lane, PsyD

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