Bipolar Disorder
(Manic Depressive Illness)
What
Is It?
According to some estimates, as
many as two and a half million Americans suffer from
manic depressive illness. Also called bipolar disorder,
this psychiatric illness involves episodes of euphoric
or elated moods, pressured and racing thoughts and
speech, and often uncontrolled, reckless behavior. While
a few people experience only manic episodes, most often
mania is experienced along with depressive episodes.
Two-thirds of those who suffer from bipolar illness have
numerous recurrences of alternating or cyclical phases;
others experience mixed states of simultaneous
depressive and manic symptoms. Some people experience
only small, occasional manic blips interrupting a more
constant hum of depression. For others, its a constant
up-and-down churning.
The milder, chronic form of
manic-depressive illness is called cyclothymic disorder.
It appears that cyclothymic disorder, in which there are
numerous brief periods of mania alternating with
numerous brief periods of depression, provides, for some
people, the temperamental foundation from which major
manic-depressive episodes spring.
When people are in the grips of
a euphoric episode, their behavior may seem a bit odd,
or, in some instances, completely bizarre. On the one
end, they may become increasingly involved in such
goal-oriented activities as sex, work, school or social
relations. On the other end, this behavior may have
problematic consequences; they may get involved in
gambling, unprotected or indiscreet sex, reckless
spending, irresponsible business or financial ventures.
Typically, during a manic phase, a person's appearance
changes abruptly: the style of dress may become more
sexually provocative or flamboyant, or disheveled and
slovenly.
Some people enjoy the
sensations and energy that accompanies manic episodes
and maintain that their success or particular genius
derives from it. While it is true that milder forms of
manic disorders can contribute to success in business or
the arts, recurrence of even the mildest mania can be
disruptive. An elated mood, for example, can lead to
impulsiveness and over-optimism concerning one's
abilities, which can lead to such unfortunate
consequences as a bad business venture or financial
investment, sexual indiscretions, or imprudent
expenditures.
Regardless of the different
symptomatic picture, mania is closely linked to
depression. Some of the symptoms -- irritability, anger,
insomnia, agitation, and tendency towards outbursts --
occur in both.
Like other mood disorders,
bipolar illness has a genetic component, and runs in
families. And like diabetes, hypertension, and cancer,
bipolar disorder is a complex disease with many causes
and variations. It is theorized that the presence of a
predisposing genetic foundation, coupled with something
in the environment -- a virus, a brain injury, a chaotic
family circumstance -- triggers the symptoms.
Symptoms
In manic-depressive illness, a
person usually experiences severe depressive symptoms
along with alternating or intermittent manic symptoms.
The manic phase of this illness includes:
· Euphoric
or expansive mood
· Unrealistic
or inflated self-esteem
· Feelings
of irritability, anger, agitation and impatience
· Decreased
need for sleep
· Increased
distractibility and talkativeness
· Rapid
and pressured speech
· Hyperactivity
and agitation
· Frenetic,
frantic activity.
What
The Doctor Looks For
A pattern of depressive
symptoms alternating with periods of manic symptoms:
loud, racing speech that is hard to follow and
interpret; attention that shifts from one focus to
another; inability to complete tasks before going on to
others; a tendency to pace, and to hold more than one
conversation at a time; poor judgment and unwarranted
optimism; grandiosity; tendency towards anger outbursts.
Treatment
Most psychiatrists treat
bipolar disorder as an chronic illness that needs to be
managed and controlled. At this time, it is not possible
to eradicate or cure the disease. However, treatment
that combines the drug lithium with psychotherapy can be
relatively effective in bring manic-depressive illness
under control or into remission.
Lithium, a natural salt, evens
out the highs and lows of the mood disorder. When it is
prescribed, lithium addresses current manic and
depressive symptoms, and, in the vast majority of
individuals, reduces the frequency and severity of
subsequent manic episodes.
Lithium requires regular
monitoring. Right after it is initially prescribed, your
psychiatrist will want to watch your response; if it
seems that the medication is not working optimally, she
may want to add another medication or adjust the dosage.
Monitoring entails assessing
levels of lithium within the blood. Lithium can suppress
thyroid functioning. In addition, dehydration can cause
lithium to concentrate dangerously within the blood.
During the summer months or if you are involved in
strenuous activity, you may experience unpleasant
side-effects. Both of these conditions can be checked
with blood tests. Thyroid problems can be addressed with
a synthetic hormone.
Other potential side-effects
include hand tremors, increased thirst, the need to
urinate frequently, acne, weight gain. In most cases,
these represent only slight nuisances. Almost always,
the benefits of the medication outweigh the problems.
With some individuals, Lithium is not effective.
Carbamazepine (Tegretol) or valproic acid (Depakote),
both anticonvulsants, can be used to stabilize a
person's mood. Your psychiatrist will work with you to
find the right medication and the lowest dose that
maximizes the benefits and minimizes side effects.
There may be the temptation,
once you begin to feel better, to discontinue the
medication. However, almost ninety-percent of the time,
symptoms recur within a year and a half of stopping the
drug.
Occasionally, before the
illness has been correctly diagnosed, or if medications
are abruptly discontinued, a person with
manic-depressive disorder may experience severe
persecutory delusions or suicidal behavior. In those
instances, hospitalization, antipsychotic medication,
and/or electroconvulsive therapy may be necessary. After
the acute episode has passed, psychopharmacological
treatment may need to be monitored closely for a while
to decrease the likelihood of relapse.
Supportive psychotherapy
provides the opportunity to monitor your medication as
well as to learn ways of managing and coping with your
illness. Living with a chronic illness will always stir
up strong feelings, and therapy is the place to deal
with them. Therapy can also furnish practical
information to help you cope: you can learn to detect
the early signs of a relapse, and to identify stresses
that might trigger an episode.
In addition, because
manic-depressive illness can be hard to live with,
family or couples' therapy may be recommended. When
someone in the family has bipolar disorder, it is
advisable to remain vigilant, on the look out for
possible signs of mania. Manic episodes can be
embarrassing, disruptive, and sometimes dangerous.
Family therapy can provide some very practical
information on living with the illness, and offer the
opportunity to consider ways in which family patterns
exacerbate symptoms.
Although treatment for bipolar
may seem complicated and cumbersome, complying with
treatment is crucial if you have this illness.
Hospitalization may be necessary from time to time,
specifically when manic symptoms become extreme or
dangerous. When the disorder is not treated or treatment
recommendations are not followed, it can lead to alcohol
and drug abuse, and, even suicide. Fifteen percent of
all individuals with manic-depressive disorder commit
suicide.
When
To Seek Treatment
Just like asthma or diabetes,
bipolar disorder is an illness and as such requires
medical attention. Unless your condition is extremely
mild, you should consult a mental health practitioner --
probably a psychiatrist who can prescribe medication --
to diagnose, treat, and monitor your manic-depressive
illness.
Prognosis
Fairly good. However,
manic-depressive disorder is a chronic illness that
needs to be managed and monitored throughout life. If
drug regimens are not closing followed, relapse is
likely. Even when one phase has been successfully
treated and it looks like the illness is in remission,
it is important that you resume treatment at the first
signs that symptoms may be breaking through.
Last updated June 01, 1998(Intelihealth-John's
Hopkins Health Information)
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