Facts of Bipolar Disorder

Overview

Bipolar disorder is one in all the foremost distinct and dramatic of mental sicknesses. It is characterised by intense episodes of elation or irritability and despair, with any combination of mood experiences in between, as well as periods of traditional moods. Mood changes area unit in the midst of changes in behavior, such as altered patterns of sleep and activity.

Traditionally, one percent of the population has been affected by bipolar disorder, but as the condition has expanded to include a spectrum of proposed bipolar conditions, this number has risen to an estimated 2.6 to 6.5 percent. According to the planet Health Organization, bipolar disorder is the sixth leading cause of disability among people aged 15 to 44. It is less common than major depression, also called “unipolar” depression, or simply, “depression.”

The classic type of affective disorder, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some folks, however, never develop severe mania but instead experience milder episodes, called hypomania, that alternate with depression; this form of the illness is called bipolar II disorder. In addition, there are two other forms of bipolar disorder: bipolar disorder not otherwise specified (BP-NOS) and cyclothymic disorder, or cyclothymia. BP-NOS is reserved for cases wherever folks have symptoms of affective disorder that don’t meet all the diagnostic criteria for bipolar I or II. Cyclothymia may be a gentle type of affective disorder wherever folks have episodes of hypomania that shift back and forth with gentle depression for a minimum of 2 years. The symptoms of cyclic disorder additionally don’t work into the diagnostic criteria for bipolar I or II.

Studies show that men and girls area unit equally doubtless to develop bipolar disorder; but, there is some evidence that women may have more depressive and fewer manic episodes than men with the illness. Women appear to possess “mixed states” (mania or hypomania occurring at identical time as depression) additional typically than men. Also, ladies area unit additional doubtless to possess the fast athletics type of the sickness, which is characterized by four or more episodes of depression, mania or hypomania a year, and may be more resistant to standard treatments. Women are also more likely to have bipolar II disorder.Bipolar Disorder

The symptoms of affective disorder is severe and draining. Bipolar disease is not curable. However, medication will facilitate many folks win remission of symptoms. Treatment and maintenance of this disorder is important throughout a personality’s life once affective disorder is diagnosed.

Like another sicknesses that need long treatment, bipolar disorder poses unique medical challenges for women with the disorder who are pregnant or considering pregnancy. The notion that gestation itself is protecting for girls with affective disorder isn’t true. The risk of recurrence of either depression or mania during pregnancy and postpartum is high. A recurrence during the postpartum period often develops as postpartum psychosis. These risks area unit high for girls World Health Organization stop their mood-stabilizing medications and even higher for girls World Health Organization stop these medications short.

So a woman with bipolar disorder who wants to become pregnant should discuss her treatment options with her health care team before conception, if possible, or as early in her pregnancy as possible. Concerns exist regarding the potential harmful effects mood-stabilizing medications accustomed treat affective disorder might wear the developing vertebrate and therefore the nursing baby. However, these concerns need to be weighed against the potential serious risks that an episode of mania or depression may pose to the developing fetus, infant or mother.

Diagnosis

Bipolar disorder, also known as manic depression, generally strikes in late adolescence or early adulthood, most often between the ages of 15 and 30, and usually continues throughout a person’s life. However, some people develop their first symptoms in childhood and others don’t develop them until later in life.

Researchers theorize that there ar variety of contributory factors for why and the way somebody develops manic depression, including a genetic predisposition, environmental influences and brain chemistry.

According to the National Institute of Mental Health (NIMH), close relatives of people suffering from bipolar illness are four to six times more likely to develop bipolar disorder than the general population. It is important to note, however, that not everybody with a family history develops the illness. No one gene has been identified for the disorder, but it appears likely that many genes act together and in combination with other factors in the person or the person’s environment to cause bipolar disorder.

Studies of identical twins who share the same genes show that a person who has an identical twin with bipolar disorder is more likely to develop the disorder than someone who contains a relation with the unhealthiness, indicating that genes are definitely involved. However, a personal World Health Organization contains a twin with {bipolar disorder|manic depression|manic depressive unhealthiness|manic-depressive psychosis|affective disorder|major affective disorder|emotional disorder|emotional disturbance} won’t continuously develop the illness, indicating that genes and other factors both play a role.

Studies recommend that stress, difficulty at work or interpersonal relationships may trigger episodes in those with bipolar disorder, particularly if the stress causes loss of sleep. The theory is that stress and/or loss of sleep precipitates changes in brain chemistry in susceptible people.

Behaviors and moods common to manic depression might at first be attributed to alternative medical issues, or other mental illnesses, which can delay an accurate diagnosis and appropriate treatment. For example, many people with bipolar disorder are misdiagnosed with major depression. In addition, alcohol and misuse and/or difficulties with work and faculty performance could also be known, however their underlying cause—bipolar disorder—may not be diagnosed. However, the disorder is not difficult to diagnose by a well-trained clinician.

Bipolar disorder is diagnosed based on an evaluation of symptoms, the course of the illness and family history. To be diagnosed with bipolar disorder, a person must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), published by the American Psychological Association. In addition to a psychiatric evaluation, a complete medical exam should be completed. A physical exam and blood tests can rule out medical conditions that can mimic or worsen bipolar disorder.

Physical tests, such as a blood test or brain scan, cannot conclusively identify the illness, although progress is being made in these areas. For example, brain-imaging studies using magnetic resonance imaging (MRI), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) procedures allow researchers to take pictures of the brain to examine its structure and activity. These noninvasive techniques are beginning to help scientists learn what goes wrong in the brain to produce bipolar disorder as well as other mental illnesses.

Symptoms

The symptoms of bipolar disorder fall into several categories: depression, mania and mixed state type of episodes (in mixed episodes, symptoms of both depression and mania are present at the same time). In addition, people experiencing any of these types of mood episodes may experience psychosis, which is a serious inability to think and perceive clearly, or losing touch with reality. If you or a family member experiences any of these symptoms, you should discuss them with a health care professional and request a thorough evaluation, which should include a physical checkup and a family health history.

The symptoms of depression include:

  • constant or persistent sadness
  • loss of pleasure and interest in activities that were once fun, including sex
  • significant change in appetite or weight (either increase or decrease)
  • restlessness or agitation
  • irritability or excessive crying
  • change in sleep patterns, either oversleeping or insomnia
  • lack of energy, feeling slowed down mentally and physically
  • feelings of guilt, worthlessness, helplessness, hopelessness
  • persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain
  • difficulty thinking or concentrating
  • recurring thoughts of death or suicide

The symptoms of mania include:

  • persistent and abnormally elevated mood (euphoria)
  • irritability
  • overly inflated self-esteem or feelings of importance
  • a decreased need for sleep
  • increased talkativeness
  • racing thoughts
  • increased activity, including sexual activity
  • distractibility
  • increased energy and/or physical agitation
  • excessive involvement in risky behaviors, such as spending money irresponsibly
  • poor judgment
  • inappropriate social behavior

Significant disruption in your sleep-wake cycle is an early warning sign of an impending episode. Controlling your sleep-wake cycle and maintaining a regular pattern is critical to avoid making the illness worse. Decreased and disrupted sleep occurs frequently for new mothers. It is necessary for girls with manic depressive illness WHO area unit pregnant or considering gestation to speak with their health care suppliers regarding ways in which to scale back their sleep disruptions when giving birth.

Other symptoms of manic depression include psychosis, which involves hallucinations and delusions (falsely believing in something with conviction, despite proof or evidence to the contrary).

Mixed state episodes include symptoms of both depression and mania, often including agitation, trouble sleeping, change in appetite, psychosis and thoughts of suicide.

Symptoms of mania, depression or mixed state are episodic and typically recur. Episodes may become more frequent with age if the condition isn’t properly treated. These episodes, especially early in the course of the illness, are separated by periods of wellness, when someone suffers few or no symptoms.

Women with bipolar syndrome area unit additional doubtless to expertise mental disease and frenzied episodes throughout gestation and when biological process. This risk is higher for girls WHO stop their mood-stabilizing medications and even higher for girls WHO stop these medications short.

The combinations and severity of symptoms vary from person to person. Some people have severe manic episodes in which they feel out of control, have tremendous difficulty functioning and severe psychosis. Other people have milder “hypomanic” episodes that embody enlarged energy, euphoria and irritability. Some suffer completely incapacitating periods of depression and are unable to function within their normal daily routine. Hospitalization is critical to treat severe episodes of mania or depression.

If you have bipolar disorder, you may have difficulty acknowledging your mood swings even if family and friends tell you about these behaviors.

During a manic episode, you might abuse alcohol, schedule too many events or meetings for one day, drive recklessly, go on a spending spree, make unwise or risky business decisions or be unusually promiscuous sexually. Untreated, the manic phase can last from days to months. As it fades, a period of normal mood and behavior may occur. Sometimes the depressive phase of the illness then sets in, but another manic episode could also follow.

When you’re experiencing a depressed episode, you might lose complete interest in everything you used to enjoy, not be able to stop crying, feel completely hopeless and contemplate suicide. In some people, depression occurs immediately after a manic episode or within the next few months. But with others, there is a long interval before the next manic or depressive episode. The depressive phase has the same symptoms as major depression (also called “unipolar” depression).

People with manic depressive illness might have abnormal endocrine gland operate. Because an excessive amount of or deficient hormone alone will result in mood and energy changes, it is important that your health care professional closely monitor your thyroid levels. Additionally, if you are treated with atomic number 3, that will cause low thyroid levels.

Treatment

If you have bipolar disorder, you will need lifelong treatment. Regular monitoring and consultation with a health care professional is necessary to establish which medication or combination of drugs works best.

Medications known as “mood stabilizers” area unit most frequently prescribed to assist management emotional disturbance, and several other styles of mood stabilizers area unit accessible. In general, individuals with sickness|manic-depressive psychosis|affective disorder|major affective disorder|emotional disorder|emotional disturbance} continue treatment with mood stabilizers for associate extended time to manage their illness, typically for years. Other medications area unit typically combined with mood stabilizers once necessary to treat powerful episodes of mania or depression which will break through despite the mood stabilizer. These additional medications may include: an antipsychotic for psychosis or mania; an antidepressant for depression; and/or a benzodiazepine for agitation.

For nearly forty years, the mood stabilizer metallic element has been one amongst the most treatments for individuals with emotional disturbance.

Lithium evens out moods so you don’t feel as high or as low, but it’s unclear exactly how the medication works in the brain. Lithium is not used just for manic attacks, but rather as an ongoing treatment to prevent all types of episodes. It will take up to a few weeks to begin reducing severe frenzied symptoms. It might take a few months of medication before the illness is under control.

When taken frequently, metallic element will effectively management depression and mania and scale back the probabilities of repetition. However, while it is effective treatment for many people, it doesn’t work for everybody.

Regular blood tests are a must if you’re taking lithium. The level of lithium in your blood can be measured with a blood test. This level is employed by your doctor, along with your symptoms, to determine the appropriate dose of lithium for you. Too small a dose might not be effective and too large might produce unwanted side effects, including weight gain, tremors, excessive thirst and urination, drowsiness, weakness, nausea, vomiting and fatigue.

Salt intake conjointly affects the number of metallic element in your body. A dramatic reduction in salt intake, excessive exercise and sweating, fever, vomiting or diarrhea may cause lithium to build up in your body to toxic levels. An dose of metallic element will cause confusion, delirium, seizures, coma and may result, although rarely, in death.

In addition to metallic element, other mood stabilizers used in the treatment of bipolar disorder include anticonvulsants. They may be combined with metallic element or with one another for optimum impact. Specific ones used for bipolar syndrome include:

  • Anticonvulsants. Antiseizure medications (also called anticonvulsants) such as valproic acid (Depakene) and divalproex (Depakote) can have a mood-stabilizing effect in people with bipolar disorder. There is some evidence that valproic acid may result in hormonal changes in teenage girls and polycystic ovarian syndrome (PCOS) in women who began taking the medication before age 20. Young women should discuss this risk with their health care professionals, and those taking valproic acid should be monitored carefully for possible hormonal problems.The anticonvulsants carbamazepine (Tegretol) and oxcarbazepine (Trileptal) even have some effects as mood stabilizers, though they’re not however approved for emotional disturbance by the U.S. Food and Drug Administration (FDA). At this point, there is more evidence on the effectiveness of Tegretol than Trileptal.And the anticonvulsant lamotrigine (Lamictal) is FDA-approved for the long-term treatment of adults with bipolar disorder. It is specifically used to treat the depressive episodes involved with bipolar disorder.Some anticonvulsants can decrease the effectiveness of hormonal contraceptives, such as birth control pills. It is important to discuss your method of contraception with your health care provider to determine if there is an interaction.

Severely ill patients may require a combination treatment with mood stabilizers and other drugs, including:

  • Antidepressant medications. Several classes of antidepressant medications are sometimes used to treat the depressive symptoms of bipolar disorder, including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin). However, the use of antidepressants in people with bipolar disorder is controversial, since antidepressants may not be any more effective than mood stabilizers at treating depressive episodes in people with bipolar disorder and can trigger manic episodes. Make sure you tell your health care professional about any prior symptoms of hypomania or mania (episodes that include increased energy, euphoria and irritability) before beginning antidepressants.Side effects and effectiveness differ for each class of antidepressant, as well as for the individual brands.
  • Antipsychotics.  If you’re experiencing psychotic or manic symptoms during an episode of bipolar disorder, health care practitioners will sometimes prescribe antipsychotic medicine alone or in combination with a traditional mood stabilizer to control symptoms.Olanzapine can also be used alone for the treatment of bipolar disorder.Examples of antipsychotics used include: olanzapine (Zyprexa), ziprasidone (Geodon), quetiapine (Seroquel), aripiprazole (Abilify) and risperidone (Risperdal), all FDA-approved for the treatment of bipolar disorder.In addition, antianxiety medications such as benzodiazepines may be used in some people with bipolar disorder with acute mania to help with sleep. There is a potential for abuse of or physical dependence on benzodiazepines. Therefore, these medications are often prescribed only for a limited time, such as during an acute episode.

Be patient. It may take up to three weeks of regular use of a new drug before your symptoms improve or subside. Stay in close communication with your health care professional and let him or her know if you don’t feel like you are responding to treatment. In some cases, treatment plans need to be changed to effectively control symptoms.

Electroconvulsive therapy (ECT) is another treatment possibility for affective disorder and alternative sorts of major depression. It is usually only used to treat bipolar disorder when medication, psychosocial treatment or the combination of these treatments are ineffective or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide. ECT can also be thought of once sure medical conditions, such as pregnancy, make the use of medication too risky.

Just prior to ECT treatment, you’re given a muscle relaxant and sometimes general anesthesia. Electrodes are then attached to your scalp. An electric current causes a brief convulsion. Treatments usually last for 30 to 90 seconds. You won’t bear in mind the treatments and can in all probability awake slightly confused. You will most likely recover in five to 15 minutes and be able to go home the same day. Acute treatments typically occur thrice per week for a couple of month. Maintenance treatments may be given after that at a reduced frequency.

ECT has been used for quite seventy years and has been refined since its early introduction as a treatment for depression. According to Mental Health America , ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals. Researchers don’t understand exactly how it works to improve symptoms of depression and/or mania in some individuals, but the evidence is clear that it does work.

Although myths and negative perceptions continue to be perpetuated about ECT, it is a very effective treatment for many people with severe depressive, manic or mixed episodes who don’t respond to or have bad effects from other treatments or can’t take other treatments for some reason. Research has shown that patients who receive ECT followed by maintenance lithium therapy have better outcomes than patients who receive lithium alone. As with all alternative treatments, you should undergo a complete physical evaluation before beginning ECT therapy.

Side effects will embrace permanent blackout and confusion. These side effects were more of a concern in the past, and modern ECT techniques have reduced them significantly. However, the benefits and risks of ECT should still be carefully weighed before an individual or his or her family and friends decide to go with the treatment.

Psychotherapy. As with all mental illnesses and other serious conditions, bipolar disorder can devastate a person’s self-esteem and relationships, especially with spouses and family. Without treatment, people with the illness may jeopardize their finances, their careers, their families and their lives. Thus, in addition to treatment with medications, psychotherapy (“talk therapy”) is also recommended for individuals with the disorder, as well as for their family members.

Bipolar Disorder and Pregnancy

Women with manic depressive illness World Health Organization need to become pregnant ought to contemplate many problems. Careful coming up with for maternity will facilitate girls with bipolar malady best manage their ill health whereas avoiding risks to their babies. The goal is to maintain a stable mood during pregnancy and postpartum. It is extremely important to consider both the risks of the medications to the unborn baby, as well as the risks of untreated bipolar disorder to both the mother and unborn baby. These should be weighed carefully in a thorough discussion with your health care provider.

After discussing risks and benefits with your health care professional, if you prefer not to use medication during pregnancy, a trial off medications (following a gradual taper) prior to pregnancy, possibly only stopping medications after conception, might be an option. Most health care professionals suggest avoiding sudden changes in medication during pregnancy, which can increase the risk of relapse.

Overall, studies show that taking just one mood stabilizer throughout maternity poses less of a risk to the developing vertebrate than will taking multiple medications. Some anticonvulsants have been shown to be harmful to fetuses, possibly leading to birth defects. However, rates of issues vary wide supported the medication. Discuss possible medications and their risks with your health care professional and always weigh this against the risk of untreated bipolar disorder.

Some of these medications can be used while breastfeeding but all options should be discussed with your health care professional. Overall, if you’re pregnant or about to become pregnant and you’ve got manic depressive illness, be sure to discuss safety of various treatment options during and after pregnancy with your health care professional.

ECT has also been used for decades (with appropriate adjustments) in pregnancy to treat severe mania or depression.

Prevention

Patients and their families ought to perceive that manic depressive illness won’t escape, and there’s no thanks to stop the disorder from developing. The only thanks to keep the disorder in check is thru continued compliance with treatment.

Facts to Know

  1. Bipolar disorder involves episodes of mania and depression.
  2. Traditionally, one percent of the population has been affected by bipolar disorder, but as the condition has expanded to include a spectrum of proposed bipolar conditions, this number has risen to an estimated 2.6 to 6.5 percent. According to the planet Health Organization, bipolar disorder is the sixth leading cause of disability among people aged 15 to 44.
  3. Most people with bipolar disorder can expect that even their most severe mood swings will be relieved with treatment.
  4. Like other serious illnesses, bipolar disorder is not only difficult for the person who has it but also hard on family members, friends and employers. Family members of individuals with manic depressive illness usually need to address serious behavioural issues (such as wild defrayal sprees) and therefore the lasting consequences of those behaviors.
  5. Bipolar disorder generally strikes between the ages of 15 and 30.
  6. Studies recommend that stress, difficulty at work or with interpersonal relationships may trigger episodes in people with bipolar disorder, particularly if the stress causes loss of sleep.
  7. Not everybody with a family history of manic depression develops the illness.
  8. Studies recommend that stress, difficulty at work or with interpersonal relationships may trigger episodes in people with Lithium has been the treatment of alternative for individuals with manic depressive illness however does not work for everybody with the disorder. Other effective treatment options are available.
  9. Bipolar disorder will intensify throughout and once maternity. Because of potential risk to the developing fetus due to both untreated illness as well as some medications, the disease must be carefully treated by a health care professional during this time.

Key Q&A

  1. What is bipolar disorder?Also called manic depressive illness or manic depression, this mental illness is characterized by episodic mood swings that range from overly “high” and/or irritable to sadness and hopelessness, and then back again, with periods of traditional mood in between.
  2. Who usually is affected by bipolar disorder?Men and women are equally likely to develop the condition, usually between the ages of 15 and 30. However, research has shown that women are more likely than men to develop the rapid cycling form of the condition—with episodes occurring four or more times within a 12-month period. Most often, symptoms begin between age 15 and 30. Research has shown that there is a genetic component to the disorder and that people with a close relative with bipolar disorder are four to six times more likely to develop it than people with no family history.
  3. Can the disorder be effectively treated?Yes. For nearly 40 years, lithium has been the treatment of choice for people with bipolar disorder. It levels out mood swings so that patients don’t feel as high or as low and is used as an ongoing treatment. Symptoms may diminish after one to three weeks of treatment, but it might take a few months of medication to control the illness. Newer drugs developed for the disorder, used alone or in combination with lithium, are also prescribed.
  4. Can bipolar disorder be cured?No. Treatment for the illness in considered lifelong. Ongoing maintenance and periodic consultation with a knowledgeable health care professional is typical.
  5. What if I can’t tolerate lithium?There are a number of other effective treatments. Your health care professional might prescribe several medications including both antidepressants and anticonvulsant medications. However, it may take several months to determine the proper medication, dosage and frequency.