Bipolar disorder

Being manic-depressive, or bipolar, is different than the normal ups and downs many people experience. In bipolar disorder (BP), like anxiety disorders, the symptoms are severe. BP is basically a disorder of brain functioning that causes extreme shifts or swings in a person's mood or energy. And it is very often debilitating.

About 5.7 million American adults, or about 2.6 percent of the population age 18 and older, in any given year have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood, but some show symptoms during childhood, while others develop later in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Bipolar disorder is not a temporary condition. It is a long-term illness that must be carefully managed throughout a person's life.

As author and PhD Kay Redfield Jamison describes in her book An Unquiet Mind (1995), "It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."

What are the symptoms of bipolar disorder?

Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normall mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. Bipolar disorder may appear to be a problem other than mental illness, such as alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness

• Excessively "high," overly good, euphoric mood

• Extreme irritability

• Racing thoughts and talking very fast, jumping from one idea to another

• Distractibility, can't concentrate well

• Little sleep needed

• Unrealistic beliefs in one's abilities and powers

• Poor judgment

• Spending sprees

• Increased sexual drive

• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications

• Provocative, intrusive, or aggressive behavior

• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

• Lasting sad, anxious, or empty mood

• Feelings of hopelessness or pessimism

• Feelings of guilt, worthlessness, or helplessness

• Loss of interest or pleasure in activities once enjoyed, including sex

• Decreased energy, a feeling of fatigue or of being "slowed down"

• Difficulty concentrating, remembering, making decisions

• Restlessness or irritability

• Sleeping too much, or can't sleep

• Change in appetite and/or unintended weight loss or gain

• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury

• Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed " dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

Current treatments for bipolar disorder can help. People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time, a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Source:  National Institue of Mental Health (NIMH)