Bipolar disorder

Definition

Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Alternative Names

Manic depression; Bipolar affective disorder

Causes, incidence, and risk factors

Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Bipolar disorder results from disturbances in the areas of the brain that regulate mood.

There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.

People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.

A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.

Symptoms

The manic phase may last from days to months and can include the following symptoms:

• Agitation or irritation
• Elevated mood
  • Hyperactivity
  • Increased energy
  • Lack of self-control
  • Racing thoughts
• Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
• Little need for sleep
• Over-involvement in activities
• Poor temper control
• Reckless behavior
  • Binge eating, drinking, and/or drug use
  • Impaired judgment
  • Sexual promiscuity
  • Spending sprees
• Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

• Difficulty concentrating, remembering, or making decisions
• Eating disturbances
  • Loss of appetite and weight loss
  • Overeating and weight gain
• Fatigue or listlessness
• Feelings of worthlessness, hopelessness and/or guilt
• Loss of self-esteem
• Persistent sadness
• Persistent thoughts of death
• Sleep disturbances
  • Excessive sleepiness
  • Inability to sleep
• Suicidal thoughts
• Withdrawal from activities that were once enjoyed
• Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.