Tuesday, March 20, 2012

What is Bipolar Disorder?

Bipolar Disorder, also known as manic depression, is a mood disorder characterized by mood swings that alternate between periods of depression, mania, hypomania or irritability. Sometimes mood swings are a mixture of depression and mania or irritability. With bipolar disorder, the symptoms experienced, the length of time in episodes and the severity of the illness course can vary from person to person.

Bipolar I Disorder requires a person to have at least one manic episode in their lifetime (with or without a major depressive episode). Bipolar II Disorder is characterized by at least one hypomanic and one depressive episode. The symptoms of hypomania are similar to mania but less severe in presentation and often less debilitating on the person's work or social life.

If the mania is left untreated it can become so severe that hospitalization is required. Below are some of the symptoms of a manic / hypomanic episode:
  • A hallmark of bipolar disorder is insomnia. People report the need for little sleep for several nights in a row. A few hours of sleep and they feel ready to face the day. They have such a high level of energy that they don't sleep and don't feel the need to sleep.
  • People can feel as if they can do anything and be anything. They feel omnipotent and have a grandiose sense of themselves. The feeling of grandiosity can reach a delusional level such as believing oneself to be famous, extremely wealthy, or having a history of great accomplishments.
  • People can become euphoric. They experience a high - everything is like a kaleidoscope. Colors are bright. Everything in life glistens. They can become the life of the party and be very entertaining.
  • Instead of being euphoric, some people experience intense irritability. Anything can set them off. They get into fights with others. Often the people closest to them bear the brunt of the irritability - anything they say is countered with irritable and angry reactions by the person with bipolar illness.
  • People with bipolar disorder often start many activities, but they are easily distracted and unable to pay attention to a single activity for every long. They can be restless and hyperactive. There can be a chaotic path of unfinished business.
  • People report racing thoughts. The thoughts rapidly switch from one topic to another - similar to watching television while constantly clicking the remote. Sometime people's thought race so fast that they have difficulty verbalizing them. It can be difficult to concentrate. Thoughts can become extremely disorganized and confused.
  • People become increasingly focused on goal-directed activities. They become highly productive or highly creative. For example, they may rearrange the entire house in a single night, work incessantly, become hyper-focused on sex, call people at all hours of the night, and create voluminous works such as writing, art, crafts to name a few things. People forget to eat or sleep because of their activity.
  • People have pressured speech. They talk rapidly and excessively and can't stop themselves.
  • People with bipolar disorder become impulsive. With little thought, they engage in behaviors that have the potential for very negative outcomes. For instance they shop without restraint (such as buying houses, cars, clothes or other items) which often leads to spending beyond their means - sometimes with little to show for it. They can become promiscuous. They may suddenly travel without restraint.
  • Often people with bipolar disorder have very little awareness about their mood states, behaviors or functioning. When in the hypomanic/manic state there is often little insight that there is a problem - they feel that they are functioning just fine.
  • Sometimes people report being very "anxious". When asked to define the anxiety, it can become clearer that they are in a restless hypomanic/manic state and have racing thoughts.
The depressed state of bipolar disorder can be very severe and debilitating. Often, it is during a depressive episode that people with bipolar disorder seek treatment. See my depression post for a discussion of depression.

Bipolar disorder is sometimes difficult to differentiate between attention-deficit-hyperactivity disorder, borderline personality disorder, unipolar depression, normal euphoria or joy, schizophrenia, substance abuse and various medical conditions. Often a person seeks treatment when in the depressed phase. Without careful assessment of any history of mania/hypomania they may be treated with medications specific for a depressive disorder that may cause switching into a manic/hypomanic state. Any diagnosis of bipolar disorder should include an evaluation for medical conditions that can cause mood swings (such as thyroid disorders, adrenal disorders, medications, neurological conditions and vitamin B12 deficiency).

People with bipolar disorder can have more than one disorder such as an anxiety disorder, attention-deficit-hyperactivity disorder and alcohol or drug dependence. Treatment should address each of these problems. If there is a co-occurring alcohol or drug problem (dual diagnosis), treatment needs to focus simultaneously on the bipolar disorder and substance problem to achieve the best outcome.

Because it is often difficult for the person with bipolar disorder to accurately depict their behaviors and functioning, it can be extremely helpful to the clinician treating them to have input from the person's loved ones. It is very helpful if the person with bipolar disorder is receptive to allowing family/loved one's support.

People with bipolar disorder with the help of their mental health clinician and family members/loved ones need to determine their particular set of warning signs of a relapse into mania/hypomania/depression as well as interventions that can help prevent, delay or minimize the relapse. If symptoms of a relapse are evident, the treatment provider should be notified so that the person can be evaluated and treatment modifications can be made sooner than the next scheduled appointment.
It can be difficult to accept that one has bipolar disorder. On the road to acceptance, people often stop their treatment because they are feeling better. This invariably results in a relapse. Bipolar disorder can have a serious impact on loved ones, work, finances, health, social relationships, involvement with law enforcement and the risk of suicide. Without treatment, the result can be devastating.

Having bipolar disorder does not automatically mean that you cannot have a productive life. There are many famous people with bipolar disorder who live with or have lived with bipolar disorder.

Bipolar disorder is treatable. The goal is to reduce the episodes of mania/hypomania and depression and to help the person function as best as possible. If you or a loved one are experiencing these symptoms, seek help from a professional – it could be a psychiatric APRN, a psychiatrist, a psychologist, a psychotherapist or another mental health professional.

Be well,   Mary Anne Zeh, APRN

Some resources that are helpful:
  • Books:
    • "Loving Someone with Bipolar Disorder" by Julie A. Fast, John D. Preston Psy D ABPP
    • "Bipolar Disorder: A Guide for Patients and Families (2nd Edition)" by Francis Mark Mondimore


The information contained in this website should not be considered by anyone viewing the website as a substitute for appropriate diagnosis and treatment provided by a licensed health practitioner. All content is for general purposes only. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website. Mary Anne Zeh, A.P.R.N., C.S., LLC is not responsible or liable for the content of any site accessed through this website.

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