What Is Bipolar Disorder?
Bipolar disorder, previously known as manic depression, is a serious,
double-edged mental illness. In contrast to the sustained bleakness of
generalized depression (technically described as unipolar disorder), bipolar
disorder is characterized by cyclical swings between elation and despair.
The pattern of the mood alternations varies widely among sufferers. In some
people, years of normal functioning can separate manic and depressive
episodes. In others, the episodes cycle frequently, three or four times a
year, with respites between. For some people, depression and mania cycle
continuously and sometimes rapidly. There are also people who experience
mixed episodes, in which mania and depression occur together or alternate
rapidly within a brief period of time. And for a rare few, an episode of
bipolar disorder may occur only once in a lifetime. (If it occurs twice, it
is usually followed by other episodes.) Generally, the depressive phase
lasts longer than the manic phase, and it also tends to be more frequent;
the cycle can be erratic.
Bipolar disorder is known to afflict about 1% of the U.S. population,
although its frequency may be much higher because almost 75% of cases go
untreated. Men and women are equally susceptible. Much evidence suggests
that the illness has a genetic basis, but its origins are still uncertain.
The symptoms result from chemical imbalances in the brain, and they lie
beyond voluntary control. The disorder is not only life-disrupting but can
also be dangerous: About 20% of people with bipolar disorder commit suicide,
usually when they are passing from one phase to another and feel
disoriented. Some 11% of sufferers take this drastic action in the first
decade after diagnosis.
Fortunately, great strides have recently been made in treating this illness;
in most cases, the symptoms can be controlled effectively by medication and
other therapies.
The disorder occurs in two main forms, known as bipolar I and bipolar II;
they may have separate genetic origins. In bipolar I, both phases of the
illness are apt to be very pronounced. In bipolar II, mania is often mild
(it is termed hypomania), and the depression can be either mild or severe.
Bipolar II is more difficult to diagnose and is often mistaken for
generalized depression. It has fewer and shorter periods of remission than
bipolar I, tends to run in families, and is somewhat less responsive to
treatment. It may be the more common form of bipolar disorder.
The illness is sometimes linked to seasonal affective disorder, with
depression occurring in late fall or winter, giving way to remission in the
spring, and progressing to mania or hypomania in the summer.
About one case of bipolar disorder in five begins in late childhood or
adolescence; adolescents are more likely than adults to have physical and
psychotic symptoms, such as hallucinations and delusions, and they are more
apt to be misdiagnosed. Usually, however, the illness strikes young adults
between the ages of 25 and 35. The first episode in males is likely to be
manic; the first episode in females, depressive -- and frequently, a woman
will experience several episodes of depression before a manic episode
occurs. As patients grow older, recurrences of either bipolar I or bipolar
II tend to come more frequently and last longer.
Bipolar disorder is thought to result from chemical imbalances in the brain,
caused by a defective gene or genes. Among the brain chemicals possibly
involved are serotonin and norepinephrine, but the chemical interaction in
bipolar disorder is complex and not yet completely understood. The
likelihood that genes play a role is supported by the fact that usually
there is some family history of mood swings, depressive illness, or suicide.
---------------------------------------------------------
What Are the Symptoms?
Dramatic and unpredictable mood swings are the primary sign of bipolar
disorder. The illness has two strongly contrasting phases.
In the manic phase:
a.. Euphoria or irritability
b.. Excessive talk; racing thoughts
c.. Inflated self-esteem
d.. Unusual energy; less need for sleep
e.. Impulsiveness, a reckless pursuit of gratification -- shopping sprees,
impetuous travel, more and sometimes promiscuous sex, high-risk business
investments, fast driving
f.. Hallucinations
In the depressive phase:
a.. Depressed mood and low self-esteem
b.. Low energy levels and apathy
c.. Sadness, loneliness, helplessness, guilt
d.. Slow speech, fatigue, and poor coordination
e.. Insomnia or oversleeping
f.. Suicidal thoughts and feelings
g.. Poor concentration
h.. Lack of interest or pleasure in usual activities
Call Your Doctor If:
a.. You notice some of these symptoms in a family member. Note: Persons
with bipolar disorder often deny anything is wrong, especially in the manic
phase. If you are worried about a family member or close friend, a doctor
can offer advice on how to handle the situation.
b.. You notice some of these symptoms in yourself.
Because of the stigma still attached to bipolar disorder (and to many other
mental diseases), patients are frequently reluctant to acknowledge that
anything is amiss, and doctors often fail to recognize the disorder. In
addition, the symptoms may sometimes seem to be merely exaggerated versions
of normal moods. In any event, research suggests that almost 75% of cases go
untreated or are treated inappropriately.
The American Psychiatric Association has established a long list of specific
criteria for recognizing the disorder. Evaluation involves investigating the
patient's history and any family history of mood swings or suicide. Other
disorders must be ruled out -- particularly such childhood problems as
school phobia and attention deficit disorder, as well as dementia,
schizophrenia, and psychotic states induced solely by alcohol or drugs. Drug
or alcohol abuse is common in persons with bipolar disorder and can mask the
symptoms, thus complicating diagnosis and treatment. Recognizing and
treating any drug abuse is a priority, since it is a strong predictor of
suicide, especially in men.
Before treatment begins, the patient receives a careful physical exam, and
blood and urine are tested to detect conditions that could put medical
constraints on the choice of treatment. A thyroid analysis is particularly
important both because hyperthyroidism can look like mania and because
lithium -- the principal drug treatment for bipolar disorder -- is known to
lower thyroid function. During treatment, frequent blood tests are necessary
to see that adequate drug levels have been reached and to detect adverse
reactions at an early stage.
---------------------------------------------------------
What Are the Treatments?
At present, bipolar disorder is treated most often with a combination of a
mood-stabilizing drug and psychotherapy. The main mood-stabilizing drugs
used for the treatment of bipolar disorder include lithium carbonate,
valproic acid (also known as Depakote) and carbamazepine (Tegretol). While
drug treatment is primary, ongoing psychotherapy is important to help
patients understand and accept the personal and social disruptions of past
episodes and better cope with future ones. In addition, since denial is
often a problem, routine psychotherapy helps patients stay on their
medications. (Patient compliance is particularly tricky in adolescence.)
Almost all forms of psychotherapy can be used -- cognitive, behavioral, or
psychodynamic; individual, family, or group.
The family or spouse of a patient should be involved with any treatment.
Having full information about the disease and its manifestations is
important for both the patient and loved ones.
Lithium carbonate has historically been the principal drug used in treating
bipolar disorder; it can be remarkably effective in reducing mania, although
doctors still do not know why. Lithium may also prevent recurrence of
depression, but it is often given in conjunction with varying combinations
of antidepressants. Other mood stabilizers that have proved helpful in
treating the manic or mixed phases of the illness include Depakote and
carbamazepine. These drugs may be used alone or in combination with lithium
to control symptoms. In addition, newer drugs are coming into the picture
when traditional medications are insufficient. Neurontin and Lamictal are
two of these newer choices and may be used in treatment-resistant cases.
When the depressive phase of bipolar disorder occurs, an antidepressant
often needs to be used along with a mood stabilizer. The newly developed
selective serotonin reuptake inhibitors (SSRIs) -- specific to the brain
chemical serotonin -- are often the antidepressants of choice because they
have fewer side effects than older drugs. Among the SSRIs are Paxil, Prozac,
and Zoloft. Other antidepressants include the tricyclics -- such as
desipramine, imipramine, and amitriptyline. Wellbutrin is similar to SSRIs
but in a different class of drugs. Newer antidepressants include Effexor,
Serzone, and Remeron. In general, your doctor may try to keep the use of
antidepressants limited and brief if possible, since prolonged used may
actually trigger a manic episode or cause cycles to be more rapid.
Haloperidol or other antipsychotic medications may sometimes be given to
patients who fail to respond to lithium, or to treat acute symptoms of mania
before lithium can take effect (seven to 10 days).
Many of these drugs can be toxic and should be closely monitored through
blood tests to see that adequate levels have been reached and to detect any
bad reactions early on. When beginning treatment, the psychiatrist will need
to experiment with medications. It is almost impossible to predict which
patient will react to what drug or what the dosage should be.
Electroconvulsive therapy (ECT) is sometimes used for severely manic or
depressed patients and for those who don't respond to medication. Because it
acts quickly, it can also help patients who are considered to be at high
risk for committing suicide. ECT fell out of favor in the 1960s, but the
procedure has been greatly refined since then. The patient is first
anesthetized. Then an electric current is passed through the brain to
produce a grand mal seizure of short duration -- no more than a few seconds.
During the course of ECT treatments -- usually two to three weeks -- lithium
is discontinued to prevent possible nerve or brain problems.
Light therapy has proved effective as an additional treatment when bipolar
disorder has a connection to winter depression. For those people who usually
become depressed in winter, sitting for 20-30 minutes a day in front of a
special light box with a full-spectrum light can effectively treat their
depression.
At-Home Remedies
Maintain a calm environment, particularly when someone is in a manic phase.
Keep to regular routines for daily activities -- sleeping, eating, and
exercise. Adequate sleep is very important in preventing the onset of
episodes. Avoid excessive stimulation: Parties, animated conversation, and
long periods of watching television or videos can exacerbate manic symptoms.
IMPORTANT! Help and Support
In the manic phase, patients may engage in risky activities, such as fast
driving or certain sports; they should be monitored and prevented from
taking chances, especially in a car. Drinks and foods containing caffeine --
tea, coffee, cola, and chocolate -- should be eliminated in the manic phase.
Avoid alcohol at all times. It is very important for a patient experiencing
manic symptoms to receive prompt psychiatric assessment. Family members may
need to contact the doctor since, oftentimes, patients in a manic or
hypomanic episode have little insight into their illness and may refuse
treatment. But prompt intervention, including possible medication
adjustments at an early point in an episode, may prevent further problems
and the need for hospitalization.
---------------------------------------------------------
WARNING !
Oct. 15, 2004 -- Federal health officials are ordering makers of
antidepressants to use stark new warnings alerting doctors and consumers
that the medications increase the risk of suicidal thoughts and behaviors in
children and adolescents who take them.
To learn more , Click on the link below
http://my.webmd.com/content/Article/95/103293.htm?pagenumber=1
.
|
