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Manic-Depressive Disorder
Bipolar Disorder Overview
BY JANE
MCGRATH
Suppose
one day you wake up feeling oddly energized and pumped for anything. The world
is at your feet.
You
can do whatever you set your mind to and nothing could possibly go wrong. In
fact, you're so full of energy that you decide you don't need to sleep.
Days,
perhaps even weeks, go by -- nothing gets you down and nothing slows you down.
But then, without warning, this feeling starts to wane.
For
no reason at all, you begin to feel bogged-down, depressed or even suicidal.
Life is joyless and meaningless.
For
weeks you feel absolutely hopeless. And then, one day you wake up -- ready for
anything.
This
cycle is characteristic of people who suffer from bipolar disorder.
According
to the National Institute of Mental Health (NIMH), bipolar disorder, also known
as manic-depressive disorder, affects approximately 5.7 million
adults in the U.S. (2.6 percent of the 18 and up population) [source: NIMH].
The
disorder causes intense, alternating episodes of mania and depression that
go far beyond normal mood swings.
Children
and adolescents can develop the disorder as well, though their mood swings
usually happen far more rapidly.
People
who have bipolar disorder face several obstacles as a result of the illness.
In
addition to the stress it can place on families and interpersonal relationships,
a bipolar patient is 40 percent less likely to have a job [source: Cox].
Someone
with bipolar disorder is also 10 times more likely than the general population
to abuse alcohol or drugs, which is unfortunate since alcohol and
drugs have the potential to trigger episodes of the disorder [source: UPMC].
Perhaps
the most terrifying fact is that about 15 percent of bipolar patients succeed
in committing suicide, out of 25 percent to 50 percent who attempt it [source: psychlaws].
What
do scientists know and what don't they know about this disorder? Keep reading
to learn the signs and symptoms of manic and depressive episodes.
Bipolar Symptoms
The mood swings a bipolar patient experiences are more
intense than the natural mood swings of a healthy person.
The
disorder typically shows up between the ages of 15 and 25 in both men and women
and is characterized by periods of mania and periods of depression [source: Healthline].
The
National Institute of Mental Health (NIMH) lays out the symptoms that are
common to a manic episode. These include:
· Feeling a "high" and an unusually good mood
· Excessive energy
· Irritability
· Feeling restless
· Talking faster than usual
· Unusually fast thoughts and ideas
· Risky decisions (spending sprees, risky investments)
· Easily distracted
· Needing little sleep
· Inflated ideas of one's abilities or importance
· Increased sexual appetite
According
to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a
certain number of manic symptoms must be present for at least a week for those
symptoms to add up to a manic episode.
Manic
episodes can affect people differently. For some, euphoric symptoms make it a
wonderful, desirable experience.
For
others, mania makes them extremely irritable and easily angered.
A
less severe kind of mania is called hypomania, which may include a
less intense form of any of the above symptoms.
Hypomania
does not interfere with one's daily life and relationships as much as a regular
manic episode [source: MedicineNet].
If
left untreated, hypomania could progress into mania.
The
following is the NIMH's list of depressive episode symptoms:
· Depressed or anxious mood
· Despair
· Decreased interest in pleasurable activities
· Fatigue, sluggishness
· Inability to focus
· Indecisiveness
· Restlessness
· Irritability
· Changes in sleeping patterns
· Changes in appetite or weight
· Mysterious pains
· Suicidal thoughts
For
these symptoms to add up to a depressive episode, a certain number of these
symptoms must persist for at least two weeks.
It
is possible for bipolar patients to actually experience manic and depressive
symptoms at the same time. When this happens for at least a week, it is
referred to as a mixed episode [source: DBSA].
In
addition, some may experience rapid cycling which is
characterized by a year of at least four episodes of mania, hypomania or
depression [source: DBSA].
During
a more severe manic or depressive episode, a bipolar patient can
experience psychotic symptoms. These can include delusions (false
beliefs) and hallucinations (false sensations) [source: NIMH].
Because
these symptoms are usually associated with schizophrenia, doctors can easily
misdiagnose these bipolar patients.
The
kinds of episodes patients experience determines the type of bipolar disorder
they are diagnosed with.
Classifications
for the disorder include:
· Bipolar I Disorder: This is the most severe form of the disorder. It includes at
least one manic or mixed episode and at least one depressive episode [source: DBSA].
· Bipolar II Disorder: Patients have had at least one depressive episode and at least
one hypomanic episode. With this type, a patient could experience periods of
normal moods as well.
· Bipolar Disorder Not Otherwise Specified (NOS): This classification is used for cases in which
bipolar patients experience patterns that don't fall into the I or II
categories.
· Cyclothymia:
This is the least severe form of the disorder. It includes two years of
episodes of hypomania and milder depression.
Now
that we can more easily recognize the disorder and what bipolar patients
experience, let's take a look at what people think might cause this mysterious
illness.
Causes of
Bipolar Disorder
Researchers don't know exactly what causes bipolar
disorder.
Most
likely, there's no single factor but rather multiple factors that cause bipolar
disorder to develop.
Genetics
do play a role and increase the likelihood that someone will develop the
disorder. But you can't always determine who will get it based on genetics.
For
example, although the disorder does run in families, one twin may develop
the disorder while the other twin never does.
Statistics
show that the children of bipolar patients have a higher risk than the general
population of developing it. Attempts to find the specific genes that lead to
the disorder have failed, but research is ongoing [source: NIMH].
Environmental
factors might actually contribute to the development of the disorder in someone
who is genetically predisposed.
For
instance, stressful periods and major life-altering events -- both good and bad
-- can trigger the disorder.
Other
environmental factors have the potential to cause specific manic and depressive
episodes in bipolar patients. These include drug and alcohol abuse, seasonal
changes and even antidepressants [source: Helpguide.org].
Chemicals
in the brain could also predispose people to bipolar disorder [source: CCI].
Researchers
suspect that the levels of neurotransmitters dopamine, serotonin,
norepinephrine, and GABA (gamma aminobutyric acid) might be involved in the
disorder.
Because
cocaine and amphetamine, which release dopamine, can instigate mania, it
is possible that high dopamine levels could lead to a manic episode [source: Davies].
This
theory is supported by the evidence that manic and psychotic symptoms correlate
with increased dopamine levels [source: Frank].
In
addition, researchers have found low serotonin activity during manic and
depressive episodes [source: Frank].
Also,
hypomania often correlates with increased norepinephrine levels.
Compared
to healthy patients, bipolar patients have lower levels of an enzyme used in
the transfer of GABA in the brain.
It
is thought this plays a role in causing the disorder because anticonvulsant
drugs, which are effective in combating bipolar disorder, increase the levels
of GABA [source: Frank].
The
more scientists find out about the causes of the condition, the more progress
they can make toward finding effective treatments.
Luckily,
many bipolar patients benefit from existing medications. Next, we'll take a
look at the most common medications used to treat bipolar disorder.
YOUR
TEST RESULTS ARE IN...
Could a blood test tell you if you have a mental
disorder? If so, it would have huge implications. Researchers are trying to
develop a blood test that attempts to measure if certain genes are active
to precisely assess a patient's mood.
Scientists
hope that this process, once perfected, will replace the flawed process of
diagnosing patients based on reports of their symptoms.
It
could also eliminate a lot of the frustration involved in finding the
particular medications that will work for a given individual.
Despite
these advantages, however, many are worried how a test like this could make
life harder for bipolar patients.
For
instance, a blood test for mental disorders could be used against patients if
it were used to deny them opportunities for employment [source: Mitchell].
Medication for
Bipolar Disorder
Because the cause of bipolar is largely unknown, the
search for effective treatments is difficult.
Though
certain medications, such as lithium, prove helpful for many bipolar patients,
scientists don't know why.
Doctors
have found that bipolar disorder is a long-term illness that requires
consistent, long-term treatment. This usually includes taking prescribed
medications even during periods of healthy moods.
Because
patients respond differently to the various drugs used to treat the disorder,
adjusting the dosage or the kind of medication is often necessary to find the
best treatment for an individual.
The
following is a list of the most popular medications used for bipolar disorder.
Lithium:
In the 1970s, the Food & Drug Administration (FDA) approved lithium for
treating bipolar disorder, and it is still one of the first lines of treatment
for the condition.
Lithium
is a mood stabilizer, effective against both depressive and manic episodes.
After
starting on lithium, patients have to visit the doctor for frequent blood tests
to monitor lithium levels.
After
finding a healthy dosage, patients won't have to take the blood tests as often.
Anticonvulsants:
Like lithium, anticonvulsants are also mood stabilizers.
Anticonvulsants
work by stabilizing the overactive parts of the brain. They also are commonly
used to prevent seizures in epileptic patients.
Different
anticonvulsants work in different ways. Some work by increasing levels of the
GABA neurotransmitter [source: Frank].
Used
alone or with lithium, anticonvulsants can be effective for many bipolar
patients.
Atypical Antipsychotics: For people who don't respond to lithium and
anticonvulsants, doctors may prescribe atypical antipsychotics, such as
clozapine.
These
kinds of drugs, which are also used to treat schizophrenia, work by affecting
the levels of certain neurotransmitters in the brain, such as dopamine.
Benzodiazepines (Anti-Anxiety Drugs): If a bipolar patient is having sleeping problems,
benzodiazepines can help promote healthy sleeping routines.
These
should be used with caution, however, and usually for only a short period
because of the possibility of addiction [source: NIMH].
Antidepressants:
Because they can trigger manic episodes, antidepressants are not prescribed to
treat bipolar disorder as commonly as they used to be [source: MayoClinic].
Depending on the kind, antidepressants work by
adjusting levels of serotonin or norepinephrine in the brain.
In
addition to the normal potential for side effects, it is dangerous for pregnant or
nursing mothers to take certain mood-stabilizing drugs.
Lithium
isn't likely to harm a fetus in the womb, but certain anticonvulsants can
cause birth defects [source: NAMI].
Changing
medications too much during pregnancy can cause negative effects as well [source: NAMI].
Because
unexpected pregnancy can make the choice difficult, it's best to discuss the
options with a doctor.
Medications
are not the only option for fighting bipolar disorder.
The
National Institute of Mental Health maintains that the best treatment
incorporates both medicines like those listed above and psychosocial treatment [source: NIMH].
In
the next section, we'll explore these and other kinds of treatments.
CREATIVITY
& BIPOLAR DISORDER
If you suffer from bipolar disorder, not only are you
not alone, but you are in great company.
Creative
types are supposedly more likely to have the condition than average folks. In
fact, many believe there is a connection between the disorder and creativity.
Here
is a list of some notable creative people who have (or may have had) bipolar
disorder:
· Ludwig van Beethoven
· Jim Carrey
· Francis Ford Coppola
· Charles Dickens
· Carrie Fisher
· Graham Greene
· Jimi Hendrix
· Michelangelo
· Sylvia Plath
· Edgar Allan Poe
· Axl Rose
· Lord Alfred Tennyson
· Vincent van Gogh
· Robin Williams
· Brian Wilson
Other Treatments
for Bipolar Disorder
Various therapies have proven helpful for bipolar
patients as a supplement to medicinal treatment.
Taking
part in any of the following can lessen the severity and give the patient more
control over symptoms:
· Cognitive Behavioral Therapy: Used for various disorders, this therapy aims to
change the patient's perceptions and habits.
By changing how bipolar patients think about the
illness and encouraging positive attitudes, cognitive behavioral therapy can
make effective improvements.
This therapy also usually involves learning more about
bipolar disorder, which helps patients become more confident and knowledgeable
about how to treat it.
· Family Therapy:
The patient's family participates in this therapy with the patient.
By identifying sources of stress and conflicts,
the family can learn to better address them and thereby offer the patient a
better and more encouraging environment.
· Group Therapy:
This therapy offers an opportunity for several people with bipolar disorder to
gather in a group led by a psychologist.
In the group sessions, the members discuss their
experiences with the illness and offer feedback for one
another.
· Interpersonal and Social Rhythm Therapy: As the name implies, the purpose of this therapy is
to improve relationships and encourage habits of regular routine (such as a
sleep schedule).
Both of these factors have a large impact on moods.
Studies show that this therapy helps prevent relapse of bipolar disorder that
might have been brought on by unhealthy relationships and irregular habits [source: Kupfer].
· Electroconvulsive Therapy (ECT): Though it still carries a stigma, ECT is an
effective treatment and is much safer than it used to be. Using ECT, doctors
induce seizures in patients, which last up to a minute long [source: MayoClinic].
After repeated treatment, ECT is effective against
many mental disorders. It works by altering the behavior of chemicals in the
brain. However, scientists don't quite know how or why it works.
In
addition to these therapies, it's a good idea to avoid drugs and alcohol, as
they can potentially trigger an episode.
As
we've seen, just learning more about the disorder might provide comfort and
hope.
Bipolar
patients should realize that they are not alone and that it is a treatable
condition.
Various
kinds of research and advancements in technology that allow for more precise
studies of the brain offer promising signs that the disorder will continue to
get more manageable.
BETTER
THAN NOTHING
For someone diagnosed with bipolar disorder, deciding
against treatment altogether could have dangerous consequences.
Although
treatment works better for some than for others, experts agree that it is
better to be treated than not be treated.
Studies
have found different chemical activity in untreated bipolar patients, such as a
deficiency of N-acetylaspartate in certain parts of the brain, which can impair
functioning [source: Bloch].
There
is reason to believe that without treatment, the disorder not only gets worse
but gets harder to treat [source: Johnson].
Also,
statistics show that those bipolar patients who go without treatment are two
times as likely to both attempt and succeed in committing suicide [source: Bloch].
Jane McGrath, Contributing Writer
Jane McGrath
holds a bachelor's degree in English from the University of Maryland, College
Park.
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