Bipolar Disorder

Bipolar (by-POLE-ar) disorder is a condition in which periods of extreme euphoria ^* (yoo-FOR-ee-uh), called mania (MAY-nee-uh), alternate with periods of severe depression. Bipolar disorder is sometimes also called manic (MAN-ik) depression.

What Is Bipolar Disorder?

Bipolar disorder is a type of depressive disorder ^* . People with bipolar disorder experience two (thus the prefix "bi") extremes in mood; they have periods of extreme happiness and boundless energy that are followed by periods of depression. Bipolar disorder can range from severe to mild. Different forms of bipolar disorder are distinguished from one another by the severity of mood extremes and how quickly mood swings take place. For example, full-blown bipolar disorder, or bipolar I, involves distinct manic episodes followed by depression. People with this form of bipolar disorder often experience trouble sleeping, changes in appetite, psychosis ^* , and thoughts of suicide. Another form of bipolar disorder called bipolar II affects some people. In bipolar II the mania is not extreme and the person does not lose touch with reality but does have periods of depression. Some people also experience mixed states where symptoms of mania and depression exist at the same time, and this form may be more common in children. Other people may experience a form of bipolar disorder in which there is a rapid cycling between "up" and "down" moods with few, if any, normal moods in between. Cyclorhythmia is a condition in which there are mood swings but with milder highs and lows.

Who Has Bipolar Disorder?

Ernest Hemingway, winner of the Nobel Prize in literature, showed signs of having bipolar disorder. So did presidents Abraham Lincoln and Theodore Roosevelt and the composer Ludwig von Beethoven. All of these men were intelligent, creative, successful individuals, but they all fought the two faces of bipolar disorder. At one moment they would be on top of the world, full of ideas and creative and physical energy. Then a few days, weeks, or months later they would be sunk in the despair and lethargy of depression.

Bipolar disorder affects about 1 out of every 100 people, or at least 2 million Americans. It affects people of all races, cultures, professions, and income levels. Men and women are affected at equal rates. Bipolar disorder tends to run in families and is believed to have an inherited genetic component. Studies on twins show that if one member of a pair of identical twins (twins who have identical genes ^* ) has bipolar disorder, the other twin has about a 70 percent chance of also having the disorder. If one of a pair of fraternal twins (twins who do not have identical

genes, but do have many of the same genes) has bipolar disorder, the risk of the other twin having it is only 15 to 25 percent.

What are the Symptoms of Bipolar Disorder?

Bipolar disorder has two distinctive sets of symptoms.

Depression

During the depression phase, a person may experience:

• persistent feelings of sadness and anxiety
• feelings of worthlessness or hopelessness
• loss of interest in activities that were formerly enjoyable
• fatigue and decreased energy
• sleeping too much or too little; difficulty getting up or going to sleep
• eating too little or too much
• unexplained periods or restlessness, irritability, or crying
• difficulty concentrating or remembering things
• difficulty making decisions
• thoughts of suicide or suicide attempts
• increased difficulties in relationships with friends, family, teachers, or parents
• alcohol or substance abuse

Mania

During the manic or euphoric stage, a person may experience:

• great energy; ability to go with little sleep for days without feeling tired
• severe mood changes from extreme happiness or silliness to irritability or anger
• over-inflated self-confidence; unrealistic belief in one's own abilities
• increased activity, restlessness, distractibility, and the inability to stick to tasks
• racing, muddled thoughts that cannot be turned off
• decreased judgment of risk and increased reckless behavior
• substance abuse, especially cocaine, alcohol, and sleeping pills
• extremely aggressive behavior

How is Bipolar Disorder Diagnosed?

Bipolar disorder usually begins in early adulthood, although experts now recognize that younger children and teens may also have the disorder. Some children who are diagnosed with attention deficit hyperactivity disorder (ADHD) ^* may actually have bipolar disorder or both disorders. These children not only have symptoms of ADHD but often also have symptoms such as significant and sustained tantrums, periods of anxiety ^* (including separation anxiety ^* ), periods of irritability, and mood changes. With many children, mood states change rapidly and without warning. Children with bipolar disorder are beginning to be researched by psychologists ^* and psychiatrists ^* who previously did not believe that such disorders occur in early childhood.

Doctors often ask family members about the person's symptoms, as people with bipolar disorder are often not aware of the changes they are experiencing. People with bipolar disorder have had at least one period of mania. Often after the first episode five or more years will pass before another manic or a depressive period occurs. Despite the stretches of normal moods, bipolar disorder does not go away. Instead, the time between mania and depression gets shorter and shorter, and the symptoms may become more severe. Not infrequently, bipolar disorder can lead to psychosis or to suicide. About 19 percent of people who have required hospitalization for bipolar disorder commit suicide.

How Is Bipolar Disorder Treated?

Most people with severe mood swings can be helped by treatment. The drug lithium has been one of the medications of choice for treating bipolar disorder, and it is often very effective. Other medications have also have been helpful in controlling mood swings. These include various antiseizure medications (for example, valproate and carbamazepine) and antipsychotic medications. People with bipolar disorder need to continue to take their medications even when they feel normal to prevent the reoccurrence of mood swings.

Living with Bipolar Disorder

Living with a loved one who has bipolar disorder can be very hard on family members.

Perhaps the most effective thing that family members can do is to help the person with the disorder get treatment. Many family members find joining a support group or participating in family therapy to be helpful in understanding and managing the impact of this difficult problem.

People who are taking about suicide need emergency help. Many telephone books list suicide and mental health crisis hotlines in their Community Service sections, or help can be obtained by calling emergency services (911 in most communities).