Filed under: Boomer's Health
Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.
Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder can include:
Other signs and symptoms of bipolar disorder
Signs and symptoms of bipolar disorder can also include:
Symptoms in children and adolescents
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.
When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.
If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.
The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:
Factors that may increase the risk of developing bipolar disorder include:
Conditions that commonly occur with bipolar disorder
If you have bipolar disorder, you may also have another health condition that's diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder. They include:
Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
Your time with your doctor may be limited, so preparing a list of questions ahead of time will help you make the most of your time together. For problems related to bipolar disorder, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications. These can include:
Diagnostic criteria for bipolar disorder
To be diagnosed with bipolar disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. Diagnostic criteria for bipolar disorder are based on the specific type of bipolar disorder.
The DSM has very specific criteria for manic, hypomanic, major depressive and mixed episodes.
Criteria for a manic episode
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). During the period of disturbed mood, three or more of the following symptoms must be present (four if the mood is only irritable):
To be considered a manic episode:
Criteria for a hypomanic episode
A hypomanic episode is a distinct period of elevated, expansive or irritable mood that lasts at least four days, and is different from the usual nondepressed mood. During the period of disturbed mood, three or more of the following symptoms must be present (four if the mood is only irritable):
To be considered a hypomanic episode:
Criteria for a major depressive episode
To be diagnosed with a major depressive episode, you must have five (or more) of the following symptoms over a two-week period. At least one of the symptoms is either depressed mood or loss of interest or pleasure. Symptoms can be based on your own feelings or on the observations of someone else. They include:
To be considered a major depressive episode:
Criteria for mixed episode
Diagnosis in children
The same official criteria used to diagnose bipolar disorder in adults are used to diagnose children and adolescents. However, bipolar symptoms in children and adolescents often have different patterns than they do in adults, and may not fit neatly into the categories used for diagnosis. While adults generally tend to have distinct periods of mania and depression, children and adolescents may have erratic, rapid changes in mood, behavior and energy levels.
It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. To make it even more difficult, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.
Although bipolar disorder can occur in young children, diagnosis in children preschool age or younger is especially difficult. The current criteria used for diagnosis have not been proved in young children, and a wide range of issues other than bipolar disorder can cause mood and behavior problems at this age.
Bipolar disorder requires lifelong treatment, even during periods when you feel better. Treatment is usually guided by a psychiatrist skilled in treating the condition. You may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:
Finding the right medication
Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.
Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects.
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:
Transcranial magnetic stimulation
This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.
In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.
Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same types of medications as those used in adults. However, there's little research on the safety and effectiveness of bipolar medications in children, so treatment decisions are based on adult research. Treatments are generally decided on a case-by-case basis, depending on exact symptoms, medication side effects and other factors. As with adults, ECT may be an option for adolescents with severe bipolar I symptoms or for whom medications don't work.
Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy — along with working with teachers and school counselors — can help children develop coping skills, address learning difficulties and resolve social problems. It can also help strengthen family bonds and communication. Psychotherapy may also be necessary to resolve substance abuse problems, common in older children with bipolar disorder.
You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder, and to make sure you get the support you need from people in your life. Here are some steps to take:
Some alternative treatments may help, but there isn't much research on them. Most of the studies that do exist are on major depression, so it isn't clear how well most of these work for bipolar disorder.
Although some alternative medicine treatments can be a good addition to your regular treatment, take some precautions first:
Coping with bipolar disorder can be challenging. Here are some things that can help:
There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.
If you've been diagnosed with bipolar disorder, some strategies can help prevent minor episodes from becoming full-blown episodes of mania or depression:
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