Bipolar disorder

Bipolar disorder is a type of mood disorder characterized by at least one manic, hypomanic or mixed (manic and depressive) episode. This cyclical disturbance of mood, thought and behavior is sometimes accompanied by depression.

Sometimes, bipolar disorder is described as bipolar 1 or bipolar 2. Bipolar 1 includes one or more manic or mixed episodes. Bipolar 2 includes one or more depressive episodes and at least one hypomanic episode.

A manic episode is a period of at least seven days during which a person experiences an abnormally expansive, elevated or irritable mood. Other characteristics include:

inflated self-esteem
increased energy
less need for sleep
agitated speech or movement
During a manic episode, it may difficult to function socially and at work or school. Delusions or hallucinations are also possible. In some cases, hospitalization is needed.

A hypomanic episode has many of the same characteristics as a manic episode, but it's less intense. A hypomanic episode lasts at least four days and doesn't impair a person's ability to function. Delusions or hallucinations don't appear, and hospitalization isn't needed.

A mixed episode lasts at least one week. There's a rapid cycling of moods, from extreme highs to extreme lows. A depressed mood and loss of interest or pleasure in nearly all activities impairs a person's ability to function. Delusions or hallucinations may appear, and hospitalization may be needed.


Causes/associated factors
More than 2 million American adults age 18 or older have bipolar disorder. Bipolar disorder affects men and women about equally. However, three times as many women experience rapid cycling -- at least four mood disturbances that cycle from extreme highs to extreme lows in a single year. Researchers suspect this is related to low thyroid levels in some cases. There also appears to be a hereditary link.
Studies suggest that bipolar disorder beginning in childhood or early adolescence may be more severe than cases that develop later. When the illness begins before or soon after puberty, it's often characterized by irritability, a mixture of manic and depressive symptoms, and continual rapid cycling. When the illness begins in late adolescence or adulthood, it tends to begin suddenly, often with a classic manic episode. Symptoms often have a more regular pattern with relatively stable periods between episodes.

Sometimes bipolar disorder accompanies a substance use disorder, panic disorder or eating disorder. It may also occur with an anxiety disorder, such as obsessive-compulsive disorder or post-traumatic stress disorder.

Without effective treatment, bipolar disorder can lead to suicide attempts. An estimated 20 to 50 percent of those who have bipolar disorder attempt suicide at least once during the course of the illness.


Symptoms
For adults
Physically, you may experience sleep disturbances, appetite changes, fatigue and agitation. You may have tense muscles and an exaggerated startle response.

Psychologically, you may have fleeting ideas, racing thoughts or loose associations between unrelated thoughts. You may experience confusion, a preoccupation with sexual or religious thoughts, or poor judgment. Without an ability to turn off the energy and focus, you may become overly vigilant about everything, including your surroundings, what people say, and your thoughts and actions.

Socially, you may inappropriately laugh or speak loudly, rapidly or in a verbose manner. You may have accelerated or frenzied activity. You may become indifferent to feedback or criticism from others. You may become withdrawn or isolated and take poor care of yourself.

For children and adolescents
For children and adolescents, the symptoms of bipolar disorder may vary. During a manic episode, they may be irritable and prone to temper outbursts. Manic adolescents are most likely to become psychotic.

During a depressive episode, children and adolescents may have physical complaints, such as headaches, stomachaches or fatigue. You may also notice:

frequent school absences
poor academic performance
talking about running away from home or actually attempting to do so
complaints
unexplained crying
social isolation
extreme sensitivity to rejection or failure
Sometimes, symptoms of bipolar disorder and attention-deficit hyperactivity disorder are similar.


Treatment
For adults
Medications such as mood stabilizers or anticonvulsants are often prescribed to treat bipolar disorder. Sometimes a combination of medications is needed.

If your doctor prescribes medication, follow his or her instructions carefully. Don't make any changes in your medication plan without consulting your doctor. While you're taking medication, your doctor may need to monitor the amount of medication and the level of thyroid hormones in your blood. If your symptoms get worse, notify your doctor.

Individual therapy is another effective treatment for bipolar disorder. Group therapy and support groups may be recommended as well. Learning about bipolar disorder, symptoms and treatment options can also be valuable, both for people who have bipolar disorder and their families. Often, a treatment plan may include both therapy and medication.

When you have bipolar disorder, it's important to maintain a regular pattern of daily activities -- including sleeping, eating, physical activity and emotional stimulation. Take any medications exactly as prescribed, and avoid alcohol or other recreational drugs. If financial extravagance is an issue, consider turning over financial responsibilities to a trusted loved one.

For children and adolescents
Currently, there's limited information on the usefulness and safety of mood-stabilizing medications for children and adolescents. Working with the child and his or her parents, the doctor or psychiatrist must decide whether the benefits of medication outweigh the potential risks or side effects. Researchers are investigating the impact of various forms of therapy as a complement to medication.