Bipolar Disorder

Bipolar Disorder

Bipolar disorder - sometimes also called manic-depressive illness - is a medical illness much like heart disease, diabetes or any other physical illness or condition.

Bipolar disorder is more than the usual ups and downs of life. It is a serious medical illness that involves the brain. Most people with bipolar disorder go back and forth between mania and depression. Some people have both feelings at the same time, which is called a state.

More than 2 million Americans have bipolar disorder. It can happen to anyone, no matter what age you are or where you come from.

Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated.

Bipolar disorder is typically a lifelong illness and most often begins in the later teenage years or early adulthood. It commonly runs in families - but not always - and affects more than 2 million Americans.

Bipolar disorder is a very treatable illness. While this illness often has a significant impact on individuals' families, friends and significant others, treatment is readily available - and when properly followed, is often successful.

A child has a much greater chance of having bipolar disorder if there is a family history of the disorder or depression. This means that parents cannot choose whether or not their children will have bipolar disorder.

Although bipolar disorder affects at least 750,000 children in the United States, it is often difficult to recognize and diagnose in children. If left untreated, the disorder puts a child at risk for school failure, drug abuse, and suicide. That is why it is important that you seek the advice of a qualified professional when trying to find out if your child has bipolar disorder.

Bipolar Disorder Symptoms

Symptoms of bipolar disorder can be mistaken for other medical/mental health conditions, and children with bipolar disorder can have other mental health needs at the same time. Other disorders that can occur at the same time as bipolar disorder include, but are not limited to, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, anxiety disorders, autistic spectrum disorders, and drug abuse disorders. The roles that a family's culture and language play in how causes and symptoms are perceived and then described to a mental health care provider are important, too. Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses-which are serious problems when a child needs help. That is why it is important that supports be in place to bridge differences in language and culture. Once bipolar disorder is properly diagnosed, treatment can begin to help children and adolescents with bipolar disorder live productive and fulfilling lives.

Unlike some health problems where different people experience the same symptoms, children experience bipolar disorder differently. Often, children with the illness experience mood swings that alternate, or cycle, between periods of "highs" and "lows," called "mania" and "depression," with varying moods in between. These cycles can happen much more rapidly than in adults, sometimes occurring many times within a day. Mental health experts differ in their interpretation of what symptoms children experience. The following are commonly reported signs of bipolar disorder:

  • Excessively elevated moods alternating with periods of depressed or irritable moods;
  • Periods of high, goal-directed activity, and/or physical agitation;
  • Racing thoughts and speaking very fast;
  • Unusual/erratic sleep patterns and/or a decreased need for sleep;
  • Difficulty settling as babies;
  • Severe temper tantrums, sometimes called "rages";
  • Excessive involvement in pleasurable activities, daredevil behavior, and/or grandiose, "superconfident" thinking and behaviors;
  • Impulsivity and/or distractibility;
  • Inappropriate sexual activity, even at very young ages;
  • Hallucinations and/or delusions;
  • Suicidal thoughts and/or talks of killing self; and
  • Inflexible, oppositional/defiant, and extremely irritable behavior.

These feeling states are often painful, last a long time and are serious. They are very different from ordinary feelings of being really happy and excited or sad and blue. These feelings usually interfere with a person's ability to conduct a normal family, work and personal life. Sometimes the strong excitement or happy feelings make it hard to realize one can be ill. Some people find they want to use alcohol or other drugs to change the way they feel - this is a bad idea.

Bipolar Disorder Diagnosis

The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person's close relatives or spouse and note how they describe the person's symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.

Bipolar Disorder Treatment

Treatment for bipolar disorder for you or your family member begins with a thorough physical and psychiatric examination by a doctor that includes a careful assessment of the symptoms the individual is experiencing. The doctor will ask questions about medical conditions you may have, family history to detect the presence of the illness in other family members, as well as history of any past or current medications that may have been given to you by other doctors or clinicians for this condition, as well as what strategies that have or have not worked for you so far.

Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year's time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.

However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state. If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse. Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.

Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.

Bipolar Disorder Medications

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.

Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.

Three types of medications are used to treat the different phases of bipolar disorder. They are:

  • Mood Stabilizers
  • Antidepressents
  • Antipsychotic Medication

Mood stabilizers are typically prescribed for people with feeling "high", talkativeness, irritability, accelerated speech and other manic symptoms as well as depression that interfere with a person's functioning. These medications commonly reduce the intensity of mood swings and usually restore the person to a more normal level of functioning. Lithium, depakote and carbamazepine are common medications in this group. They also are particularly important to help people prevent symptoms from coming back after they are controlled.

Antidepressants are prescribed for persons with the symptoms of depression. These may include feelings of sadness and depression as well as slowed, sluggish behavior. These medications help the body regain its energy so that the person has more interest in daily life. It is important to note that antidepressants may worsen manic symptoms and should be used after careful consultation with your doctor.

Antipsychotic medications are sometimes used for people with bipolar disorder who may have hallucinations or delusions. Hallucinations are perceptual experiences that are not actually occurring, such as hearing voices telling one to harm oneself. Delusions are fixed false beliefs about the self, such as "Everyone is out to get me." Antipsychotic medications can be very helpful in these cases and your or your loved one's doctor will have several to choose from, including newer medicines such as olanzapine, quietiapine, risperidol and ziprasidone.

Decades of research has shown that medications are an important treatment intervention with good results. The range of medications available allows your doctor to select the type most suitable for your or your family member's needs. When prescribing medication, doctors often think in terms of how the medication might affect different phases of the illness. The phases of bipolar disorder includes an initial manic and/or depressed stage, known as the ACUTE PHASE. The next is the early and initial recovery stage, known as the CONTINUATION OR EARLY STABLE PHASE. The third is the maintenance stage, or PROPHYLACTIC PHASE. Medicines may be changed as the course of recovery continues. It is important to know that all medications have benefits, risks and potential side effects. It is equally important to know that there are also risks in NOT taking medications. You should discuss all of these issues carefully with your doctor.

Side effects will be discussed between you and your doctor. Individuals who are using these medications will be carefully monitored in order to minimize these effects. Sometimes, changing medications will eliminate some side effects. Elderly patients, pregnant patients and mothers who are nursing should take particular care in discussing side effects in detail with their doctors.

Common Bipolar Disorder Medications and Generic Names

TRADE OR COMMON NAME GENERIC NAME
ATIVAN LORAZEPAM
CALAN VERAPAMIL
CLOZARIL CLOZAPINE
DEPAKENE VALPROIC ACID
DEPAKOTE DIVALPROEX
GEODON ZIPRASIDONE
HALDOL HALOPERIDOL
KLONOPIN CLONAZEPAM
LAMICTAL LAMOTRIGINE
LITHOBID/LITHIUM LITHIUM CARBONATE
NEUROTIN GABAPENTIN
PROZAC FLUOXETINE
RISPERDAL RISPERIDONE
SEROQUEL QUETIAPINE
TEGRETOL CARBAMAZEPINE
TOPAMAX TOPIRAMATE
WELLBUTRIN BUPROPION
ZYPREXA OLANZAPINE

Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits. In some cases, side effects may not appear until a person has taken a medication for some time.

If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

Other Treatments for Bipolar Disorder

  1. Electroconvulsive Therapy (ECT) - For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.

    Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30-90 seconds. People who have ECT usually recover after 5-15 minutes and are able to go home the same day.

    Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.

    ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.

  2. Sleep Medications - People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.

People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Bipolar Disorder Interventions

As with any chronic illness, a person with bipolar disorder may occasionally have a reappearance of acute phase symptoms as well as difficulty managing daily activities. It is common for people with bipolar illness to have periods of high functioning interrupted by periods of low functioning. For instance, people with bipolar disorder often have success at work, but may need support to maximize their funcitoning. There are several ways to address this - some of the more common approaches include family therapy, group therapy, skills-based programs and psychoeducation.

It is very important to understand that no family member caused their loved one's bipolar illness, since it is a medical condition. The quality of support and the reliability of personal relationships may affect the course of the illness. At the same time, the person's illness may cause concern for himself or herself as well as increased general stress for the family.

Family pyschoeducational therapy can be helpful in these situations by focusing on improving communication among family members, helping the person with bipolar illness understand the benefits of consistently taking their medication and learning strategies to prevent relapses. In this type of treatment, family members can feel supported and the individual with the illness can learn new ways for maintaining recovery.

Group therapy can also provide needed support and helpful skills for the person with bipolar disorder. In group therapy, people learn they are not alone with the illness; they receive important emotional support; learn skills for coping with medications, interpersonal and work-related issues; and learn ways to cope with stigma from others. Maximizing work or social functioning is a core aspect of recovery and skill-based interventions - for example, school and job training can help with this.

Overall, psychoeducational treatments help the person and his or her family members to better understand bipolar illness so that recovery can be reached sooner. In these types of approaches, individuals with the illness and their family members can expect to discuss topics such as accepting the illness, identifying early warning signs of difficulties about to happen, learning to cope with mood changes, understanding medications and where to find self-help groups and accessing employment or training resources.

Bipolar Disorder Counseling

Since people with bipolar disorder often experience swings in mood, even the most motivated individual can occasionally become overwhelmed. Denial, guilt, self-blame and hostility toward both the self and other can be seen as a solution. To prevent this from happening, ongoing counseling with your doctor and your health care treatment team can help in identifying early warning signs, treating the warning signs quickly and keeping up morale. The frequency of psychotherapy visits is an individual preference, but these visits are an important aspect of recovery.

If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.

  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies.

You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.

To help a friend or relative, you can:

  • Offer emotional support, understanding, patience, and encouragement
  • Learn about bipolar disorder so you can understand what your friend or relative is experiencing
  • Talk to your friend or relative and listen carefully
  • Listen to feelings your friend or relative expresses-be understanding about situations that may trigger bipolar symptoms
  • Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
  • Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments about your friend or relative harming himself or herself. Always report such comments to his or her therapist or doctor.