Bipolar
Disorder : Symptoms and Treatment
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.
Effective
treatments 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.
Here are some
facts about bipolar disorder.
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
detected.
- 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 necessary.
D/ART: A
National Educational Program
The National
Institute of Mental Health (NIMH) has launched the
Depression/Awareness, Recognition, and Treatment (D/ART)
campaign to help people:
- Recognize the
symptoms of depressive disorders, including
bipolar disorder
- Obtain an
accurate diagnosis
- Obtain
effective treatments
D/ART Also:
- Encourages and
trains health care professionals to recognize the
signs of manic-depressive illness and utilize the
most up-to-date treatment approaches
- Organizes
citizens' advocacy groups to extend the D/ART
program
- Works with
industry to improve recognition, treatment, and
insurance coverage for depressive disorders
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 and powers
- 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 behavior
- 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 helplessness
- Loss of
interest or pleasure in ordinary activities,
including sex
- Decreased
energy, a feeling of fatigue or of being
"slowed down"
- Difficulty
concentrating, remembering, making decisions
- Restlessness
or irritability
- Sleep
disturbances
- Loss of
appetite and weight, or weight gain
- Chronic pain
or other persistent bodily symptoms that are not
caused by physical disease
- Thoughts of
death or suicide; suicide attempts
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 mania.
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 bipolar
disorder:
Depression:
I 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 clinical depression.
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 depressive episodes.
- 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 eventially 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 also used.
- 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 value.
- For
depression, several types of antidepressants can
be useful when combined with lithium,
carbamazepine, or valproate.
- 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 disease.
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
treatment.
Help can be
found at:
- University- or
medical school-affiliated programs
- Hospital
departments of psychiatry
- Private
psychiatric offices and clinics
- Health
maintenance organizations
- Offices of
family physicians, internists, and pediatricians
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 mental illness.
- 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 Association.
- Families and
friends of people with bipolar disorder can also
benefit from mutual support groups such as those
sponsored by NDMDA and NAMI.
- National
Institute of Mental Health
- Public
Inquiries, Room 7C-02
- 5600 Fishers
Lane
- Rockville, MD
20857
- National
Depressive and Manic Depressive Association
- 730 Franklin
Street, Suite 501
- Chicago, IL
60610
- (312)
642-0049; (312) 642-7243 FAX; 1-800-826-3632
- National
Alliance for the Mentally Ill
- 200 North
Glebe Road, Suite 1015
- Arlington, VA
22203-3754
- (703)
524-7600; (703) 524-9094 FAX; 1-800-950-NAMI
(6264)
- National
Foundation for Depressive Illness
- P.O. Box 2257
- New York, NY
10116
- (212)
268-4260; (212) 268-4434 FAX; 1-800-248-4344
- National
Mental Health Association
- 1021 Prince
Street
- Alexandria, VA
22314-2971
- (703)
684-7722; (703) 684-5968 FAX; 1-800-969-NMHA
(6642)
The year 1996 marks
the fiftieth anniversary of the National Institute of
Mental Health (NIMH). Throughout the past 50 years, the
results of research supported by the Institute have
brought new hope to millions of people who suffer from
mental illness and to their families and friends. In work
with animals as well as human participants, researchers
have advanced our understanding of the brain and vastly
expanded the capability of mental health professionals to
diagnose, treat, and prevent mental and brain disorders.
During this last
decade of the twentieth century--designated "The
Decade of the Brain" by the U.S. Congress--knowledge
of brain function has exploded. Research is yielding
information about the causes of mental disorders such as
depression, bipolar disorder, schizophrenia, panic
disorder, and obsessive-compulsive disorder. With this
knowledge, scientists are developing new therapies to
help more people overcome mental illness.
The National
Institute of Mental Health is part of the National
Institutes of Health (NIH), the Federal Government's
primary agency for biomedical and behavioral research.
NIH is a component of the U.S. Department of Health and
Human Services.
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