Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and their ability to function. It is an illness that affects thoughts, feelings, perceptions and behavior and is distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. It can cause dramatic mood swings from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between.

Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from several days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most scientists now agree that there isn't a single cause for bipolar disorder rather, many factors act together to produce the illness.

It is classified according to symptom severity as Bipolar Disorder I, Bipolar Disorder II, and Cyclothymic Disorder. Bipolar Disorder Type I is usually characterized by at least one manic episode, with or without major depression. It involves episodes of severe mood swings,from mania to depression and is the classic manic-depressive form of the illness as well as the most severe type.

Bipolar II disorder is usually a milder form, involving milder episodes of hypomania that alternate with depression. Some people never develop severe mania but instead experience milder episodes of hypomania that alternate with depression.

When four or more episodes of illness occur within a 12-month period, a person has rapid-cycling bipolar disorder.

Bipolar disorder will typically develop in late adolescence or early adulthood. In children or teens it can be difficult to distinguish from other problems such as attention-deficit hyperactivity disorder (ADHD), conduct disorder, oppositional defiant disorder, and depression. It can also manifests in late life as well. Bipolar disorder may appear to be a problem other than mental illness - alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships for instance.

Bipolar disorder affects more than one in forty American adults and affects men and women equally. Bipolar disorder often runs in families, and recent studies suggest a genetic component to the illness.

Different from the normal ups and downs that everyone can go through, the symptoms of bipolar disorder are severe. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives. Most people can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Between episodes, many people with are free of symptoms, but as much as one-third of people have some residual symptoms.

Treatment, in disabling bipolar disorder, is with mood stabilizers (classically, the lithium salts) that balance the manic and depressive states experienced by patients. Treatment and maintenance of this disorder is necessary throughout a person's life once bipolar disorder has been diagnosed. Treatments may include medication, talk therapy, and/or support groups.

The following medications may be used to treat bipolar disorder (many patients are treated with a combination of two or more of these medications):

Lithium

A mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)

Valproate (Depakote), carbamazepine (Tegretol), lamotrigine, topiramate

Antiseizure medications, also used as mood stabilizers instead or in combination with lithium.

Benzodiazepines, clonazepam (Klonopin) or lorazepam (Ativan)

Can be used to treat agitation or insomnia.

Zolpidem (Ambien)

Used to treat insomnia.

Antidepressants

Serotonin reuptake inhibitors or bupropion (Wellbutrin) can be used to treat depression.

Antipsychotic medications

Uused for acute manic or mixed episodes and maintenance treatment.

Classic antipsychotic medications (eg, haloperidol (Haldol)) are not often used because of risks of tardive dyskinesia (uncontrollable movements).

Atypical antipsychotic medications (eg, risperidone, olanzapine, aripiprazole, zisprasidone, and quetiapine) are more effective with less risk of tardive dyskinesia Treatment may need to be continued for prolonged periods or indefinitely, depending on the pattern of the illness, to prevent significant mood swings.

Treatment of depression may also include support groups, talk therapy or other strategies that you and your health care provider may want to try. Treatment should not be postponed, however, because of the risk of suicide and school failure.

Bipolar disorder is also known as manic depression. Bipolar disorder is a psychological disorder that effects a person's mood. The mood swings are very extreme with a manic (high elation) phase and a very deep depressive phase. There is estimated to effect approximately 1% of the adult population. There is also evidence that shows that neither men nor women have a greater chance of suffering from bipolar disorder than the other. Bipolar is the third most common disorder after major depression and dysthymic disorder (a mild but persistent form of depression). Because of the extreme psychological disturbances caused by bipolar disorder, it can destroy lives. Alcohol and drug problems are often present in sufferers and without proper medication and care, it leads to 20% of sufferers committing suicide.

Many people experience a depressive phase most of the time, while only experiencing very few manic episodes. It is the swing between moods that people find hardest to deal with. Although no one would care to feel deeply depressed.

There is no cure for bipolar disorder and it is a life-long condition that often needs to be controlled with medication. Lithium is used to help control mania phases of people who suffer from bipolar disorder. Bipolar often begins in adolescence or early adulthood, and continues throughout life. Bipolar disorder is very seldom diagnosed in people who are 40 years old and above.

Types of Phases

Although it is generally accepted that bipolar disorder alternates the sufferers mood between mania and depression, the American Psychiatric Association has identified four different moods that are experienced in varying degrees of intensity and length, or not at all.

Depression - typical depression from a lack of motivation or interest in anything including eating to thoughts and attempts at suicide.

Mania - often begins with an elated or euphoric feeling. can also cause a sufferer to feel angry and irritable.

Hypomania - a milder form of mania where the person feels good and feels they are becoming more productive with their life.

Mixed mood - a mixed episode is characterised by experiencing feelings of mania and depression all in the same day.

Symptoms of Bipolar Disorder

Bipolar disorder symptoms are disturbances or abnormality of moods with the sufferer alternating between a manic phase and a depressive phase repetitively.

Depressive Phase Symptoms
Very deep negative moods often with thoughts or attempts at suicide.
Eating disorders.
No interest in activities enjoyed in the past.
None or very little interest in sex.
No self esteem.
Sleeping problems high an low.
Feeling guilty.

Manic Phase Symptoms
Excessive high or euphoric feelings along with many grand or over-ambitious ideas or plans.
Excessive amounts of energy.
Unnaturally high self-esteem and self-belief.
Increased sex drive which may lead to promiscuity and aggressive sexual behaviour.
Extreme irritability and easily distracted.
Alcohol and drug abuse, usually cocaine and sleeping medication.
Little need for sleep.
Manic phase lasts at least one week.

You're happy! You've never been happier! You feel full of life! You're so up, you haven't even been able to sleep for two days! You're on a natural high! And then the crash happens. And you never know why.

People with bipolar disorder live in a world of extremes. If you know someone with bipolar disorder, it might seem like they have multiple personalities. Co-workers, family members, or significant others may feel dizzy trying to keep up. What did you say now? She's so angry that she won't even talk to you! Wait, now she's back; she's crying and depressed and needs you for emotional support. You come back to check the next day, only to find her giddy with joy; she's burned through two credit cards buying home decorating supplies and she is now up at 2 AM wallpapering her bedroom. You keep waiting for it to make sense, but the mysteries only get deeper. Where's the happy medium?

And that's just the problem: there is none. In earlier times we might have misdiagnosed a bipolar sufferer as schizophrenic, just plain depressed, paranoid, delusional, or even drug-addicted. It has only been in recent decades that we have gotten to understand this exotic disease. It is no accident that bipolar disorder can be misdiagnosed as other diseases, because at times its symptoms are indistinguishable from many other disorders. Bipolars also show a marked tendency to abuse drugs, perhaps in an attempt to stabilize themselves or to try to lengthen their manic phases.

Bipolars often resist treatment, because they feel so good in their manic phase. In fact, their life is much sadder than they themselves may realize. Bipolars sink into a bottomless depression and may consider and act on suicidal impulses or deliberately harm themselves through cutting the skin. Bipolars wreck their lives, both in desperation during low times and in over-confidence during high times. In addition, a sufferer in manic phase may even become irritable or fly into a rage; the mind's way of showing that even too much of an up feeling is... too much!

The good news about bipolar disorder is that it is especially responsive to medication. Unlike many psychological disorders for which treatments for only some of the symptoms exist, bipolar disorder virtually vanishes under a regular dosage of the proper medication. The toughest part is in keeping the patient treated. Those afflicted are likely to put any rationalization to their behavior, and even after treatment may stop taking their medication during times of stress, simply because they miss the high of the manic phase.

Famous bipolar cases, some diagnosed only retroactively, include Lord Byron, Kurt Cobain, Patty Duke, Carrie Fischer, F. Scott Fitzgerald (but he had everything!), Ernest Hemingway, Marilyn Monroe, Ozzy Osborne, Axl Rose, and Vincent van Gogh.

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease.

Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment. However, they are unable to prescribe any medications that might become necessary.

Help can be found at:
· University or medical school-affiliated programs
· Hospital departments of psychiatry
· Private psychiatric offices and clinics
· Health maintenance organizations (HMOs)
· Offices of family physicians and internists
· Public community mental health centers

People with bipolar disorder may need help to get help.

Often people with bipolar illness do not realize how impaired they are, or they blame their problems on some cause other than mental illness.

A person with bipolar disorder may need strong encouragement and support from family and friends to seek treatment.

Family physicians can play an important role in providing referral to a mental health professional.

Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.

A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized involuntarily.

Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.

In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.

Like other serious illnesses, bipolar is also hard on spouses, family members, friends, and employers. Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.

Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations.

For contact information, see the following websites:
www.ndmda.org
www.nami.org
www.nmha.org

Bipolar disorder, once known as manic depression, is an illness where the sufferer alternatively experiences both extreme joy and terrible desolation. Medication and therapy are generally used to stabilize the condition.

Sufferers are often detached, introverted, and emotionally sensitive even though during the manic phase their behaviour takes on a very extroverted form. In some cases the condition may have a fanatical or religious element.

This is a severe mental disturbance and an affective psychosis. It is sometimes referred as bipolar disorder psychosis. Sometimes a sufferer tries to hide emotions such as anxiety or shyness and, in so doing, he or she becomes carried away with their feelings.

Bipolar disorder does not appear to be caused by stress itself but can be affected by outside tensions or abnormal attitudes in their upbringing. It is thought that these things may stimulate the area of the brain which produces chemicals, thus creating the mood swings experienced in bipolar disorder.

The cause of bipolar disorder remains inconclusive but it is thought that a deficiency in the hormonal means that regulate the balance of emotions may be a contributing factor. The brain produces two chemicals that regulate mood and these are serotonin and norepinephrine. Serotonin, if insufficient, may cause general mood instabilities. Norepinephrine, if in low supply, can cause depression. If it is excessive, it can produce mania.

There are two forms of mania associated with bipolar disorder. These are hypomania and hypermania. Hypomania is the form of mania when it is not excessive and hypermania refers to the mania when it is very extreme – when the patient is in a highly frantic and euphoric state. Usually, when a patient is in a manic state, they talk excessively and at high speed. They flit from one subject to another and become very easily distracted. In extreme cases, the patient may experience delusions and hallucinations or act violently. They may also become confused and disoriented.

As well as manic periods, the patient may go into a severe depressive state. This is characterized by fatigue, despondency, and extreme sadness. When the depression is at its most severe, the patient may become silent and motionless. One of the real risks during this stage is that of suicide.

Manic and depressive moods often arise without warning and last for some time- even weeks or months if no treatment is given. Living with someone in either the manic or depressive stage is not easy although they are usually not dangerous to others. However, they may become a danger to themselves if not treated.

Conventional drug therapy for bipolar disorder is generally used to help with both the depression and the manic episodes. Tricyclic antidepressants control the depressive states and sedatives and tranquilizers control the manic occurrences. Lithium carbonate is commonly used as it stabilizes both of the mood swings.

Bipolar disorder is still very much a mystery but people who suffer from the disease have learned to recognize the early signs of mood swings. This helps them to cope by taking the necessary medication or other actions. This helps them to lead relatively normal lives.

Copyright 2006 Anne Wolski

As an addition to medication, psychosocial treatments-including certain forms of psychotherapy (or "talk" therapy) are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disease include: cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. National Institute of Mental Health researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.

Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.

Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.

Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.

As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments For Bipolar

In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or serious suicidal thoughts, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky.

ECT is said to be a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.

Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications. In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.

Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease.

Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment. However, they are unable to prescribe any medications that might become necessary.

Help can be found at:
· University or medical school-affiliated programs
· Hospital departments of psychiatry
· Private psychiatric offices and clinics
· Health maintenance organizations (HMOs)
· Offices of family physicians and internists
· Public community mental health centers

People with bipolar disorder may need help to get help.

Often people with bipolar illness do not realize how impaired they are, or they blame their problems on some cause other than mental illness.

A person with bipolar disorder may need strong encouragement and support from family and friends to seek treatment.

Family physicians can play an important role in providing referral to a mental health professional.

Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.

A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized involuntarily.

Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.

In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.

Like other serious illnesses, bipolar is also hard on spouses, family members, friends, and employers. Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.

Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations.

For contact information, see the following websites:
www.ndmda.org
www.nami.org
www.nmha.org

Bipolar disorder is the medical name for manic-depressive illness and doesn't just effect sufferers but can have a serious effect on family members and friends. Early diagnosis can be a big factor in the effective combating or this serious mental illness and without diagnosis it can become much more serious possibly leading to suicide. Bipolar disorder effects over 2 million American adults every year so it is by no means a rare disorder and doctors and psychiatrists alike are on hand to help you or your family member or friend through it. If you think someone you know is suffering from bipolar disorder the best thing you can do for them is to take them to see their doctor.

1- Long term preventative treatment is likely to be required because bipolar disorder is a recurrent illness. Stopping the medication or psychological treatment received can cause a regression to the mood swings associated with the disease.

2- If you or someone you know has a bipolar disease then it is recommended that you see a psychiatrist and not your general physician although your GP can refer you to a specialist in the field that will be in the best position to offer you the help, support and information you need to beat it.

3- There are medications known as mood stabilizers available and a person who suffers from bipolar disorder is likely to be prescribed these by their psychiatrist. They will normally have to take these for the rest of their lives because bipolar disease is recurrent. Sometimes other drugs are combined with mood stabilizers but this will probably only be over a short period of time.

4- Therapy should be combined with medication and can be attended in one on one sessions or at group therapy classes. by talking to somebody who understands the patient's problems the support can often lead to a very desirable outcome. Consult your psychiatrist about where to go to attend these group talks.

5- Always be prepared for the worst. Don't forget that bipolar disease will mean constant ups and downs and many patients try to commit suicide because they see it as their only way out. Be prepared and always be ready to call 911 if you think this is going to be the case. Don't be afraid that you will be wasting their time if your family member or friend is just having a down day because if you don't ring the consequences could be a lot worse.

What is Bipolar Depression?

The distinguishing characteristic of bipolar depression, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar depression has a unique pattern of mood cycles, combining depression and manic episodes, which is specific to that individual, but predictable once the pattern is identified. Research studies suggest a strong genetic influence in bipolar depression.

Bipolar depression typically begins in adolescence or early adulthood and continues throughout life. Bipolar depression is often not recognized as a psychological problem, because it is episodic. Consequently, those who have bipolar depression may suffer needlessly for years without treatment.

Treatment for Bipolar Depression

Effective treatment is available for bipolar depression. Without treatment, marital breakups, job loss, alcohol and drug abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance with treatment. Most individuals with bipolar depression do not perceive their manic episodes as needing treatment, and they resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode, and do not want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many individuals with bipolar depression abuse drugs or alcohol during manic episodes, and some of these develop secondary substance abuse problems. Therefore, it is advisable to treat Bipolar Depression at its early stage

How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.

The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.

Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.

These drugs are relatively safe but they don’t come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.

For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.

What is the treatment for bipolar depression? In general, the mood stabilizers’ dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a “therapeutic level.” If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.

If these measures don’t help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.

When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.

Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug’s indication, side effects, and prognosis with or without treatment is a must.

Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won’t suffice to address financial problems, marital conflict, work issues, and prior abuse.

In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.