Bipolar Disorder or Manic – Depressive Illness

What is Bipolar Disorder?
Bipolar disorder, also known as manic-depressive illness, is a treatable illness involving episodes of serious mania and depression: mood swings from overly “high” and irritable to sad and hopeless, and then back again, with periods of normal mood in between. The mood extremes may be of varying severity; the mood changes may occur gradually or rapidly over hours, days, weeks or months.
A lifetime illness that typically begins in adolescence or early adulthood, bipolar disorder is often not recognized as an illness, causing needless suffering for years or even decades.
Effective treatment for this illness can alleviate suffering and usually prevent its devastating complications, which can include marital breakups, financial and occupational difficulties or losses, alcohol and drug abuse, and suicide.

Facts About Bipolar Illness
  At least 2 million Americans suffer from this distressing and disruptive illness.
  Like other serious illnesses, bipolar disorder also impacts family, friends, and co-workers.
  Families of those affected may have to cope with the resulting behavior problems (i.e. wild spending) and their lasting consequences.
  Bipolar illness often runs in families. Research continues to look for the inherited genetic defect associated with the illness.

Symptoms of Mania
  Extreme irritability and distractibility
  Excessive ”high” or euphoric feeling
  Sustained period of unusual behavior
  Increased energy, activity, rapid talking and thinking, agitation
  Decreased sleep
  Unrealistic belief in one’s own abilities
  Poor judgement
  Increased sex drive
  Substance abuse
  Provocative or obnoxious behavior
  Denial of problem

Symptoms of Depression
  Persistent sad, anxious, or empty mood
  Feeling helpless, guilty, or worthless
  Hopeless or pessimistic feelings
  Loss of pleasure in usual activities
  Decreased energy
  Loss of memory or concentration
  Irritability or restlessness
  Sleep disturbances
  Loss of or increase in appetite
  Thoughts of death or suicide 

The Spectrum of Bipolar Disorder
The mood states of bipolar illness occur in a continuous range: severe depression, moderate depression, mild “blue” periods, normal mood, hypomania (mild mania), and mania.
The course of the illness varies. Untreated, some people have repeated depressions and occasional hypomania (called bipolar II). In others, mania is dominant and depression infrequent. Mania and depression may also occur together, in what is called a mixed bipolar state.
Understanding the variety of expression of bipolar illness is essential to recognition and treatment of this disorder. 

Treatment is Effective
  Almost all those with bipolar disorder, even in severe forms, can stabilize mood swings with proper treatment.
  Mood stabilizing medications are usually very effective in controlling mania and preventing recurrence of both manic and depressive episodes.
  Available mood stabilizers include lithium, and the anticonvulsants valproate (Depakote or Depakene), carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal) and topiramate (Topamax) which are often effective. Patients should review the relative risks and benefits of each with their treating professional.
  Antidepressants may be combined with the treatments above to treat depressive episodes. However, they may trigger mania or rapid cycling.
  Electroconvulsive therapy (ECT) may treat severe episodes, including those that do no respond to medications.
  As an addition to medication, psychotherapy can often provide critical support, education, and guidance to patient and family.

Bipolar Illness Is Often Unrecognized
  An early sign of bipolar illness may be hypomania – with high energy, moodiness, and impulsive or reckless behavior.
  Hypomania may feel good to the person who experiences it, so that he or she will deny that anything is wrong.
  In early stages, symptoms may appear as other problems: alcohol or drug abuse, or poor performance at work or school.
  Left untreated, bipolar disorder tends to worsen so that the person experiences more severe episodes of mania or depression.

More Facts
  Symptoms of bipolar disorder may prevent those affected from recognizing their illness.
  Family, friends, and physicians can provide encouragement and referrals for treatment.
  To ensure proper treatment and personal safety, commitment to a hospital may be necessary for a person in a severe episode.
  A qualified professional should always give suicidal thoughts, remarks, or behaviors. Hospitalization can be lifesaving. It is not true that if a person talks about suicide, they will not kill themselves. With appropriate treatment, it is possible to overcome suicidal tendencies.
  Bipolar disorder is a lifetime illness – to keep moods stable, ongoing treatment is needed, even when the person if feeling better.
  It may take time to discover the best treatment regimen for an individual – it is important for both patient and family to work with the doctor to develop the treatment plan.
  In addition to treatment, mutual support groups can benefit patients and their families.

Getting Treatment
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in its diagnosis and treatment. Other mental health professionals, such as psychologist and psychiatric social workers, can provide the patient and his or her family with support, education, understanding and help with monitoring symptoms and maintaining treatment. 

Assessment, diagnosis and treatment are available at the Sheppard Pratt Health System by calling the Assessment Office at 410-938-3800.

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