The Facts.
Nature of the illness
Bipolar I
Bipolar II
Cyclothymia
Bipolar NOS
Causes
Symptoms
Depressive episodes
Treatment
Medical interventions
Psychosocial interventions
Alternative Treatment
- mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows
- alternating episodes of mania (euphoric state) and depression
- manic-depressive afflicts about 3 million people in the U.S. and costs over $45 billion annually
- more common in women than men
- average age of onset: adolescence through early twenties
- correct diagnoses can take years
- There are 4 types of bipolar disorder:
- Bipolar I
- Bipolar II
- Cyclothymia
- Bipolar not otherwise specified (NOS)
Bipolar I
- characterized by manic episodes
- during one's manic cycle they often feel self-importance, elation, talkativeness, increased sociability, desire for goal-oriented activities, irritability, impatience, impulsiveness, hyperactivity, decreased need for sleep
- manic period is normally followed by depression period, although some do not experience a major depressive episode
- mixed states (both manic or hypomanic symptoms and depressive symptoms occur at the same time) are common in bipolar I; for example: depression with racing thoughts of mania
- dysphoric mania also common (mania characterized by anger and irritability)
- 20% of patients have rapid cycling--manic & depressive episodes alternate frequently (at least 4 times a year to reach diagnosis)
- in some cases ultra-rapid cycling--alternate between manic and depressive several times within the span of one day (hard to distinguish from mixed states)
- some patients experience episodes alternating with seasonal changes
Bipolar II
- characterized by major depressive episodes alternating with hypomania (milder form of mania)
- difficult to distinguish bipolar depression from unipolar depression
- bipolar depression includes: extremely low energy, retarded physical and mental processes, fatigue
- rapid cycling or ultra-rapid cycling may occur
Cyclothymia
- alternating hypomanic episodes with less severe depression (does not reach major depression)
- 33% of patients develop bipolar I or II later in life
Bipolar NOS
- does not clearly fit into bipolar I, II, or cyclothymia categories
Causes
- no clear cause
- 66% of bipolar patients have family history of emotional disorders
- identical twins have an 80% concordance rate
- studies show autosomal (any chromosome besides sex chromosomes) dominant inheritance from parent to child--either affected parent has 50% chance (disregarding gender) of having a child with disorder
- studies show specific chromosomes in specific regions of chromosomes 13, 18, 21 are susceptible to mutated gene
- studies show certain nucleotide repeat is observed with bipolar II on chromosome 18
- possible cause is excessive calcium buildup in cells
- dopamine and other neurotransmitters seem to be involved with bipolar disorder
- over 50% of patients have history of substance abuse (high association rate between cocaine abuse and bipolar)
Symptoms
Depressive episodes
- low energy levels
- feelings of despair
- difficulty concentrating
- extreme fatigue
- slowed mental and physical capabilities
- euphoric episodes
- lack of inhibitions
- racing thoughts
- decreased need for sleep
- talkativeness
- risk taking
- irritability
- hallucinations or grandiose delusions
Treatment
Medical interventions
- mood stabilizing agents--lithium, carbamazepine, valproic acid (valproate)
- antidepressants (normally for short-term use)--fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), tranylcypromine (Parnate), phenelzine (Nardil), bupropion (Wellbutrin)
- adjunct treatments--clonazepam (Klonapin), alprazolam (Xanax), chlorpromazine (Thorazine), haloperidol (Haldol), ECT (electroconvulsive therapy)
- antipsychotics--clozapine (Clozaril), risperidone (Risperdal)
- anticonvulsant--gabapentin
- rTMS (repeated transcranial magnetic stimulation)
Psychosocial interventions
- psychotherapy--cognitive-behavioral therapy
- social support
- support groups
Alternative Treatment
- maintaining calm environment
- avoiding over-stimulation
- sleeping
- regular exercise
- proper diet
- biofeedback