Bipolar Disorder

Bipolar Disorder is a brain disorder that causes extreme swings in mood, energy, and ability to function. The mood changes of Bipolar Disorder are different from normal ups and downs. They can hurt relationships and cause poor job or school performance.

Causes

The cause of Bipolar Disorder is not known. Bipolar Disorder tends to run in families. Specific genes may play a role, but it is not caused by one single gene. Many different genes probably act together. Life factors may also play a role.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Family members with bipolar disorder
  • Acute or chronic stress

Symptoms

Symptoms include:
  • Dramatic mood swings ranging from elated excitability to hopeless despondency
  • Periods of normal mood in between
  • Extreme changes in energy and behavior
Periods of highs are called Mania. 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
Periods of lows are called Depression. 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, 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

Diagnosis

The doctor will ask about your symptoms and medical history, and will usually perform a physical exam. In some cases laboratory tests are ordered to rule out other causes for mood and behavior. Diagnosis of Bipolar Disorder is based on:
  • Symptoms over time
  • Absence of other disorders
  • Family history of Bipolar Disorder
Mania is diagnosed if abnormally elevated mood, lasting at least one week, occurs with three or more of the other symptoms. If the mood is irritable, four additional symptoms must be present.

Depression is diagnosed if depressed mood or loss of interest or pleasure occurs every day (or nearly every day) over at least two weeks, and is accompanied by five or more of the symptoms.

Treatment

Treatment may include:

Medications
  • Lithium - mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
  • Valproate (Depakote) and Carbamazepine (Tegretol) - anti-seizure medications, also used as mood stabilizers instead of or in combination with lithium
  • Benzodiazepines - clonazepam (KlonopinŽ) or lorazepam (AtivanŽ) can be used to treat agitation or insomnia
  • Zolpidem (Ambien) - used to treat insomnia
  • Antidepressants - seratonin reuptake inhibitors or bupropion (WellbutrinŽ) can be used to treat depression
  • Anti-psychotics - used if patient exhibits psychotic behavior at extremes of mood
Psychotherapy

Psychotherapy may include:
  • Cognitive behavioral therapy
  • Counseling
  • Family therapy
  • Interpersonal therapy