What Is Bipolar Disorder? Bipolar Symptoms And Treatments

Bipolar disorder - also known as manic-depression or manic-depressive illness - is a mental illness characterized by mood instability that is often serious and disabling. A person with bipolar disorder has unusual shifts in mood, energy, and ability to function that can last for weeks or months. The fluctuations of bipolar disorder are different from the general "ups" and "downs" that everyone goes through because symptoms are severe and can result in damaged relationships, poor job or school performance, or even suicide. There are treatments available for bipolar disorder that have allowed people to lead full and productive lives.

Bipolar disorder can be classified into the following types:

• Bipolar I disorder: At least one manic episode, with or without previous depressive episodes.


• Bipolar II disorder. At least one episode of depression and at least one hypomanic episode (a brief and less severe manic episode). The periods of depression are usually much longer than the periods of hypomania in bipolar II disorder.


• Cyclothymia: A mild form of bipolar disorder with mood swings and less severe highs and lows compared to full bipolar disorder.

Many people have their first symptoms of bipolar disorder during late adolescence or early adulthood, but some have first symptoms during childhood and others later in life. People often suffer for years because it can be difficult to diagnose and, therefore, may not be properly treated.

What causes bipolar disorder?

Although we do not know the exact cause of bipolar disorder, there are several factors that are thought to be associated with causing the disorder and triggering bipolar episodes. For example, physical changes in the brain have been observed by analyzing biochemicals in the brains of people with bipolar disorder. Brain chemicals called neurotransmitters and certain hormonal imbalances are likely involved in triggering episodes.

Bipolar disorder may also be a hereditary condition. That is, the disorder is more common in people who have family members that also have the condition. Currently it is unknown which genes are responsible for bipolar disorder.

Environmental factors - such as self-esteem problems, significant loss, childhood trauma, or high stress - may also cause bipolar disorder or bipolar episodes.

What are the symptoms of bipolar disorder?

Symptoms of bipolar disorder differ from the periods of lows and highs - the episodes of depression and mania. The changes in mood occur with similar changes in energy and behavior. Although symptoms may vary from person to person, a summary of common ones is below.

Signs and symptoms of manic episodes (mania):

• Euphoria
• Excessively "high," overly good mood
• Inflated self-esteem
• Poor judgment
• Rapid speech and racing thoughts
• Aggressive and intrusive behavior
• Agitation and extreme irritability
• Increased energy, activity, and restlessness
• Risky behavior
• Spending sprees
• Increased drive to perform or achieve goals
• Increased sexual drive
• Decreased need for sleep
• Tendency to be easily distracted and difficulty concentrating
• Drug abuse, particularly cocaine, alcohol, and sleep aides
• Unrealistic beliefs in one's abilities and powers
• Denial that anything is wrong

Signs and symptoms of depressive episodes (depression):

• Sadness
• Feeling of emptiness
• Hopelessness or pessimism
• Decreased energy
• Suicidal thoughts or behavior
• Anxiety
• Guilt, worthlessness, and helplessness
• Sleep problems
• Appetite problems
• Unintentional weight gain or loss
• Fatigue
• Loss of interest in daily activities
• Lack of desire for sex
• Problems concentrating
• Difficulty making decisions
• Irritability
• Chronic pain without a known cause

Who is at risk of having bipolar disorder?

About one percent of the population has bipolar disorder, but this number is estimated to be as high as six percent when additional forms of the disorder and undiagnosed or misdiagnosed cases are taken into consideration. Although bipolar I disorder affects men and women equally, bipolar II disorder is much more common in women. Both sexes are at highest risk between the ages of 15 and 30. Additional risk factors include a family history of bipolar disorder, periods of high stress, drug and alcohol abuse, and significant life changes such as the death of a loved one.

How is bipolar disorder diagnosed?

In order to diagnose bipolar disorder, physicians will conduct a series of tests. A standard physical exam will provide information on height and weight, heart rate, blood pressure, heart and lung function, and abdominal state. Blood and urine may be sent to a laboratory for a complete blood count (CBC), thyroid test, and urinalysis.

The key piece of the bipolar diagnosis comes from a psychological evaluation. Thoughts, feelings, and behaviors will be evaluated by a mental health provider such as a psychologist or psychiatrist. The doctor may ask about alcohol and drug abuse and may ask to talk to close friends and family members in order to better understand symptoms and the events during mania or depressive episodes.

A diagnosis of bipolar I disorder usually requires one or more manic or mixed episodes with or without a major depressive episode. A bipolar II disorder diagnosis usually requires hypomanic episodes and at least one major depressive episode. A diagnosis of cyclothymia usually requires a presence or history of hypomanic episodes with periods of depression, but not major depressive episodes.

Bipolar disorder treatments

Bipolar disorder treatments primarily consist of medications and psychotherapy. In order to reduce the frequency and severity of both manic and depressive episodes, it is important to treat the disorder during episodes and during periods of remission. Additional complications, such as alcohol or substance abuse, should also be treated since they may exacerbate bipolar disorder symptoms.

A psychiatrist or other mental health professional may prescribe one or several medications to help control bipolar disorder. Because many medications have side effects like diabetes, obesity and high blood pressure, it may take some time to find the optimal treatment regimen.

Common medications prescribed to treat bipolar disorder include:

• Mood stabilizers - Lithium, for example, is one of the most frequently prescribed medications for bipolar disorder.


• Anti-seizure medications (anticonvulsants) - Valproic acid, divalproex, and lamotrigine are often used as mood regulators.


• Antidepressants - Though they may lead to manic episodes, antidepressants have been carefully prescribed for bipolar disorder.


• Atypical antipsychotics and anti-anxiety - Olanzapine, risperidone, and quetiapine are common antipsychotics, and benzodiazepines are common anti-anxiety drugs.

Psychotherapy treatments for bipolar disorder include:

• Cognitive behavioral therapy - Individual therapy that focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones as well as managing stress and coping with upsetting situations.


• Family therapy - Group therapy that focuses on identifying and reducing stressors within your family and improving communication and problem-solving.


• Group therapy - With other bipolar disorder sufferers that focuses on communication and learning from others.

An additional treatment for bipolar disorder is electroconvulsive therapy (ECT) - electricity is passed through the brain to trigger a seizure. It is primarily for those who have episodes of severe depression with suicidal tendencies or for people who have not seen improvements in their symptoms after other treatments. Sometimes, people with bipolar disorder may benefit from inpatient hospitalization and psychiatric treatment.

How is bipolar disorder prevented?

Unfortunately, there is no sure way to prevent bipolar disorder. Treatment at the earliest sign of mental health disorder can help prevent bipolar disorder from worsening, and long-term preventive treatment can help prevent minor episodes from becoming full manic or depressive episodes.

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Relationship Between Borderline Personality Disorder And Bipolar Disorder, Long-Term Study

Results from a long-term study indicate that borderline personality disorder (BPD) and bipolar disorder do not commonly coexist, a finding which has important implications for treatment. The findings are reported in the July 2006 issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA).

BPD is a long-term, pervasive pattern of impulsive behavior, instability and changeable mood. Whether it is a variant of bipolar disorder is the focus of the AJP article, "Descriptive and Longitudinal Observations on the Relationship of Borderline Personality Disorder and Bipolar Disorder" by John G. Gunderson, M.D., medical director for the Borderline Personality Disorder Treatment Center at McLean Hospital.

The study found only modest connections to bipolar disorder among 196 patients with BPD. The rate of co-occurring bipolar disorder in these patients was 19 percent. In patients with other personality disorders, the rate was eight percent. Among the patients who did not have bipolar disorder at the beginning of the study, eight percent of the BPD patients developed bipolar disorder over the next four years, compared to three percent of the patients with other personality disorders.

Despite these differences, the rates of bipolar disorder in the BPD patients remained under 20 percent. This low frequency has important implications for treatment, as many BPD patients receive only a diagnosis of bipolar disorder and the two diagnoses generally are treated with different approaches. Psychosocial interventions are important in the treatment of BPD, whereas medication is generally the first choice for bipolar disorder.

"The diagnosis of borderline personality disorder arose from psychoanalytic psychotherapy practice, whereas bipolar disorder is the subject of intensive neurobiological research and psychopharmacological treatment," stated Robert Freedman, M.D., AJP editor-in-chief. "This study is an important step in examining the extent of overlap between the two disorders."

The co-occurrence of bipolar disorder did not worsen the course of BPD over four years. Remission occurred in two-thirds of both the BPD patients with and without bipolar disorder.

In an accompanying editorial, Michael H. Stone, M.D., of Columbia University notes the article's "more balanced position on the controversy" about the relationship of borderline personality to bipolar disorder. He suggests that the moderately higher rates of bipolar disorder in patients with BPD disorder may indicate a subgroup of BPD patients with higher genetic risk for bipolar disorder.

This study was funded by the National Institute of Mental Health.
(Am J Psychiatry. 2006; 163: 1173-1178).

About the American Journal of Psychiatry

The American Journal of Psychiatry, the official journal of the American Psychiatric Association, publishes a monthly issue with scientific articles submitted by psychiatrists and other scientists worldwide. The peer review and editing process is conducted independently of any other American Psychiatric Association components. Therefore, statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association. The Journal's editorial policies conform to the Uniform Requirements of the International Committee of Medical Journal Editors, of which it is a member.

For further information about the Journal visit http://www.ajp.psychiatryonline.org.

About the American Psychiatric Association:

The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders.

Visit the APA at http://www.psych.org and http://www.healthyminds.org.

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