Manic Depression

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Bipolar disorder
By Mayo Clinic staff

From high to low. From euphoria to depression. From recklessness to listlessness. These are the extremes associated with bipolar disorder, which can be a serious and disabling mental illness. The condition is also known as manic-depressive illness — from manias on the one extreme to depression on the other.

Bipolar disorder affects more than 2 million American adults, or about 1 percent of the population age 18 and older. It often begins in adolescence or early adulthood and may persist for life.

Its causes are elusive, and there's no cure. But it can be managed. Left untreated, the condition usually worsens. The flares of bipolar disorder may last for weeks or months, causing great disturbances in the lives of those affected, their friends and their families.

Signs and Symptoms
Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression). The intensity of the signs and symptoms varies. Bipolar disorder can range from a mild condition to a severe condition.

For many people, the manic signs and symptoms include:

Feelings of euphoria, extreme optimism and inflated self-esteem
Rapid speech, racing thoughts, agitation and increased physical activity
Poor judgment and recklessness
Difficulty sleeping
Tendency to be easily distracted
Inability to concentrate
Extreme irritability
In the depression phase, signs and symptoms include:

Persistent feelings of sadness, anxiety, guilt or hopelessness
Disturbances in sleep and appetite
Fatigue and loss of interest in your daily activities
Difficulty in concentrating
Recurring thoughts of suicide

Doctors and researchers don't know exactly what causes bipolar disorder. But a variety of biologic, genetic and environmental factors seem to be involved in causing and triggering episodes of the illness.

Evidence indicates that differences in the chemical messengers between nerve cells in the brain (neurotransmitters) occur in people who have bipolar disorder. In many cases people with bipolar disorder may have a genetic disposition for the disorder. The abnormality may be in genes that regulate neurotransmitters.

Factors that may contribute to or trigger episodes of bipolar disorder include drug abuse and stressful or psychologically traumatic events.

Risk Factors

Bipolar disorder tends to run in families. A family history appears to exist in about 60 percent of cases of bipolar disorder. Researchers are attempting to identify genes that may make people susceptible to bipolar disorder.

When to Seek Medical Advice

People with bipolar disorder often don't recognize how impaired they are when experiencing a mood episode and how greatly the disorder is affecting their lives and the lives of others. Friends, family and primary care physicians are important in recognizing possible signs of bipolar disorder and urging the person to seek professional help.

If a family member or friend shows the apparent signs of bipolar disorder, encourage that person to seek the care of a psychiatrist.
Screening and Diagnosis

Your doctor may ask you or a family member who has accompanied you about your signs and symptoms and to describe apparent episodes of mania and depression. Diagnosis also involves ruling out other mental health conditions that may produce some symptoms similar to bipolar disorder. These may include other mood disorders, sometimes schizophrenia, attention-deficit/hyperactivity disorder or borderline personality disorder.

You may also undergo tests to see if your mood swings are due to physical causes, such as:

Substance abuse. Abuse of alcohol, marijuana and cocaine may affect your moods.
Thyroid disorders. A blood test for thyroid function can determine whether you have a thyroid disorder, such as an underactive thyroid.
Your doctor may also ask about your use of medications, alcohol and recreational drugs, and your diet. Certain medications including corticosteroids, such as prednisone, and medications used to treat depression, anxiety and Parkinson's disease can cause mood swings. Abuse of alcohol and recreational drugs also can cause mood swings. As well, deficiency of vitamin B-12 may alter moods.

Bipolar disorder isn't as black-and-white as it may sound.

Other problems, such as anxiety disorder or alcoholism, may affect people with bipolar disorder. The length, severity and frequency of mood swings vary from person to person. In about 15 percent of people with bipolar disorder, there is rapid cycling, with more frequent and shorter periods of mood disturbance.

It's also possible for mania and depression to be present at the same time. In this mixed state, you may experience combinations of agitation, disturbances in sleep and appetite, suicidal thoughts and psychosis. Psychosis is a major mental disorder in which the personality is disorganized and contact with reality is impaired, often including auditory hallucinations and delusions — firmly held erroneous beliefs

Medication and psychotherapy are the main treatments. Occasionally, electroconvulsive therapy (ECT) also is used.

Medication. Most people with bipolar disorder take medication to regulate their moods. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer. In April 2002, the American Psychiatric Association suggested using lithium or lamotrigine (Lamictal) as first-line treatment for people in the acute depressive phase of bipolar disorder who were not already on a mood stabilizer medication. Also used widely as a mood regulator are the antiseizure medications valproic acid (Depakene) and divalproex (Depakote). Sometimes, doctors also use antidepressant medications to treat bipolar disorder. These may include paroxetine (Paxil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft) or bupropion (Wellbutrin, Zyban), among others. In other circumstances, doctors may use antipsychotic medications such as risperidone (Risperdal), olanzapine (Zyprexa) or quetiapine (Seroquel), among others. You may need to take medications for several weeks before they reach their full effect.
Psychotherapy. This approach is often used with medication. Your therapist will help you detect patterns leading up to episodes of bipolar disorder, trying to identify triggers for the episodes. These patterns might include your use of medications or anything that happens to you physically or emotionally. Psychotherapy helps provide strategies for managing stress and coping with uncertainties. This, along with basic education about the nature of the disorder, helps you understand why you may well need to keep taking medication over many years.
ECT. Doctors use this form of treatment mainly for episodes of major depression associated with suicidal tendencies or when using medication has proved to be ineffective. In this treatment, electrodes are taped to your head. Then, while you're anesthetized and after you've received a muscle relaxant, a small amount of electrical current is passed through your brain for less than a second. This current produces a brain seizure, but because of the muscle relaxant your body remains calm. ECT profoundly affects brain metabolism and blood flow to various areas of the brain. But how that correlates to easing depression remains unknown. ECT works quickly — usually showing a response after several treatments, generally within the first week — and significantly lowers the risks of untreated depression, including suicide.

Bipolar disorder isn't an illness that you can treat on your own. But you can do some things for yourself that will bolster your treatment program:

Take your medications. Even if you're feeling well, resist the temptation not to take your medications. If you stop, you may again encounter signs and symptoms of bipolar disorder.
Pay attention to warning signs. You and your caregivers may have identified a pattern to your episodes of bipolar disorder and what triggers them. Call your doctor if you feel you're facing an episode. Involve family members or friends in watching for warning signs.
Avoid drugs and alcohol. Drugs, especially stimulants including diet drugs, and alcohol may be part of what triggers episodes of bipolar disorder.
Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of bipolar disorder or may interact with medications you're taking for bipolar disorder.

Coping Skills
Self-help organizations have become potent allies for people who are coping with mental illness or who care about someone with such an illness. For bipolar disorder or other mental illnesses, self-help groups include the National Mental Health Association (NMHA) and the National Alliance for the Mentally Ill (NAMI).

The NMHA is based in Washington, D.C., and has hundreds of affiliates across the United States. The group educates the public and the policy makers about mental health issues. The association's online resources include discussion groups and screening for depression.

The NAMI provides support and education to people with severe mental illness and their families. Founded in 1979, the group has more than 1,200 state and local chapters. The chapters rely on volunteers, most of whom have had mental illness in their families.


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