Definition

Bipolar 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 extremes of the illness are mania and depression . In mania, energy peaks. The mood may be overly happy or irritable. In depression, lethargy takes over. The mood may be very blue.

There are three forms of this condition:

  • Bipolar I disorder involves recurrent episodes of mania and depression
  • Bipolar II disorder involves milder episodes of mania (called hypomania) that alternate with episodes of depression
  • Cyclothymic disorder may be diagnosed in patients who experience frequent depressive symptoms and hypomania for at least two years and who have been without symptoms for no more than two months

Causes

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

Color coded brain
Bipolar disorder may be a result of genetic influences on the brain.
© 2009 Nucleus Medical Art, Inc.

Risk Factors

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

Symptoms include:

  • Dramatic mood swings, ranging from elated excitability 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

Diagnosis

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 symptoms over time
  • Absence of other causes, such as some medications, thyroid disease, or Parkinson's disease
  • Family history of bipolar disorder

Mania is diagnosed if:

  • Mood is elevated and there are three or more mania 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 and other medical issues may show similar features such as:

The diagnosis is made only when none of these causes are present.

Treatment

Talk with your doctor about the best plan for you. Treatment options include:

Medications

Many patients are treated with a combination of two or more of these medications:

  • Lithium —a mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
  • Antiseizure medications—also used as mood stabilizers instead or in combination with lithium
  • Benzodiazepines—can be used to treat agitation or insomnia
  • Zolpidem (Ambien)—used to treat insomnia
  • Antidepressants (serotonin reuptake inhibitors or bupropion [Wellbutrin])—used to treat depression
  • Antipsychotic medications—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

Psychotherapy may include:

  • Cognitive-behavioral therapy
  • Counseling
  • Family therapy
  • Interpersonal and social rhythm therapy, a form of therapy designed to treat bipolar disorder

Electroconvulsive Therapy

Electroconvulsive therapy may be effective when medications fail. It can be used for both mania and depression.

Prevention

There are no guidelines for preventing bipolar disorder.