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Manic Depression - Bipolar Disorder

Overview, Causes, & Risk Factors

Bipolar disorder is characterized by episodes of mania, or hypomania, and depression. Mania is an overly "high" period. Hypomania is a milder form of mania. Depression is a "low" period.

People with bipolar I disorder have alternating episodes of mania and depression. Individuals with bipolar II disorder have alternating episodes of hypomania and depression. Four or more episodes of mood swings in a 12-month period is known as rapid-cycling bipolar disorder.

What is going on in the body?

Bipolar disorder is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved. Nerve impulses cause the release of neurotransmitters from one nerve cell to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released. This can cause or contribute to bipolar disorder. Some of the neurotransmitters believed to be linked to bipolar disorder are serotonin, norepinephrine, and dopamine.

What are the causes and risks of the condition?

Usually bipolar disorder first appears when the person is between the ages of 15 and 25. Teens who have had a major depressive episode are at greater risk for developing bipolar disorder in their late teens or 20s.

While the exact cause of bipolar disorder is unknown, genetics does seem to play a role. Fifty percent of all individuals with bipolar disorder have at least one parent who has a mood disorder.


Symptoms & Signs

What are the signs and symptoms of the condition?

When an individual is in the manic phase of bipolar disorder, the following symptoms may occur:

  • behavior that is aggressive or intrusive
  • denial that behavior is abnormal
  • fast, incessant talking
  • increased energy and activity
  • increased interest in sex
  • irritability
  • poor judgment that may lead to spending sprees or risky behaviors
  • sleeplessness
  • a tendency to be easily distracted
  • The depressive phase of this disorder is characterized by the following:

  • appetite problems
  • decreased energy
  • difficulty paying attention or making decisions
  • feeling very sensitive emotionally
  • feelings of sadness, despair, and emptiness
  • inability to feel pleasure
  • irritability
  • loss of motivation and withdrawal from others
  • low self-esteem
  • pessimism, negativity
  • sleeping problems
  • thoughts about suicide and death
  • A manic or depressive episode may last from a few days to several months. Some people switch between moods several times each day.

    Some people with bipolar disorder have episodes of psychosis. Psychosis is a significant mental disorder that has a physical or emotional source. Symptoms of psychosis may include hallucinations and delusions. Hallucinations occur when a person hears or sees something that isn't really there. Delusions are false beliefs that aren't logical.

    Some people have symptoms of a mixed bipolar state. These individuals are often agitated and very sad. They may have high energy. Psychosis and suicidal thinking are common in a mixed bipolar state.


    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of bipolar disorder begins with a medical history and physical exam. If symptoms are extreme, the healthcare provider may diagnose bipolar I disorder. If symptoms are less intense and severe, a bipolar II diagnosis may be made.


    Prevention & Expectations

    What can be done to prevent the condition?

    There is no known way to prevent bipolar disorder.

    What are the long-term effects of the condition?

    Without treatment, people with bipolar disorder generally have lifelong episodes of mania and depression. The episodes tend to become more frequent and more severe. The disorder can disrupt social relationships and ability to work. The person may be unable to carry out normal daily activities. People with untreated bipolar disorder have a high risk for suicide.

    What are the risks to others?

    Bipolar disorder is not contagious. However, it does tend to run in families.


    Treatment & Monitoring

    What are the treatments for the condition?

    People with bipolar disorder are generally treated with a combination of psychotherapy and medication. Medications used to treat bipolar disorder are known as mood stabilizers. Lithium is often the first choice. Other mood stabilizers include anticonvulsants, such as valproate or carbamazepine. Various combinations of these medications may be used. Many other medicines are currently being studied for treatment of bipolar disorder.

    What are the side effects of the treatments?

    Lithium may cause increased thirst and urination. It may also cause nausea and trembling. Valproate may cause hormone changes in teen girls. This can lead to polycystic ovary syndrome. Medications used to treat bipolar disorder in a woman can harm her fetus or nursing infant.

    What happens after treatment for the condition?

    Treatment of bipolar disorder is generally lifelong. Successful treatment allows the individual to function well at work and home. Some people, however, have chronic symptoms despite ongoing treatment.

    How is the condition monitored?

    An individual who has bipolar disorder generally has regular visits with the healthcare provider. Blood tests may be done periodically to monitor levels of medication. Any new or worsening symptoms should be reported to the healthcare provider.



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