Dr. MJ Bazos MD,
What Is Bipolar Disorder?
Bipolar disorder, which is also known
as manic-depressive illness and will be called by both names throughout this
publication,-is a mental illness involving episodes of serious mania and
depression. The person's mood usually swings from overly "high" and irritable to
sad and hopeless and then back again, with periods of normal mood in between.
Bipolar disorder typically begins in
adolescence or early adulthood and continues throughout life. It is often not
recognized as an illness, and people who have it may suffer needlessly for years
or even decades.
are available that greatly alleviate the suffering caused by bipolar disorder
and can usually prevent its devastating complications. These include marital
break-ups, job loss, alcohol and drug abuse, and suicide.
Manic-Depressive Illness Has a
Devastating Impact on Many People
•At least 2 million Americans suffer from
manic-depressive illness. For those afflicted with the illness, it is extremely
distressing and disruptive.
•Like other serious illnesses, bipolar
disorder is also hard on spouses, family members, friends, and employers.
•Family members of people with bipolar
disorder often have to cope with serious behavioral problems (such as wild
spending sprees) and the lasting consequences of these behaviors.
•Bipolar disorder tends to run in families
and is believed to be inherited in many cases. Despite vigorous research
efforts, a specific genetic defect associated with the disease has not yet been
•Bipolar illness has been diagnosed in
children under age 12, although it is not common in this age bracket. It can be
confused with attention-deficit/hyperactivity disorder, so careful diagnosis is
Bipolar disorder involves cycles of
mania and depression. Signs and symptoms of mania include discrete periods of:
•Increased energy, activity, restlessness,
racing thoughts, and rapid talking
•Excessive "high" or euphoric feelings
•Extreme irritability and distractibility
•Decreased need for sleep
•Unrealistic beliefs in one's abilities
•Uncharacteristically poor judgment
•A sustained period of behavior that is
different from usual
•Increased sexual drive
•Abuse of drugs, particularly cocaine,
alcohol, and sleeping medications
•Provocative, intrusive, or aggressive
•Denial that anything is wrong
Signs and symptoms of depression include
discrete periods of:
•Persistent sad, anxious, or empty mood
•Feelings of hopelessness or pessimism
•Feelings of guilt, worthlessness, or
•Loss of interest or pleasure in ordinary
activities, including sex
•Decreased energy, a feeling of fatigue or
of being "slowed down"
•Difficulty concentrating, remembering,
•Restlessness or irritability
•Loss of appetite and weight, or weight
•Chronic pain or other persistent bodily
symptoms that are not caused by physical disease
•Thoughts of death or suicide; suicide
It may be helpful to think
of the various mood states in manic-depressive illness as a spectrum or
continuous range. At one end is severe depression, which shades into moderate
depression; then come mild and brief mood disturbances that many people call
"the blues," then normal mood, then hypomania (a mild form of mania), and then
Some people with untreated
bipolar disorder have repeated depressions and only an occasional episode of
hypomania (bipolar II). In the other extreme, mania may be the main problem and
depression may occur only infrequently. In fact, symptoms of mania and
depression may be mixed together in a single "mixed" bipolar state.
Descriptions provided by patients
themselves offer valuable insights into the various mood states associated with
doubt completely my ability to do anything well. It seems as though my mind has
slowed down and burned out to the point of being virtually useless....[I am]
haunt[ed]...with the total, the desperate hopelessness of it all... Others say,
"It's only temporary, it will pass, you will get over it," but of course they
haven't any idea of how I feel, although they are certain they do. If I can't
feel, move, think, or care, then what on earth is the point?
Hypomania: At first when I'm
high, it's tremendous...ideas are fast...like shooting stars you follow until
brighter ones appear...all shyness disappears, the right words and gestures are
suddenly there...uninteresting people, things, become intensely interesting.
Sensuality is pervasive, the desire to seduce and be seduced is irresistible.
Your marrow is infused with unbelievable feelings of ease, power, well-being,
omnipotence, euphoria...you can do anything...but, somewhere this changes.
Mania: The fast ideas become
too fast and there are far too many...overwhelming confusion replaces
clarity...you stop keeping up with it—memory goes. Infectious humor ceases
to amuse. Your friends become frightened...everything is now against the
grain...you are irritable, angry, frightened, uncontrollable, and trapped.
Recognition of the various mood states
is essential so that the person who has manic-depressive illness can obtain
effective treatment and avoid the harmful consequences of the disease, which
include destruction of personal relationships, loss of employment, and suicide.
Manic-depressive illness is often not
recognized by the patient, relatives, friends, or even physicians.
•An early sign of manic-depressive illness
may be hypomania–a state in which the person shows a high level of energy,
excessive moodiness or irritability, and impulsive or reckless behavior.
•Hypomania may feel good to the person who
experiences it. Thus, even when family and friends learn to recognize the mood
swings, the individual often will deny that anything is wrong.
•In its early stages, bipolar disorder may
masquerade as a problem other than mental illness. For example, it may first
appear as alcohol or drug abuse, or poor school or work performance.
•If left untreated, bipolar disorder tends
to worsen, and the person experiences episodes of full-fledged mania and
Most people with manic depressive
illness can be helped with treatment.
•Almost all people with bipolar
disorder—even those with the most severe forms—can obtain
substantial stabilization of their mood swings.
•One medication, lithium, is usually very
effective in controlling mania and preventing the recurrence of both manic and
•Most recently, the mood stabilizing
anticonvulsants carbamazepine and valproate have also been found useful,
especially in more refractory bipolar episodes. Often these medications are
combined with lithium for maximum effect.
•Some scientists have theorized that the
anticonvulsant medications work because they have an effect on kindling, a
process in which the brain becomes increasingly sensitive to stress and
eventually begins to show episodes of abnormal activity even in the absence of a
stressor. It is thought that lithium acts to block the early stages of this
kindling process and that carbamazepine and valproate act later.
•Children and adolescents with bipolar
disorder are generally treated with lithium, but carbamazepine and valproate are
•Valproate has recently been approved by
the Food and Drug Administration for treatment of acute mania.
•The high potency benzodiazepines
clonazepam and lorazepam may be helpful adjuncts for insomnia.
•Thyroid augmentation may also be of
•For depression, several types of
antidepressants can be useful when combined with lithium, carbamazepine, or
•Electroconvulsive therapy (ECT) is often
helpful in the treatment of severe depression and/or mixed mania that does not
respond to medications.
•As an adjunct to medications,
psychotherapy is often helpful in providing support, education, and guidance to
the patient and his or her family.
•Constructing a life chart of mood
symptoms, medications, and life events may help the health care professional to
treat the illness optimally.
•Because manic-depressive illness is
recurrent, long-term preventive (prophylactic) treatment is highly recommended
and almost always indicated.
Anyone with bipolar disorder should be
under the care of a psychiatrist skilled in the diagnosis and treatment of this
Other mental health
professionals, such as psychologists and psychiatric social workers, can assist
in providing the patient and his or her family with additional approaches to
Help can be found at:
•University- or medical school-affiliated
•Hospital departments of psychiatry
•Private psychiatric offices and clinics
•Health maintenance organizations
•Offices of family physicians, internists,
People With Manic-Depressive Illness Often Need
Help to Get Help
•Often people with bipolar disorder do not
recognize how impaired they are or blame their problems on some cause other than
•People with bipolar disorder need strong
encouragement from family and friends to seek treatment. Family physicians can
play an important role for such referral.
•If this does not work, loved ones must
take the patient for proper mental health evaluation and treatment.
•If the person is in the midst of a severe
episode, he or she may have to be committed to a hospital for his or her own
protection and for much needed treatment.
•Anyone who is considering suicide needs
immediate attention, preferably from a mental health professional or a
physician; school counselors and members of the clergy can also assist in
detecting suicidal tendencies and/or making a referral for more definitive
assessment or treatment. With appropriate help and treatment, it is possible to
overcome suicidal tendencies.
•It is important for patients to
understand that bipolar disorder will not go away, and that continued compliance
with treatment is needed to keep the disease under control.
•Ongoing encouragement and support are
needed after the person obtains treatment, because it may take a while to
discover what therapeutic regimen is best for that particular patient.
•Many people receiving treatment also
benefit from joining mutual support groups such as those sponsored by the
National Depressive and Manic Depressive Association (NDMDA), the National
Alliance for the Mentally Ill (NAMI), and the National Mental Health
•Families and friends of people with
bipolar disorder can also benefit from mutual support groups such as those
sponsored by NDMDA and NAMI.