Bipolar Disorder
Bipolar disorder is a biologically based psychiatric condition that can in some cases lead to significant impairment in functioning. The disorder used to be called manic-depression, a term that was somewhat misleading since the typical pattern of manic symptoms followed by depression is not always seen.

Good evidence exists that bipolar disorder is genetically transmitted. When we look at the family histories of people with the disorder, we often find that other family members have been diagnosed with it. Sometimes family members are alcoholic or have committed suicide. A history of clinical depression or schizophrenia often represents untreated bipolar disorder or a missed diagnosis in a previous generation.

The primary problem in bipolar disorder is the regulation of mood states. Under stress, the susceptible individual will have a change in mood that is out of proportion to circum-Bipolar disorder is a biologically based psychiatric condition that can in some cases lead to significant impairment in functioning. The disorder used to be called manic-depression, a term that was somewhat misleading since the typical pattern of manic symptoms followed by depression is not always seen.

Good evidence exists that bipolar disorder is genetically transmitted. When we look at the family histories of people with the disorder, we often find that other family members have been diagnosed with it. Sometimes family members are alcoholic or have committed suicide. A history of clinical depression or schizophrenia often represents untreated bipolar disorder or a missed diagnosis in a previous generation.

The primary problem in bipolar disorder is the regulation of mood states. Under stress, the susceptible individual will have a change in mood that is out of proportion to circumstances. Manic episodes involve an abnormal elevation of mood, decreased sleep and appetite, increased activity, racing thoughts, overtalkativeness, and impaired judgment. Mild cases are termed hypomania, which means “just short of mania.” Delusions of grandeur or religious delusions can occur in severe cases. Depressive episodes involve a lowering of mood, increased sleep, increased appetite or nervous overeating, lack of interest in activities, slowed thinking, and disturbed concentration. Thoughts of suicide and actual attempts are a common complication. A mixed state occurs when there are manic symptoms of overactivity, racing thoughts, and poor sleep in combination with an irritable or depressed mood.

We see a variety of patterns in bipolar disorder. In the classic pattern, episodes of mania are followed by severe depression with periods of remission in between. Some people have isolated episodes of mania with little depression; others have more episodes of depression and only a few of mania.

There are people with strong family histories of bipolar disorder who have only episodes of depression. Bipolar II, a less severe condition, involves episodes of hypomania alternating with depression. Cyclothymic disorder is characterized by an even milder instability of moods and is seen in people with a family history of bipolar disorder.

Changes in mood according to season also occur in some with bipolar disorder and are thought to be a reflection of the brain’s ability to sense the amount of ambient light. A worsening of depression in the winter months and the onset of manic symptoms in the spring are common. Some people experience depression only in the winter months, with no symptoms during other seasons, a condition that is called seasonal affective disorder. The use of phototherapy (exposure to strong light for about twenty minutes a day) is helpful in these cases.

In bipolar disorder, periods of remission usually occur between episodes. Rapid cycling refers to a condition in which there are frequent episodes with little remission of symptoms.

Plotting a time line and charting the onset, duration, and type of symptoms is a useful adjunct to treatment and helps the person with bipolar disorder manage the illness.

The mainstay of treatment of bipolar disorder is the use of mood-stabilizing medications that prevent the shifts toward mania or depression. The oldest of these is lithium. Lithium is a low molecular weight ion that is administered in the form of a salt - for example, with a carbonate ion. It stabilizes the membranes of nerve cells and prevents the cycles of depression and mania.

Over the past twenty years, a number of medicines that are used to treat epilepsy have been found to be useful for bipolar disorder. The same mechanism that stabilizes brain cells and prevents seizures also prevents the mood swings of bipolar disorder. Valproate (Depakote) and carbamazepine (Tegretol) are two such medications being prescribed widely by psychiatrists. Some of the newer anticonvulsants also show promise in the treatment of bipolar disorder. Other medications such as antidepressants, minor tranquilizers, and antipsychotic medications are used to manage the different phases of bipolar disorder. It is important for a person with bipolar disorder to become familiar with all prescribed medications and learn to recognize symptoms of mania or depression in an early stage so as to prevent a full-blown episode.

Bipolar disorder can vary in severity from being a minor inconvenience to involving major impairment in all areas of functioning. Proper psychiatric management and careful compliance with treatment recommendations can reduce the disability associated with this disorder. Many people with bipolar disorder lead full and productive lives.

People with bipolar disorder are at particularly high risk of developing addiction. There may be a genetic vulnerability to both disorders. Also, people with bipolar disorder often attempt to alleviate their symptoms with alcohol or drugs, especially before the illness has been properly identified.

Substance abuse intensifies the symptoms of depression and anxiety over time. Judgment is impaired as the illness becomes active, and the tendency to abuse substances increases.

Some people with bipolar disorder come to enjoy feeling slightly manic. At the early stages of a manic episode, the heightened sense of well-being and increased productivity are similar to the effects produced by stimulants such as amphetamines or cocaine. People with bipolar disorder can learn to manipulate their medications to induce this feeling.

However, it’s very difficult to control the effect. What usually happens is that the symptoms of mania worsen and judgment becomes impaired, leading to a loss of control.

Supportive and educative therapy is important for people with bipolar disorder, and an ongoing relationship with a psychiatrist or psychologist helps reduce the frequency of episodes. In severe cases, when there is significant impairment of functioning and judgment, case management is also helpful.