Bipolar disorder or manic depression is a medical illness that causes extreme shifts in mood. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life. These swings or cycling can be as frequent as hourly or as infrequent as yearly. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most people generally require some sort of lifelong treatment. While medication is a key element in successful treatment of bipolar disorder, psychotherapy, support, and education about bipolar disorder are also essential components of the treatment process. Often seasonal affective disorder SAD or seasonal depression is more closely linked to bipolar disorder than depression. Some people self medicate bipolar disorder with opiates such as Oxycontin, this should be seen as an indicator that a mood stabilizer is necessary. Additionally studies are also showing that certain anesthesia such as Ketamine may be used to treat bipolar disorder, albeit in a very controlled environment. Recent studies have shown that the longer bipolar disorder goes untreated the more brain damage it might cause. This is similar to depression and anxiety in that they both damage and kill brain cells and the synapses between the cells. Read more on the benefits of SSRIs.
Symptoms of Mania in Bipolar Disorder
Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
- Either an elated, happy mood or an irritable, angry, unpleasant mood
- Increased physical and mental activity and energy
- Racing thoughts and flight of ideas
- Increased talking, more rapid speech than normal
- Ambitious, often grandiose plans
- Risk taking, gambling, shopping binges
- Impulsive activity such as spending sprees, hyper-sexual indiscretion, and alcohol abuse
- Decreased sleep without experiencing fatigue
Symptoms of Depression:
Depression is the other phase of bipolar disorder. The symptoms of depression may include:
- Loss of energy
- Prolonged sadness
- Decreased activity and energy
- Restlessness and irritability
- Inability to concentrate or make decision
- Increased feelings of worry and anxiety
- Less interest or participation in, and less enjoyment of activities normally enjoyed
- Feelings of guilt and hopelessness
- Thoughts of suicide
- Change in appetite (either eating more or eating less)
- Change in sleep patterns (either sleeping more or sleeping less)
- Depression brought on by the changing of the seasons SAD or Seasonal Affective Disorder
Causes of Bipolar Disorder
The exact cause of bipolar disorder is not known, most scientists believe that bipolar disorder is likely caused by multiple factors that interact with each other to produce a chemical imbalance affecting certain parts of the brain. Bipolar disorder often runs in families, and studies suggest a genetic component to bipolar disorder. A stressful environment that is repeated from one generation to the next may play a role in the genetic component, or negative life events may interact with an underlying genetic or biological predisposition to manifest the bipolar disorder. There are other possible triggers of bipolar disorder episodes. In other words, we really aren’t certain of the causes and definitely cannot pinpoint these in any one case. The treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar disorder episodes can and often do occur without any obvious triggers as well. There is new genetic data that claims that prenatal stress on the fetus can actually change the genes of the fetus and therefore provide the genetic basis for many mental illnesses; this might apply to bipolar disorder as well. The good news is that other studies have shown that genetic engineering is making strides in identifying and manipulating these genes, thus giving us hope for a cure from bipolar disorder someday.
Treatment for Bipolar Disorder
Sometimes a mood stabilizer alone will not be adequate and need the augmentation of an antidepressant. This must be done with great caution because in some cases, the antidepressant can send the patient into mania. Other times people with bipolar disorder are treated for anxiety and depression; so they are given an anti-anxiety medication and an antidepressant. The end result is radical swings from depression back to mania. Bipolar disorder has to be treated by someone with a lot of experience in the disease.
As with many other mental illnesses, there is no cure for bipolar disorder, although bipolar disorder is a treatable and manageable illness. After an accurate diagnosis of bipolar disorder, most people can achieve an optimal level of wellness and quality of life. Medication is an essential element of successful treatment for people with bipolar disorder. In addition, psychosocial therapies including cognitive-behavioral therapy, interpersonal therapy, family therapy, and psycho-education are important to help people understand the illness and to internalize skills to cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of bipolar disorder. It is useful to know whether the “mood stabilizing medication” prescribed has been approved by the FDA for use in bipolar disorder or if it is being used off label. Sometimes it might take several medications before the right one is found, treating bipolar disorder in this case is a bit more difficult than clinical depression.
Medications for Mania: Currently FDA approved: lithium (Eskalith or Lithobid), divalproex sodium (Depakote), carbamazepine (Tegretol), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify).
Medications for bipolar depression: Currently FDA approved: combination of olanzapine and fluoxetine (Symbyax).
Medications for preventing (or delaying) recurrence: Currently FDA approved: lithium (Eskalith or Lithobid), lamotrigine (Lamictal), olanzapine (Zyprexa), and aripiprazole (Abilify).
Frequently a combination of two or more medications are used, especially during severe episodes of acute mania or depression. These lists of medications are subject to change with the ever-increasing developments of new therapies and medications.
Anti-convulsants: The Food and Drug Administration (FDA) approved divalproex sodium (Depakote) in 1995 for treating bipolar episodes. Originally approved in 1983 as a drug to treat epilepsy. Treating a medical condition with a drug originally intended for treating another illness is called Off Label.
Use of Antidepressants in Treating Bipolar Disorder
Standard antidepressant medications (those approved for the treatment of unipolar depression) have not yet been proven effective for bipolar depression. Although the evidence supporting their use for bipolar depression is limited to small or less rigorous studies, these medications remain the most commonly used treatment for bipolar depression. The data from larger studies finds neither evidence of benefit nor evidence that these agents cause large numbers of depressed patients to switch into mania.
Use of Antipsychotic Medications as Mood Stabilizers
To control acute episodes, anti-psychotic medications may be used alone (monotherapy), or added to anti-convulsant medications (combination therapy). Medication guidelines for bipolar disorder now recommend the combination of these two medications as most effective for acute manic episodes. Because the older typical anti-psychotic medications run the risk of causing permanent movement disorder and have been associated with depression when used over the long term, the new atypical anti-psychotics are now preferred for this purpose. All the new atypicals are effective in the treatment of acute and mixed mania.
Side effects of the atypicals are different than with first-generation anti-psychotics, although sedation, weight gain, and risk of diabetes are problems associated with many of the new anti-psychotics. As the science develops in this area, it will continue to inform medicine choices for the person that best reflect their risks and benefits. For the entire article click on the following link bipolar disorder NAMI. Note that WebMD does a fine job of describing the causes, symptoms, and treatments for bipolar disorder as well.