Overview
Causes
Symptoms
Diagnosis
Treatment
Bipolar
disorder, or manic-depressive disorder, is a
mood disorder in which people experience
alternating episodes of mania and major
depression. Mania is characterized by
elation, irritability, excitability, racing
thought and speech, and hyperactivity. Major
depression is characterized by sadness,
withdrawal, despair, and suicidal thoughts.
[Karl Loren Note: Here is the sad truth about Bi-Polar Dysfunction.
This is an invented disease. It is name given to behavior by psychiatrists. There is no honesty here. There is no "disease" there is only a "behavior." Psychiatrists see this behavior and give it a name -- that is the sole origin of "Bi-Polar Dysfunction."
There are two reasons why this name is invented.
Psychiatrists see some behavior, want to sell psychiatric drugs, so give the behavior a name and claim that the drug will cure the behavior. This is terribly false.
Or,
Psychiatrists give some psychiatric drug, for any reason. The psychiatric drug CAUSES some unusual behavior. The psychiatrists THEN put a label on that behavior, call it a "disease," claim that this "disease" is caused by some "chemical imbalance in the brain," and then sell a psychiatric drug to cure this "disease."
There is hardly anything on the planet more evil that the psychiatric group, and the drug companies that make their stuff.
The above is the truth of the matter. If you believe anything else you have fallen for the lies by the medical establishment. It matters to me if you decide I am nuts on this. But, that is the truth of it.
See my article on psychiatric drugs -- HERE.]
In the early 1900s, the German psychiatrist Emil Kraeplin was the first to formally describe bipolar disorder. He used the term "manic depressive" to explain how mania and depression both affect the patient. His work in the early 20th century led to advancements in classifying, treating, and predicting the course of mental illness, which ushered in the formal discipline of psychiatry.
Bipolar disorder has two distinct classifications:
Bipolar I
An onset before the age of 30 usually results in
frequent, severe episodes. Psychosis is more common in
this group and symptoms tend to linger between episodes.
An onset after the age of 40 has a better prognosis.
Generally, short episodes, late onset, the absence of
other medical or psychiatric conditions, and early
treatment have a better prognosis.
Most people are symptom free for months or even years between episodes of depression and mania. Approximately 25% of people never fully recover from an episode. Nearly 33% of people have great difficulty functioning at work and in social settings.
Three-fourths of manic episodes occur before or right after a major depressive episode. After the first manic episode, there's a 90% chance that a second one will occur. Typically, a greater number of manic episodes are experienced over a lifetime. Approximately 40% of people with bipolar disorder have an average of one episode every 2 1/2 years, or four in every 10 years.
Bipolar II
People with bipolar II disorder experience major
depressive episodes that alternate with hypomania (milder
manic episodes). During hypomanic episodes, patients may
become more productive or noticeably goal driven, but
their ability to function well in their normal daily
activities is not impaired.
About 10% of people who experience hypomanic episodes eventually have manic episodes.
Incidence and Prevalence
Bipolar disorder affects approximately 3% of people in
the United States. The age of onset is usually the late
teens or early 20s and there is usually a history of
depression.
Men and women are affected in equal numbers. Women's first episode is typically manic, while men typically experience a depressive episode first.
While there are many biological factors associated
with mania and depression, none of them has been proven
to be a cause or to be diagnostic of bipolar disorder.
At least 50% of people with bipolar disorder have a parent with a mood disorder, most often major depressive disorder. A person has a 30% chance of inheriting a mood disorder if one parent has bipolar disorder, and a 60% chance if both parents have it. Research has found an even greater risk among twins, especially identical twins, who have a parent with bipolar disorder.
New mothers with bipolar disorder have a great risk—30% to 50%—for an episode during the first month after childbirth. This means that the pregnancy must be managed properly to ensure safety for both mother and child.
Symptoms
Mania
Untreated symptoms of mania can last up to 3 months.
Symptoms include the following:
Delusions occur in 75% of manic episodes. In a delusional state, a person loses their perception of reality. For example, a person may believe they possess amazing strength and ability, are extremely wealthy, or are publicly desired. Auditory and visual hallucinations are common and can be dangerous.
Patients are at risk for injuring themselves or others during a manic state. In severe episodes, hospitalization may be necessary.
Depression
After a manic episode, people with bipolar disorder may
experience a symptom-free phase that can last for months.
Eventually, a depressive episode ensues. Symptoms of
depression include the following:
Mixed Episode
During a mixed episode, both manic and depressive
symptoms are experienced daily for at least 1 week. The
person usually feels very anxious and disorganized and
commonly will develop insomnia, psychosis, and loss of
appetite.
A mixed episode can last from a week to several months and is usually followed by a depressive episode. They occur more often in people (especially men) under 25 and over 60 years of age. Mixed episodes are seen most frequently in teenagers who have experienced major depression.
Mixed episodes are severe and impair daily functioning in social interactions, occupational activity, and intimate relationships. In some cases, there are psychotic features or other symptoms that are so severe that hospitalization is necessary to prevent the patient from harming him- or herself or others.
When mixed episodes occur in children, especially those under 8 years of age, attention deficit disorder (ADD) should be considered, because ADD has similar symptoms, such as hyperactivity, elation, sudden sadness, and low self-esteem.
Rapid Cycling
In rapid cycling there are more manic and depressive
episodes of shorter duration, and they become more severe
as the patient ages. Typically, four or more
rapid-cycling episodes occur within 1 year.
Physicians rely on the following to make a diagnosis:
Diagnosis can be difficult because the first episode of mania may go undetected, and an episode of depression does not necessarily predict a subsequent manic episode. Generally, however, there is a history of depression before the first manic episode.
Diagnostic Criteria for Mania
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.
From the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1996. Washington, DC: American Psychiatric Association (APA).
The diagnostic criteria for major depressive disorder apply to the diagnosis of bipolar disorder (see symptoms of depression).
Differential Diagnosis
When the patient is suffering symptoms of a mixed
episode, the direct physiological effects of a substance
(e.g., a drug of abuse, antidepressant medication, ECT,
light therapy) or a general medical condition (e.g.,
hyperthyroidism) must be ruled out.
Treatment for bipolar disorder includes medication,
psychotherapy, and, when necessary, electroconvulsive
shock therapy (ECT). Treating the acute episode is
similar to treating the underlying mood disorder
(continual), though there are differences between the two
approaches.
Acute Treatment of Manic Episode
The following drugs are commonly used to treat manic
episodes:
These medications control mood swings and acute symptoms, manage recurrences, reduce the risk of suicide, and restore a sense of well-being.
Lithium revolutionized psychiatry when first introduced as a drug of treatment in the 1950s. The realization that a simple salt could cure a mental illness supported the theory that chemical imbalances caused them. Moreover, it dispelled beliefs that things like bad parenting or neglect were the sole causes. Lithium is the mainstay of bipolar treatment. It effectively treats both manic and depressive episodes and prevents devastating relapses. People with bipolar disorder often can control their condition with lithium alone. It typically takes 1 to 2 weeks for lithium to produce the desired effect.
Also, there is a high rate of suicide among people with untreated bipolar disorder. Studies show that lithium treatment significantly reduces this risk. Conversely, people who stop lithium treatment are 20 times as likely to commit suicide during the first 6 months following discontinuation.
Side effects commonly experienced by patients taking lithium include the following:
Long-term effects include weight gain, possible hypothyroidism, and kidney dysfunction. Patients who have kidney disease should not take lithium. Levels of lithium in the blood are monitored regularly to ensure that the proper concentration of lithium is maintained.
Pregnant women have to weigh the risks of taking lithium during pregnancy. The drug has been linked with birth defects.
Valproate was initially prescribed for the treatment of seizures but is now also approved by the Food and Drug Administration (FDA) for treating bipolar disorder. Its use requires blood-level checks because it can be toxic. Valproate is more effective than lithium in treating rapid-cycling bipolar disorder. Its effect on depression alone, however, has not been well studied. Side effects commonly experienced by patients taking valproate include the following:
Long-term effects include weight gain and possible liver dysfunction. Patients with liver disease should not take this medication. Levels of valproic acid in the blood are monitored regularly.
Carbamazapine is also an antiseizure drug. Although not approved by the FDA for the treatment of bipolar disorder, it effectively controls mania and depression in bipolar disorder. Studies of its effect on depression alone have not been done.
Side effects commonly experienced by patients taking carbamazapine include the following:
Long-term effects include leukopenia (reduced white blood cell count) and liver dysfunction. Patients who have liver disease should not take this drug. Levels of carbamazapine in the blood are monitored regularly.
Carbamazepine may cause birth control pill failure, so women should use another form of birth control while taking it. Women should weigh the potential risks against the benefits of taking this medication during pregnancy. There may be an association between this drug and some birth defects.
Antipsychotic medication, like olanzapine (Zyprexa®), is used to treat psychosis when it occurs in a manic episode.
Side effects commonly experienced by patients taking olanzapine include the following:
Antipsychotic medication is continued at the lowest effective dose until symptoms resolve. Antipsychotic medication should be discontinued because of serious long-term side effects (e.g., tardive dyskinesia), unless psychotic symptoms worsen while tapering the dosage. Patients should be evaluated periodically to assess the need for maintenance therapy (see treatment of schizophrenia).
Benzodiazepines are used to treat anxiety or agitation during a manic episode.
Acute Treatment of Depressive Episode
Treating the depressive episode in bipolar disorder is
controversial for two main reasons. First, antidepressant
medication may send a person into a manic or hypomanic
episode. Second, antidepressants may cause rapid cycling.
A person may recover more quickly from depression, but
may experience the next episode sooner.
To reduce these risks, most psychiatrists prescribe mood stabilizers (e.g., lithium, valproate) in combination with antidepressants. Once the symptoms of the depressive episode resolve, the dosage of the antidepressant medication is tapered down over several weeks and finally discontinued.
If psychotic symptoms are present during an acute depressive episode, antipsychotic medication is prescribed. This medication is not used for maintenance therapy because of serious side effects that develop over the long term.
Otherwise, treating an episode of depression in bipolar disorder is the same as major depressive disorder (see treatment of depression).
Chronic Treatment (Prophylaxis) of Bipolar Disorder
Once bipolar disorder is diagnosed, it is necessary to
continue treatment indefinitely. Various mood stabilizers
are typically used for continual treatment, alone or
combined. In some cases, an antidepressant or
antipsychotic drug is used in the combination.
Patients require lifelong lithium therapy to prevent relapses. When lithium treatment stops, relapses occur within 6 months in 90% of patients, and subsequent lithium treatment and other treatments are less likely to be effective.
Chronic treatment with more than one type of medication requires close monitoring to ensure that the proper concentrations of the drugs are maintained and to make any necessary adjustments (e.g., change medications or dosages) to alleviate side effects.
Ongoing psychotherapy is necessary for the following reasons:
Support groups are beneficial for patients, their families, and close friends. Patients receive encouragement, learn coping skills from others, share their concerns, and feel less isolated. Family members and friends acquire a better understanding of the illness, share their concerns, and learn how to support their loved ones.
Hospitalization
Hospitalization is required for severe episodes of mania
and depression to protect patients from injuring
themselves or others.
Electroconvulsive therapy (ECT) is used primarily as an acute treatment for hospitalized patients who are suicidal, psychotic, or dangerous to others. It is effective in nearly 75% of patients who undergo this treatment. Receiving ECT during pregnancy is considered safe.
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