Treatment of Bipolar Disorder: A Guide for Patients and ...

1 109 DECEMBER 2004A POSTGRADUATE MEDICINE SPECIAL REPORTTREATMENT OFBIPOLARDISORDER2004 Bipolar disorder (also known as manic-depressive illness) is asevere biological disorder that affects slightly more than 1% of theadult population (more than million people in the UnitedStates). Although symptoms and severity vary, Bipolar disorderalmost always has a powerful impact on those who have the illnessand on their family, partners, and friends. If you or someone youcare about has been diagnosed with Bipolar disorder, you proba-bly have many questions about the illness, its causes, and treat-ments that are available.

2 This Guide is intended to answercommonly asked questions about Bipolar disorder. The treatmentinformation given here is based on research findings and a recentsurvey of approximately 50 leading experts on Bipolar disorder.*WHAT ISBIPOLARDISORDER?As human beings, we all experience a variety of moods hap-piness, sadness, anger, to name a few. Unpleasant moods andchanges in mood are normal reactions to everyday life, and we canoften identify events that caused our mood to change. However,when we experience mood changes or extremes that are out ofproportion to events or come out of the blue and make it hardto function, these changes may be due to a mood disorder.

3 Mooddisordersare medical illnesses that affect our moods and how wefeel. There are 2 main types of mood disorders . In unipolar(1pole) disorders , such as major depressive disorder, the moodchanges all involve a lowering of mood. In Bipolar (2 pole) disor-ders, at least some of the changes involve an excessive elevation inmood. All mood disorders are associated with changes in brainchemistry. They are not the fault of the person suffering fromthem. Mood disorders are treatable medical illnesses for whichthere are specific interventions that is the diagnosis made?

4 Although Bipolar disorder is a biological disease, there are nolaboratory tests or other procedures a clinician can use to make afirm diagnosis. Instead, the clinician makes the diagnosis based ona group of symptoms that occur together. To make an accuratediagnosis, the clinician needs to take a careful history from theperson who is ill and, if possible, from family members. The clin-ician will want to know about symptoms the person is currentlyhaving as well as any symptoms he or she had in the are the symptoms of Bipolar disorder?

5 Bipolar disorder is a disease in which mood changes in different times, the person experiences periods of elevatedmood, periods of depressed mood, and times when mood is nor-mal. Four kinds of mood episodes can occur in Bipolar Disorder: Mania (manic episode).Mania often begins with a pleasurablesense of heightened energy, creativity, and social ease. However,these feelings quickly progress to full-blown euphoria (extremelyelevated mood) or severe irritability. People with mania typicallylack insight they often deny anything is wrong and may angrilyblame anyone who points out a problem.

6 In a full manic episode,the following symptoms are present for at least 1 week and makeit very hard for the person to function:Feeling unusually high, euphoric, or irritable Plus at least 3 of the following symptoms:Needing little sleep but having great amounts of energyTalking so fast that others cannot follow youHaving racing thoughtsBeing so easily distracted that your attention shifts betweenmany topics in just a few minutesHaving an inflated feeling of power, greatness, or importanceDoing reckless things without concern about possible bad con-sequences ( , spending too much money, inappropriate sex-ual activity, making foolish business investments)

7 In severe cases, the person may also have psychotic symptomssuch as hallucinations (hearing or seeing things that are not there)or delusions (firmly believing things that are not true).Hypomania (hypomanic episode).Hypomania is a milder formof mania that has similar but less severe symptoms and causesless impairment. During a hypomanic episode, the person mayhave an elevated mood, feel better than usual, and be more pro-ductive. These episodes often feel good and the person may notrecognize that anything is wrong. The desire to experience hypo-mania may even cause some people with Bipolar disorder to stoptheir medication.

8 However, hypomania can rarely be maintainedindefinitely, and it is often followed by an escalation to mania ora crash to (major depressive episode).In a major depressiveepisode, the following symptoms are present for at least 2 weeksand make it hard for the person to function:Feeling sad, blue, or down in the dumps or losing interest inthe things one normally enjoysPlus at least 4 of the following symptoms:Trouble sleeping or sleeping too muchLoss of appetite or eating too muchProblems concentrating or making decisionsFeeling slowed down or feeling too agitated to sit stillFeeling worthless or guilty or having very low self-esteemThoughts of suicide or deathSevere depressions may also include hallucinations or delusions.

9 Mixed the most disabling episodes are those thatinvolve symptoms of both mania and depression occurring at thesame time or alternating frequently during the day. The personfeels excitable or agitated but also irritable and are the different patterns of Bipolar disorder? People with Bipolar disorder vary in the types of episodes theyusually have and how often they become ill. Some people haveequal numbers of manic and depressive episodes; others haveTreatment of Bipolar Disorder: A Guide for Patients and FamiliesDavid A.

10 Kahn, , Paul E. Keck, Jr., , Roy H. Perlis, , Michael W. Otto, , Ruth Ross, *Published in a Postgraduate MedicineSpecial Report December Guide is adapted from Kahn DA, Ross R, Printz DJ, Sachs Med Special Report April 2000:97-104. An Adobe Acrobat fileof this Guide can be downloaded at POSTGRADUATE MEDICINE SPECIAL REPORTDECEMBER 2004 Expert Consensus Guideline Seriesmostly 1 type or the other. The average person with Bipolar dis-order has 4 episodes during the first 10 years of the illness. Whilea number of years can elapse between the first 2 or 3 episodes ofmania or depression, without Treatment most people eventuallyhave more frequent episodes.