Manic depression; Bipolar affective disorder
Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. The "mood swings" between mania and depression can be very quick.
Bipolar disorder affects men and women equally. It usually starts between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.
Types of bipolar disorder:
In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people with bipolar disorder:
The manic phase may last from days to months. It can include the following symptoms:
These symptoms of mania occur with bipolar disorder I. In people with bipolar disorder II, the symptoms of mania are similar but less intense.
The depressed phase of both types of bipolar disorder includes the following symptoms:
There is a high risk of suicide with bipolar disorder. Patients may abuse alcohol or other substances, which can make the symptoms and suicide risk worse.
Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.
Many factors are involved in diagnosing bipolar disorder. The health care provider may do some or all of the following:
Note: Drug use may cause some symptoms. However, it does not rule out bipolar affective disorder. Drug abuse may be a symptom of bipolar disorder.
Periods of depression or mania return in most patients, even with treatment. The main goals of treatment are to:
The health care provider will first try to find out what may have triggered the mood episode. The provider may also look for any medical or emotional problems that might affect treatment.
The following drugs, called mood stabilizers, are usually used first:
Other antiseizure drugs may also be tried.
Other drugs used to treat bipolar disorder include:
Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder if it does not respond to medication. ECT uses an electrical current to cause a brief seizure while the patient is under anesthesia. ECT is the most effective treatment for depression that is not relieved with medications.
Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. It is most often used after ECT.
Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stable and their behavior is under control.
Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the possible risks and benefits of treatment for their children.
SUPPORT PROGRAMS AND THERAPIES
Family treatments that combine support and education about bipolar disorder (psychoeducation) may help families cope and reduce the odds of symptoms returning. Programs that offer outreach and community support services can help people who do not have family and social support.
Important skills include:
Getting enough sleep is very important in bipolar disorder. A lack of sleep can trigger a manic episode. Therapy may be helpful during the depressive phase. Joining a support group may help bipolar disorder patients and their loved ones.
Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to make sure that mania and depression are treated as early as possible.
Some people stop taking the medication as soon as they feel better or because the mania feels good. Stopping medication can cause serious problems.
Suicide is a very real risk during both mania and depression. People with bipolar disorder or think or talk about suicide need immediate emergency attention.
Stopping medication or taking it the wrong way can cause your symptoms to come back, and lead to the following complications:
This illness is hard to treat. Patients, their friends, and family must know the risks of not treating bipolar disorder.
Call your health provider or an emergency number right way if:
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Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722.
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