There is a tendency to romanticize bipolar disorder. Many artists, musicians,
and writers have suffered from its mood swings. But in truth, many lives are
ruined by this disease; and without effective treatment, the illness is
associated with an increased risk of suicide.
Bipolar disorder, also known
as manic-depressive illness, is a serious brain disease that causes extreme
shifts in mood, energy, and functioning. It affects approximately 2.3 million
adult Americans-about 1.2 percent of the population. Men and women are equally likely to develop this disabling
illness. The disorder typically emerges in adolescence or early adulthood, but
in some cases appears in childhood.
Cycles, or episodes, of depression, mania, or "mixed" manic and depressive
symptoms typically recur and may become more frequent, often disrupting work,
school, family, and social life.
Depression: Symptoms include a persistent sad mood; loss of
interest or pleasure in activities that were once enjoyed; significant change in
appetite or body weight; difficulty sleeping or oversleeping; physical slowing
or agitation; loss of energy; feelings of worthlessness or inappropriate guilt;
difficulty thinking or concentrating; and recurrent thoughts of death or
suicide.
Mania: Abnormally and persistently elevated (high) mood or
irritability accompanied by at least three of the following symptoms:
overly-inflated self-esteem; decreased need for sleep; increased talkativeness;
racing thoughts; distractibility; increased goal-directed activity such as
shopping; physical agitation; and excessive involvement in risky behaviors or
activities.
"Mixed" state: Symptoms of mania and depression are present
at the same time. The symptom picture frequently includes agitation, trouble
sleeping, significant change in appetite, psychosis, and suicidal thinking.
Depressed mood accompanies manic activation.
Especially early in the course of illness, the episodes may be separated by
periods of wellness during which a person suffers few to no symptoms. When four
or more episodes of illness occur within a 12-month period, the person is said
to have bipolar disorder with rapid cycling. Bipolar disorder is often
complicated by co-occurring alcohol or substance abuse.
Severe depression or mania may be accompanied by symptoms of
psychosis. These symptoms include: hallucinations (hearing, seeing, or
otherwise sensing the presence of stimuli that are not there) and delusions
(false personal beliefs that are not subject to reason or contradictory evidence
and are not explained by a person's cultural concepts). Psychotic symptoms
associated with bipolar typically reflect the extreme mood state at the
time.
Treatments
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people
with the illness have some residual symptoms. Certain types of psychotherapy or
psychosocial interventions, in combination with medication, often can provide
additional benefit. These include cognitive-behavioral therapy, interpersonal
and social rhythm therapy, family therapy, and psychoeducation.
Lithium has long been used as a first-line treatment for bipolar disorder.
Approved for the treatment of acute mania in 1970 by the U.S. Food and Drug
Administration (FDA), lithium has been an effective mood-stabilizing medication
for many people with bipolar disorder.
Anticonvulsant medications, particularly valproate and carbamazepine, have
been used as alternatives to lithium in many cases. Valproate was FDA approved
for the treatment of acute mania in 1995. Newer anticonvulsant medications,
including lamotrigine, gabapentin, and topiramate, are being studied to
determine their efficacy as mood stabilizers in bipolar disorder. Some research
suggests that different combinations of lithium and anticonvulsants may be
helpful.
According to studies conducted in Finland in patients with epilepsy,
valproate may increase testosterone levels in teenage girls and produce
polycystic ovary syndrome in women who began taking the medication before age
20. Increased testosterone can lead to polycystic
ovary syndrome with irregular or absent menses, obesity, and abnormal growth of
hair. Therefore, young female patients taking valproate should be monitored
carefully by a physician.
During a depressive episode, people with bipolar disorder commonly require
additional treatment with antidepressant medication. Typically, lithium or
anticonvulsant mood stabilizers are prescribed along with an antidepressant to
protect against a switch into mania or rapid cycling. The comparative efficacy
of various antidepressants in bipolar disorder is currently being studied.
In some cases, the newer, atypical antipsychotic drugs such as
clozapine or olanzapine may help relieve severe or refractory symptoms of
bipolar disorder and prevent recurrences of mania. More research is needed to
establish the safety and efficacy of atypical antipsychotics as long-term
treatments for this disorder.
Research Findings
More than two-thirds of people with bipolar disorder have at least one close
relative with the disorder or with unipolar major depression, indicating that
the disease has a heritable component. Studies
seeking to identify the genetic basis of bipolar disorder indicate that
susceptibility stems from multiple genes. Scientists are continuing their search
for these genes using advanced genetic analytic methods and large samples of
families affected by the illness. The researchers are hopeful that
identification of susceptibility genes for bipolar disorder, and the brain
proteins they code for, will make it possible to develop better treatments and
preventive interventions targeted at the underlying illness process.
Researchers are using advanced imaging techniques to examine brain function
and structure in people with bipolar disorder. An important area of imaging research focuses on
identifying and characterizing networks of interconnected nerve cells in the
brain, interactions among which form the basis for normal and abnormal
behaviors. Researchers hypothesize that abnormalities in the structure and/or
function of certain brain circuits could underlie bipolar and other mood
disorders. Better understanding of the neural circuits involved in regulating
mood states will influence the development of new and better treatments, and
will ultimately aid in diagnosis.
Source: National Institute of Mental Health
