What is bipolar disorder?
  • Bipolar disorder, which is also known as manic-depressive illness is a mental illness involving episodes of serious mania and depression: mood swings from overly "high" and irritable to sad and hopeless and then back again, with periods of normal mood in between.

  • Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life.

  • It is often not recognized as an illness, and people who have it may suffer needlessly for years or even decades.

  • Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These include marital break-ups, job loss, alcohol and drug abuse, and suicide.
Awareness
Manic-Depressive Illness Has a Devastating Impact on Many People.
  • At least 2 million North Americans suffer from this distressing and disruptive illness.
  • Like other serious illnesses, bipolar disorder is also hard on spouses, families, friends, coworkers and employers.
  • Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.
  • Bipolar disorder tends to run in families. Research continues to look for the inherited genetic defect associated with the illness.
Recognition
Bipolar disorder involves cycles of mania and depression.

Signs and symptoms of mania include discrete periods of:

  • Increased energy, activity, restlessness, racing thoughts, and rapid talking

  • Excessive "high" or euphoric feelings
  • Extreme irritability and distractibility
  • Decreased need for sleep
  • Unrealistic beliefs in one's abilities and powers
  • Uncharacteristically poor judgment
  • A sustained period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

Signs and symptoms of depression include discrete periods of:

  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in ordinary activities
  • Decreased energy, a feeling of fatigue
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleep disturbances
  • Loss of appetite and weight, or weight gain
  • Thoughts of death or suicide; suicide attempts
The Spectrum

The mood states in bipolar illness occur as a spectrum or continuous range: severe depression, moderate depression, blue periods, normal mood, hypomania (a mild form of mania), and mania.

Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single "mixed" bipolar state.

Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment, and suicide.

Treatment
  • Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.
  • One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
  • Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful.
  • For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.
  • Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
  • As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
Getting Help

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease.

Other mental health professionals, such as psychologists and psychiatric social workers, can assist in providing the patient and his or her family with additional approaches to treatment.

Help can be found at: University- or medical school-affiliated programs, Hospital departments of psychiatry, Private psychiatric offices and clinics, Health maintenance organizations, Offices of family physicians, internists, and pediatricians.

  • An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior.
  • Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.
  • In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.
  • For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.
  • If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
  • Families and friends of people with bipolar disorder can also benefit from mutual support groups such as those sponsored by the National Depression and Manic Depression Association (NDMDA) and the National Association of Mentally Ill (NAMI).

Information supplied by the National Institute of Mental Health,

U.S. Department of Health and Human Services.

For more information, contact:

Your doctor

Your school / university / private practice counsellor

The Mental Health Unit at the hospital