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Bipolar Disorder

Onset and Prevalence

Also called manic depression, bipolar disorder is a very serious, in some cases life-threatening, psychiatric problem which in many cases requires medication as a part of the treatment plan (please see the section on medication below). It affects nearly 3% of the population – 6 million people – in any given year.

Typically, bipolar disorder begins in adolescence or early adulthood, but cases of onset in childhood, mid adulthood, and late adulthood also occur. This should be considered a life-long disorder and treated as such: Any lapse in medication treatment can lead to a manic or depressive episode, leaving the patient in grave risk of harm.

It should be noted that bipolar disorder is genetically influenced and thus tends to run in families. When beginning in childhood or adolescence, bipolar disorder tends to be less clearly defined, making it harder to diagnose. The most common indicators of the early onset of this problem are frequent and dramatic mood swings which are more severe than is the developmental norm. Instead of euphoria, children with bipolar disorder tend to be very irritable and prone to destructive tantrums or behavior.

Symptomatology and Course

The signal event distinguishing bipolar disorder from major depression is the occurrence of at least one manic episode. During such an event, the sufferer begins to experience symptoms such as racing thoughts, pressured speech, poor impulse control, poor judgment, decreased need for sleep, overspending, inflated self-esteem, euphoria and prolonged irritation.

Bipolar II disorder, a variation of bipolar disorder, must be accompanied by at least one “hypomanic” episode, which has fewer symptoms than that noted in a full manic episode and tends to be less intense, prolonged, or severe.

If left untreated and especially if severe, bipolar disorder can be accompanied by:

1) hallucinations, especially auditory hallucinations (hearing voices or messages that are not occurring in reality); and/or

2) delusions (strongly held concepts that are untrue). Delusions tend to reflect the existing mood state of the disorder; for example, while in a manic state a patient may claim to be president of the United States or rich beyond imagination. While depressed, a patient may claim to be homeless despite having a nice house and devoted family...or falsely admit to having committed a terrible crime.

The other important characteristic of untreated, bipolar disorder is that it tends to worsen over time, either with more severe depressive or manic episodes or by cycles of mania and depression which escalate in frequency.

Causes

As indicated, genes play an important role in the onset of bipolar disorder, and research is ongoing to find which segments of DNA are most influential. It is incorrect to assume that this disorder is completely controlled by genetic factors, however. Twin studies indicate that if one twin has bipolar disorder the other is more likely to develop it, too, but this does not always occur. At this point it appears that bipolar disorder is influenced by not one but a multitude of genes interacting with the environment in complex and as yet little understood ways.

Treatment

A majority of bipolar patients who are properly medicated show significant improvement in bipolar symptoms. (Unfortunately, many patients with this illness will not take their medications properly or reliably, which is one reason that psychotherapy is recommended along with medication.)

The combination of medication with psychotherapy and family is considered to be the optimum treatment approach to this condition. Psychosocial treatments such as individual, marital, and family counseling provide benefits such as: additional monitoring of the condition, a check on compliance with medication, family support, better understanding of the problem, and often more willingness by the patient to face his or her bipolar illness more appropriately.

Medication

Lithium is effective in the control of manic episodes and in the prevention of the recurrence of manic and depressive cycles.

Anticonvulsants such as Depakote, Neurontin, Lamictal, and Tegretol are also being used as mood stabilizers, although as with many medications it’s important to monitor side effects carefully. With Lamictal, for instance, a rare but very serious rash may appear which requires immediate medical attention.

“Atypical” antipsychotics such as Clozaril are in clinical trials, and from current indications may be quite helpful as mood stabilizers and as treatments for acute manic episodes.

Antidepressants also may be helpful, especially for the depressive stage of the illness, but they must be prescribed by an expert, typically a psychiatrist with specialization in bipolar illness. For example, the use of serotinergic antidepressants is cautionary with this condition because they may trigger or exacerbate manic states.

Recommended Reading

An excellent book on bipolar disorder is An Unquiet Mind, by Dr. Kay Jamison, who is an esteemed psychologist under ongoing care for this condition.