Bipolar Disorder

Bipolar Disorder

Causes, Symptoms and Treatment of Bipolar Disorder

What is Bipolar disorder, or manic depression? This is a medical illness that causes extreme shifts in mood. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. These swings or "cycling" can be as frequent as hourly or as infrequent as yearly. Bipolar disorder is generally life-long condition that often begin in adolescence or early adulthood, and occasionally even in children. Most people generally require some sort of lifelong treatment. While medication is one key element in successful treatment of bipolar disorder, psychotherapy, support, and education about the illness are also essential components of the treatment process.

Symptoms of mania:

Mania is the word that describes the activated phase of bipolar disorder.

• either an elated, happy mood or an irritable, angry, unpleasant mood
• increased physical and mental activity and energy
• racing thoughts and flight of ideas
• increased talking, more rapid speech than normal
• ambitious, often grandiose plans
• risk taking, gambling, shopping binges
• impulsive activity such as spending sprees, hyper-sexual indiscretion, and alcohol abuse
• decreased sleep without experiencing fatigue

Symptoms of depression:

• loss of energy
• prolonged sadness
• decreased activity and energy
• restlessness and irritability
• inability to concentrate or make decisions
• increased feelings of worry and anxiety
• less interest or participation in, and less enjoyment of activities normally enjoyed
• feelings of guilt and hopelessness
• thoughts of suicide
• change in appetite (either eating more or eating less)
• change in sleep patterns (either sleeping more or sleeping less)

Causes of bipolar disorder:

The exact cause of bipolar disorder is not known, most scientists believe that bipolar disorder is likely caused by multiple factors that interact with each other to produce a chemical imbalance affecting certain parts of the brain. Bipolar disorder often runs in families, and studies suggest a genetic component to the illness. A stressful environment that is repeated from one generation to the next may play a role in the so-called "genetic component" or negative life events may interact with an underlying genetic or biological vulnerability to produce the disorder. These genetic studies claim that prenatal stressors can cause changes in the genes that are responsible for mental illness. There is a lot of promise for genetic engineering and mental illness. There are other possible "triggers" of bipolar episodes. In other words - we really aren't certain of the causes and definitely cannot pinpoint these in any one case. The treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar episodes can and often do occur without any obvious trigger.

Treatment for bipolar disorder:

As with many other mental illnesses, there is no cure for bipolar disorder, although bipolar disorder is a treatable and manageable illness. After an accurate diagnosis, most people can achieve an optimal level of wellness and quality of life. Medication is an essential element of successful treatment for people with bipolar disorder. In addition, psychosocial therapies including cognitive-behavioral therapy, interpersonal therapy, family therapy, and psycho education are important to help people understand the illness and to internalize skills to cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness. It is useful to know whether the "mood stabilizing medication" prescribed has been approved by the FDA for use in bipolar disorder or if it is being used "off label."

Medications for Mania:
Currently FDA approved: lithium (Eskalith or Lithobid), divalproex sodium (Depakote), carbamazepine (Tegretol), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify) haloperidol (Haldol).

Medications for bipolar depression:
Currently FDA approved: combination of olanzapine and fluoxetine (Symbyax).

Medications for preventing (or delaying) recurrence:
Currently FDA approved: lithium (Eskalith or Lithobid), lamotrigine (Lamictal), olanzapine (Zyprexa), and aripiprazole (Abilify).

Frequently a combination of two or more medications are used, especially during severe episodes of acute mania or depression. This list is subject to change with the development of new medications.

Medication specifics and possible side effects:

Anti-convulsants: such as Depakote can be used for treating bipolar episodes. Originally approved as a drug to treat epilepsy. In this case we say that this drug is being used "off label" since it was originally intended to treat other medical conditions. This is very common as we see all areas of medicine treating illnesses with "off label" medications.

Use of Antidepressants:
Standard antidepressant medications (those approved for the treatment of unipolar depression) have not yet been proven effective for bipolar depression. Although the evidence supporting their use for bipolar depression is limited to small or less rigorous studies, these medications remain the most commonly used treatment for bipolar depression. The data from larger studies finds neither evidence of benefit nor evidence that these agents cause large numbers of depressed patients to switch into mania.

Use of Antipsychotic Medications as Mood Stabilizers:
To control acute episodes, antipsychotic medications may be used alone (monotherapy), or added to anti-convulsant medications (combination therapy). Medication guidelines now recommend the combination of these two medications as most effective for acute manic episodes. Because the older typical antipsychotic medications run the risk of causing permanent movement disorder, and have been associated with depression when used over the long term, the new atypical antipsychotics are now preferred for this purpose. All the new atypicals are effective in the treatment of acute and mixed mania.

Side effects of the atypicals are different than with first-generation antipsychotics, although sedation, weight gain, and risk of diabetes are problems associated with many of the new antipsychotics. Clozapine and olanzapine, both effective antipsychotics and mood stabilizers, offer the most risk in this area.

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This article is for informational purposes only and not to be used in diagnosing or treating any illness