IntroductionBipolar Disorder is a psychiatric condition commonly known as manic-depressive disorder. As the name implies, people who suffer from Bipolar Disorder experience a wide range of emotions, from extreme happiness and energy (mania) to extreme depression. According to the American Psychiatric Association, between 0.4% to 1.6% of the population suffers from this disorder. The term bipolar is more descriptive than manic-depressive because this disorder shows itself in a variety of different ways. Some people with bipolar disorder will experience the full range of extreme emotions, such as full mania and full depression. Others, however, may experience symptoms that are not as extreme. For example, these people may experience hypomania (mild mania) and/or dysthymia (mild depression) or they may have symptoms that are extreme on one end of the spectrum and not on the other. Currently, the American Psychiatric Association uses the terms Bipolar I, Bipolar II , and Cyclothymic Disorder to refer to these variations.
DefinitionsBefore we can proceed, it is necessary to define and explain several terms that are used by doctors in diagnosing Bipolar Disorder. The first term that must be defined is mania. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), an individual suffers from a manic episode when for at least one week he/she experiences an abnormally and continuously elevated, expansive, or irritable mood. During the same period the individual may experience inflated self-esteem or grandiosity, such believing that he/she can accomplish 30 difficult goals in a single day. During this stage the person has little need for sleep and is hyperactive to such an extent that he/she could go days without rest. Manics are usually very talkative and have racing thoughts or flights of ideas. Conversations with a manic person are often one-way; he/she talks and talks while no one else can get a word in. Manics become easily distracted, and their mood can quickly change from euphoric (happy) to irritated. Since during the manic episode social inhibitions are down, patients engage in pleasurable and risky behavior, such as going on reckless buying sprees or engaging in unsafe sexual practices. Of course, one must keep in mind that, just like any other mental disorder, manic behaviors and symptoms are in the extreme and not just variations of a person’s normal behavior or differences related to culture. In order for such symptoms to be qualified as symptoms of manic episodes, three of the above mentioned behaviors or symptoms must be present.
If the patient experiences the manic symptoms but the symptoms are not so extreme as to significantly interfere with his/her daily life, then the episode is classifed as hypomanic. A person experiencing a hypomanic episode most often can keep his/her daily functioning and meet his/her responsibilities. Mixed episodes occur when the individual experiences a manic episode and a major depressive episode nearly every day for at least one week. An individual suffers from dysthymia when he/she experiences a depressed mood or sadness most of the time in a two-year period. For Dysthymia, the symptoms of depression are not so extreme as to warrant a diagnosis of Major Depressive Disorder.
Bipolar I, Bipolar II, and Cyclothymic DisordersNow that the above terms have been defined, the distinctions between the different forms of bipolar disorder are easy. A patient who has ever suffered a manic episode or a mixed episode is classified as having Bipolar I disorder. It is very important to remember that in Bipolar I disorder, the individual may or may not have experienced a depressive episode. In most cases, however, individuals suffering from Bipolar I disorder also experience either major depression or dysthymia. If an individual has never experienced a manic or mixed episode but has experienced a hypomanic episode and also has major depressive disorder, he/she has Bipolar II disorder, in which both hypomania and depression must have been present. If the individual experiences only hypomania and dysthymia, he/she is classifed as having a Cyclothymic disorder. Many individuals who are initially diagnosed with Bipolar II or Cyclothymic disorders eventually develop Bipolar I disorders.
CausesAccording a report by the U.S. Surgeon General’s Office, pinpointing the exact causes of mood disorders is difficult because the disorders tend to manifest themselves in a wide range of forms in patients. Although the idea that unipolar disorder (depression) can be caused by stressful events, genetics appear to play a much greater role in development of Bipolar Disorder. Genetic studies with twins and blood relatives have shown that 60-65% of those suffering from Bipolar have siblings or relatives who also have the disorder. Other studies have investigated the role of abnormal regulation of the brain’s biochemistry in development of Bipolar disorder. More specifically, the abnormal regulation of one brain chemical in particular, called norepinephrine, has been shown to be involved in mood disorders. During manic episodes, an excess amount of norepinephrine and during depressive episodes low levels of the same appear to be the culprit. Other studies have suggested that to cause manic symptoms, excess norepinephrine must be accompanied by low levels of another brain chemical called Serontonin.
TreatmentThe issue of treatment for Bipolar Disorder can be complicated since a person who is experiencing a manic episode has little or no insight into, or knowledge of, the problem. To put it simply, the euphoria and energy experienced during a manic episode is such that the manic individual does not feel anything is wrong. The person is too busy generating ideas and engaging in too many activities to stop and recognize that he/she is not well. Of course, the person’s beliefs regarding need for treatment changes as he/she becomes depressed. A major threat during the depressive episode is the chance of suicide. In fact, 5-10% of those suffering from Bipolar Disorder eventually commit suicide.
The treatment of choice for Bipolar disorder is a naturally occurring salt called lithium. Lithium is available by prescription under such brand names as Eskalith, Lithonat, Lithane, Lithotabs and Cibalith. Although the exact mechanism of action for lithium is not well known, it is believed to decrease the responsivity of neurons to norepinephrine and dopamine. Similar to any other medication, Lithium may create some side effects, however. These side effects may include hand tremors, fatigue, mild intellectual impairment, and stomach distress. Also, in high doses, lithium can become toxic in the body. Therefore, the level of lithium in the patient’s blood should be monitored. In addition to Lithium, antiseizure medicines (Tegretol or Depakote) and antipsychotic (Thorazine, Mellaril or Haldol) medications have shown some effectiveness in treating some forms of Bipolar disorder.