Bipolar Disorder

a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

For a while, many people who were "moody" were called bipolar. But bipolar disorder is something beyond moodiness. Bipolar disorder is going from casually playing video games to scaling the side of a building trying to escape the Secret Service in order to save the president. It's being highly productive and creative at work, often not sleeping for weeks, gaining admiration of everyone around you only to lose all credibility when that mania crosses into psychosis. It's buying new cars for everyone at your favorite restaurant even though there is no way you can realistically afford new cars for everyone at your favorite restaurant.

Bipolar disorder is characterized by changes in activity levels and sleep patterns, periods of intense emotion, and unusual behaviors that could have dangerous or undesirable effects. Formerly known as manic depression, bipolar disorder has three types.

Bipolar I: involves a manic episode that lasts for at least one week
Bipolar II: has more depressive symptoms, and if there are manic episodes, they will likely be less severe
Cyclothymia: combines depressive and hypomanic symptoms, but the symptoms are not so severe to meet the clinical threshold

What causes bipolar disorder?

Like most psychiatric disorders, the exact cause of bipolar disorder is still unknown. It appears to be the result of a mix of physical, social, and environmental factors. Some evidence suggests that an imbalance of neurotransmitters in the brain can lead to bipolar disorder. Too much norepinephrine can trigger manic episodes according to research, and too little norepinephrine is associated with depression.

Beyond brain chemistry, there appears to be a genetic link to bipolar disorder, as it does run in families. It can be triggered from stressful life situations (like the end of a relationship, abuse, death of a loved one) physical illness, and lack of sleep.

What are the symptoms of bipolar disorder?

Because bipolar disorder is a mood disturbance, symptoms are wide ranging.

In mania, you're on the top of a mountain. Symptoms include feeling wired or elated, with endless energy. You may be irritable or have racing thoughts and talk about a lot of different topics in rapid succession. You may feel like you don't need to stop what you're doing to eat or sleep. Feelings of grandiosity, of being god-like or exceptionally important and powerful, can also be a symptom of mania.

With a depressive episode, you plummet into the valley. You may feel sad, empty or hopeless. You may not be able to muster the energy to do anything, even though you're restless. Depressive episodes make it hard to concentrate and may leave you feeling like you have nothing to say.

Bipolar episodes can have a mixed presentation, with symptoms of mania and symptoms of depression. In many cases, it is the people around you who notice your change in mood and your symptoms before you do.

How is bipolar disorder treated?

Bipolar disorder does not have a cure, but it can be managed. With effective treatments, you can be successful in containing the condition and keeping your mood regulated. Medications used to treat bipolar include:

mood stabilizers: lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal)
antipsychotics: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)
antidepressants, which are often prescribed with a mood stabilizer or antipsychotic since that can trigger mania
antidepressant-antipsychotic, which is a combination medication called Symbyax combines an antidepressant (fluoxetine) and an antipsychotic (olanzapine) that works to treat depression and stabilize mood
anti-anxiety medications including benzodiazepines may be used in the short-term to improve sleep and anxiety issues.

The medications used in treating bipolar vary depending on the symptoms that are present, and it can take some trial and error to find the optimal combination for each individual. Fortunately, there are a number of medications, and though it may take some time to dial it in, most patients are able to manage bipolar disorder with good medication compliance and therapy as indicated.

Psychotherapy is an excellent tool in the treatment of bipolar, as it helps patients gain insight into their disease and learn skills to manage symptoms. If an episode of mania or depression becomes so severe that it leads to psychosis or places a patient at risk of suicide, hospitalization may be indicated.