Bipolar affective disorder is a mood disorder characterized by mood swings from mania (exaggerated feeling of well-being, stimulation, and grandiosity in which a person can lose touch with reality) to depression (overwhelming feelings of sadness, anxiety, and low self-worth, which can include suicidal thoughts and suicide attempts).

Alternative Names

Bipolar disorder; Manic depressive illness

Causes, incidence, and risk factors

The disorder usually appears around the age of 25 and affects men and women equally. Children are rarely affected. The cause is unknown, but genetics do seem to be involved. Relatives of people with bipolar affective disorder and depression are more likely to be affected. There are different types of bipolar affective disorder. Bipolar I is the classic form of the condition, with discrete periods of mania alternating with depression. In a person with bipolar II, the depressive phase predominates and there is no true mania. There may be periods of elevated mood and energy in which the person doesn't completely lose touch with reality (hypomania). People with bipolar II may appear to have depression rather than bipolar affective disorder (especially since few people complain about periods of good mood and energy that don't cause problems), but mood stabilizers seem to help more than antidepressants.

Signs and tests

A psychiatric history of mood swings and observation of current behavior and mood are critical in diagnosing this disorder. Obtaining information from family members regarding the patient's behavior is also helpful. It is important to inquire about family history. A physical examination as well as some laboratory tests (thyroid and drug screen) may be performed to rule out other causes for the symptoms, though use of recreational drugs does not rule out bipolar affective disorder, as it may be a symptom. People with this condition are at increased risk of substance misuse disorders.

Treatment

Hospitalization may be required during an acute phase to control the symptoms and for the safety of the patient. The mainstay of treatment are mood-stabilizing medications (such as valproic acid, lithium, and carbamazepine) which are effective for both the manic and the depressive phases as well as in preventing recurrence. Antidepressant drugs may be given during the depressive phase, while neuroleptic (antipsychotic) drugs and benzodiazepines are often used to control mania in the acute phase. Patients usually must take a mood stabilizer before antidepressants are given, since giving an antidepressant without a mood stabilizer may result in the patient becoming manic. In severe cases, electroconvulsive therapy ( ECT ) may be used to treat persistent depression . ECT is a psychiatric treatment that causes a seizure of the central nervous system by means of an electrical current. It is used to treat severe depression and can be effective in manic disorders. Psychotherapy may also be needed for emotional support during the depressive and manic phases.

Support groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems.

Expectations (prognosis)

Treatment with mood-stabilizing medication can prevent recurrence of symptoms. However, many people with this condition stop taking the medication as soon as they feel better, or because they want to experience the period preceding mania that can be productive and creative. Some people are almost "addicted" to the experience of this state, and it takes many negative consequences before they recognize the need to stay on medication. Proper medication use is also difficult to sustain because of side effects. People with this condition and their families need support to encourage proper medication use and to ensure that any episodes of mania and depression that do occur are treated as early as possible. Suicide in both phases is a very real risk and suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require emergency attention.

Complications

Disruption of relationships, work, and finances is common. Alcohol and other drug problems are another common complication.

Calling your health care provider

Call your health care provider or mental health professional if you experience symptoms of bipolar affective disorder.

Prevention

There is no known way to prevent this condition, but maintaining good and regular sleep habits may prevent switches into mania.