Bipolar Disorder

What is "bipolar disorder"?

Bipolar disorder is a mood disorder that is characterized by episodes of both depression and an elevated mood that we term hypomania, or mania. Most people know what the depression stage of bipolar disorder is, and that's a pervasive sadness, accompanied by changes in sleep and appetite, and feelings of worthlessness and hopelessness. In contrast to this, mania and hypomania are characterized by feeling very good - almost euphoric. When people get into this stage of bipolar disorder, they tend to speak quickly, be very outwardly expressive and joke. People will comment that it's hard to get a word in because they're talking so fast. As the mood progresses to mania, the thought processes start to become somewhat disjointed. We call this racing thoughts, and flight of ideas, where the actual thoughts are very loosely connected, and the person is jumping from one thing to another.

What's the difference between "major depression" and "bipolar disorder"?

Sometimes, when people talk about bipolar disorder, they also use the term "manic depression." Manic depression refers to the observation that individuals with this illness have episodes of both depression and mania - or hypomania - which are two states of elevated mood. Depression, when we use it in the diagnosis of major depression, refers to an illness where you only have episodes of depression, rather than the mania experienced by bipolar sufferers.

What are the different kinds of bipolar disorder?

Bipolar disorder comes in a variety of different forms and they're categorized based on the characteristics of the mood episodes. Bipolar I disorder refers to a pattern where you have major depression and also periods of mania. Bipolar II disorder refers to a pattern where you have depression and only episodes of hypomania. You could consider bipolar II to be a milder version of bipolar I. There are other variations of bipolar disorder, such as rapid cycling bipolar disorder - which is characterized by rapid switches between depression and mania or hypomania - and mixed states - where a person manifests characteristics of depression, but also shows some signs of mania or hypomania at the same time, such as irritability and pressured speech.

What are the symptoms of bipolar disorder?

In bipolar disorder, typical symptoms of mania (one of the mood episodes in bipolar disorder) include grandiosity, or a feeling of greatly inflated self esteem and power. People will also have increased rate of speech, which we call pressured speech. There is often irritability and impulsiveness. Patients that are manic typically have a preoccupation with pleasurable activities, so it's not unusual to see people going to Vegas to engage in gambling, and you can often see increased sexual activity. Other symptoms include decreased sleep; patients can go for days without sleep. As the episode worsens they have impaired judgment, and typically will have run-ins with the law due to their behaviour. They also exhibit something we call flight of ideas, in which their ideas are very loosely connected, sometimes to the point where it's difficult to follow their train of thought.

What are the most common causes of bipolar disorder?

We really don't understand what the causes of bipolar disorder are. Certainly there is evidence for a genetic predisposition but, beyond that, it's very difficult to predict who might develop bipolar disorder.

What are the most common dangers associated with bipolar disorder?

Similarly to depression, the incidence of suicide by bipolar disorder sufferers is very high. Approximately 1 to 15 percent of bipolar patients will commit suicide over their lifetime. Bipolar disorder is associated with a number of other dangers. These dangers include problems with the legal system due to poor judgment during manic episodes. Also, bipolar patients on spending sprees during mania can incur significant financial losses that can impact their life in the future. There is a danger of considerable social disruption through divorce and loss of children because of bipolar disorder.

How will a psychiatrist determine whether I suffer from bipolar disorder?

Making a diagnosis of bipolar disorder primarily stems from a psychiatric interview and an assessment of a patient's history. History is especially important in bipolar disorder because it's the pattern of mood episodes that is primarily considered. There aren't specific tests, but sometimes psychiatrists will use instruments such as rating scales to assist them in systematically evaluating various symptoms of depression or mania.

What are the common treatments for bipolar disorder?

The primary treatment for bipolar disorder is pharmacotherapy. Patients with bipolar disorder typically are treated with a mood stabilizer such as lithium, depakote, or other anticonvulsants. More recently, psychiatrists have found that some of the atypical antipsychotics are useful for treating episodes of mania and even depression, and preventing future episodes of mania or depression. Patients with bipolar disorder will often also benefit from some sort of psychotherapy. Inevitably, their illnesses cause some sort of wake of destruction in their social or interpersonal lives which can then come back to bother them in terms of guilt and feelings of loss. These things are amenable to treatment from various psychotherapy techniques. It's also very important in bipolar disorder to educate the patient about their disease. This is important because a patient needs to be able to recognize the onset of a mood episode so it doesn't progress to the point of impairing their ability to function. Another factor to consider in the treatment of bipolar disorder is that as the illness progresses, it's not uncommon to find that we need more than one medication to achieve our treatment goals. This typically would be a combination of anticonvulsant, or antidepressant or a combination with an antipsychotic medication.

Is there anything I can do to avoid developing bipolar disorder?

There aren't any known ways to prevent bipolar disorder from developing. We understand it to be a significantly inheritable illness. However, there is some evidence that controlling the illness early on can have benefits later in life. The natural course of bipolar disorder is that as a person ages, the episodes become more severe and they become more frequent. There is some evidence to suggest that this progression can be modified if the disease is treated aggressively early on.