Bipolar Disorder
En Español (Spanish Version)More InDepth Information on This ConditionBipolar disorder results in extreme swings in mood, energy, and ability to function. The mood changes of bipolar disorder are more dramatic than normal ups and downs. They can hurt relationships and cause poor job or school performance. Bipolar disorder can be treated. Contact your doctor if you think you may have this condition.
The two mood extremes of bipolar disorder are mania and depression. In mania, one of the defining symptoms is an increase in energy and a decreased need for sleep. The mood may be overly happy or irritable. In
depression
, a down mood with fatigue takes over, and it is often accompanied with irritability.
There are two forms of this condition:
- Bipolar I disorder—involves recurrent episodes of mania often immediately followed by depression
- Bipolar II disorder—involves milder episodes of mania (called hypomania) that alternate with episodes of depression
The cause of bipolar disorder is not known. This condition tends to run in families. Specific genes may play a role. It is most likely many different genes that act together.
The Brain
Bipolar disorder may be a result of genetic influences on the brain.
© 2011 Nucleus Medical Media, Inc.
A family history of the disorder increases your chance of developing it. Tell your doctor if you have a family member with bipolar disorder.
Symptoms include:
- Dramatic mood swings—This can range from elated excitability, unrealistic goal setting, and an exaggerated sense of self to hopeless despondency.
- Periods of normal mood in between ups and downs
- Extreme changes in energy and behavior
Signs and symptoms of mania include:
- Persistent and inexplicable elevation in mood
- Increased energy and effort toward goal-directed activities
- Restlessness and agitation
- Racing thoughts, jumping from one idea to another
- Rapid speech or pressure to keep talking
- Trouble concentrating
- Decreased need for sleep
- Overconfidence or inflated self-esteem
- Poor judgment, often involving spending sprees and sexual indiscretions
Signs and symptoms of depression include:
- Prolonged sad, hopeless, or empty mood
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in activities once enjoyed, including sex
- Decreased energy or fatigue
- Trouble concentrating, remembering, and/or making decisions
- Restlessness or diminished movements
- Agitation
- Sleeping too much or too little
- Unintended weight loss or gain
- Thoughts of death or suicide with or without suicide attempts
Severe episodes of mania or depression may sometimes be associated with psychotic symptoms such as:
- Hallucinations
- Delusions
- Disorders of thought
Your doctor will ask about your symptoms and medical history. A physical exam may be done. In some cases, lab tests are ordered. They will help to rule out other causes of mood and behavior symptoms. You may be referred to a mental health specialist. Diagnosis of bipolar disorder is based on:
- Presence of certain symptoms over time
- Absence of other causes, such as some medicines and certain conditions
- Family history of bipolar disorder
Mania is diagnosed if:
-
Mood is elevated and there are three or more manic symptoms (listed above)
- If the mood is irritable, not elevated, four symptoms must be present for a diagnosis of mania
- Symptoms last during most of the day, nearly every day, for one week or longer
A depressive episode is diagnosed if:
- There are five or more of the depressive symptoms (listed above)
- Symptoms last for most of the day, nearly every day, for a period of two weeks or longer
Some medicines, illicit drugs, and conditions may show similar features, such as:
The diagnosis is made only when none of these causes are present.
Talk with your doctor about the best plan for you.
The primary treatment is with medicines called mood stabilizers. There are many different types and combinations of medicines, which must be tailored by your doctor to target your symptoms. Examples of common medicines used to treat bipolar disorder include:
- Lithium
—the oldest and most effective mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
-
Antiseizure medicines—also used as mood stabilizers instead or in combination with lithium
- Depakote
(Valproate)—one of the most effective antiseizure medicines for treating and preventing mania
- Carbamazepine
(Tegretol)——often used if lithium or depakote cannot be taken or tolerated
- Lamotrigine
(Lamictal)—usually used in treating people who spend most of the time in the depressed phase of the illness, also helps to prevent manic episodes
- Topiramate
(Topamax)
-
Benzodiazepines—a potentially addicting class of medicines that can be used to treat agitation or
insomnia
, usually on a short term basis
- Zolpidem
(Ambien)—used to treat insomnia
-
Antidepressants (serotonin reuptake inhibitors or
bupropion
[Wellbutrin])—used to treat depression, usually prescribed in combination with a mood stabilizer, like lithium
-
Antipsychotic medicines—used for acute manic or mixed episodes and maintenance treatment
The plan is based on the pattern of the illness. Treatment may need to be continued indefinitely. It should prevent significant mood swings.
Psychotherapy is often an integral component of a comprehensive treatment plan. Therapy may include:
- Cognitive-behavioral therapy
- Counseling
- Family therapy
- Interpersonal and social rhythm therapy, a form of therapy designed to treat bipolar disorder
Electroconvulsive therapy may be effective when medicines fail. It can be used for both mania and depression.
There are no guidelines for preventing bipolar disorder. Taking your daily medicine and following your treatment plan can help prevent future mood episodes from recurring.
Child and Adolescent Bipolar Foundation
Depression and Bipolar Support Alliance
National Institute of Mental Health
Canadian Psychiatric Association
Mood Disorder Association of Canada
Belmaker R. Medical progress: bipolar disorder.
N Eng J Med
. 2004;351:476-486.
Jacobson JL, Jacobson AM.
Psychiatric Secrets.
2nd ed. Philadelphia, PA; Hanley & Belfus, 2001.
Stern TA, et al. Massachusetts General Hospital Comprehensive
Clinical Psychiatry.
Philadelphia, PA: Mosby Elsevier; 2008.
Yatham LN, Kusumakar V, eds.
Bipolar Disorder: A Clinician’s Guide to Biological Treatments.
New York, NY: Taylor & Francis Group; 2009.
4/29/2011 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: Nivoli AM, Colom F, Murru A, et al. New treatment guidelines for acute bipolar depression: a systematic review.
J Affect Disord.
2011;129(1-3):14-26.
Last Reviewed September 2011