Bipolar disorder is a fairly common mental illness that was once called manic depression or manic depressive disorder. These older names describe the characteristic cycling nature of the condition. People with bipolar typically cycle between depression and manic states, and this can be very disruptive to ordinary life. A person may have dangerous feelings of invulnerability during manic phases and long periods of depression that make accomplishing anything a challenge.
There are a few different types of bipolar disorder, and getting diagnosed accurately is crucial. It allows for professionals to create the right treatment plan for each individual patient. Bipolar mood swings can be controlled with medications, but also with therapy and support. While medications are important for this condition, some of them come with risks that patients need to understand.
What is Bipolar Disorder?
Bipolar disorder is a mood disorder, a type of mental health condition that largely affects a person’s mood. With bipolar disorder a person typically experiences cyclic shifts in mood from extreme emotional high, called mania or a manic episode, to a low mood, called depression. The low part of the cycle is sometimes referred to specifically as bipolar depression to distinguish it from major depression, a separate condition.
The cycle of mood changes experienced by people with bipolar disorder affects more than just the individual’s mood. These extreme changes can have a serious and negative impact on behaviors, relationships, sleep, academics, work, judgment, the ability to think or concentrate, and energy levels. How often mood cycles between the two phases depends on the individual. They may be rare, or many times per year.
Nearly four percent of American adults will be diagnosed with bipolar disorder at some point in their lives. The average age of onset of bipolar disorder is 25, but children and teens can be affected too. Statistics for children and adolescents are minimal, but estimates suggest that up to three percent of teens may be diagnosed with bipolar disorder. There is no cure for bipolar disorder, but it can be treated and managed.
The two phases of bipolar disorder have very different symptoms and one can shift to the other rapidly. Symptoms of a manic or hypomanic episode (hypomanic is less severe) may include any of the following:
- Increased levels of energy and activity
- Less sleep or less need for sleep
- A sense of euphoria, or a sense of well-being and ability that is exaggerated
- Extreme self-confidence
- Racing thoughts
- Poor judgment and decision-making
Mania can be severe and can cause serious problems for a person at work, at school, within a family and other relationships, and may even lead to physical harm. Someone who is manic may believe they are invulnerable to injury and may even experience psychosis, or a break from reality. This may require hospitalization.
On the opposite end of the spectrum from mania is bipolar depression, or depressive episodes. These episodes may also vary in severity and often interrupt normal activities. Possible signs and symptoms include:
- Feelings of depression, sadness, hopelessness, and emptiness
- Insomnia or too excessive sleeping
- Loss of energy
- Difficulty concentrating or thinking
- Feeling worthless, ashamed or guilty
- Loss of interest in normal activities
- Weight loss or weight gain because of decreased or increased appetite
- Thoughts of suicide
In children and teens with bipolar disorder the symptoms may be a little different and are often more difficult to distinguish from normal mood swings, trauma, or stress. Children and teens may swing more rapidly from one extreme to the other than adults do. One of the most important signs a child or teen may be struggling with bipolar disorder is the shifting of mood swings that seem abnormal for a particular individual.
Types of Bipolar Disorder
There are four subcategories of bipolar disorder, characterized by how the mood swings occur, how long they last, their severity, and how frequent they are. Bipolar I disorder causes mania that lasts a week or more or that is so severe that it requires hospitalization and depressive episodes that last at least two weeks. Bipolar II disorder is similar to bipolar I, but the manic episodes are hypomanic, less severe than full-blown mania.
Cyclothymic disorder is characterized by cycling many times through hypomania and depression for a period of about two years. The episodes are less severe than those seen in bipolar I and II. Any similar disorder that does not quite match the diagnostic criteria for bipolar I, bipolar II, or cyclothymic disorder is classified as other specified or unspecified bipolar and related disorders.
Risk Factors and Causes
No one can say for certain what causes bipolar disorder or even if there is a definite cause. There does seem to be a genetic component and researchers have found that people with bipolar disorder have changes in their brains as compared to people without the condition. Exactly what this means is still not understood, but may lead to the discovery of a cause for bipolar disorder.
While the causes are murky, there are some clear risk factors for bipolar disorder. One of the most important of these is having an immediate family member with the condition. Having a sibling or parent with bipolar increases the risk of a diagnosis significantly. Other risk factors, or what may be triggers for the first episode, include drug and alcohol abuse and trauma or high stress situations.
Most treatment plans for bipolar disorder include both therapy and medications. Types of therapy used for bipolar patients include cognitive behavioral therapy, family therapy, group therapy, and interpersonal therapy. Professional therapists can help patients learn to manage their thoughts, moods, and behaviors. Especially for severe bipolar disorder, therapy is often not enough to manage moods and symptoms. Medications are used to control and stabilize moods, to relieve depression, and to prevent psychosis. In severe situations, hospitalization may be part of treatment for bipolar disorder.
Medications for Bipolar Disorder
There are three main categories of prescription medications used to treat bipolar disorder: mood stabilizers, antidepressants, and antipsychotics. Mood stabilizers are used to control mania or hypomania. These include drugs like lithium, valproic acid, divalproex sodium (Depakote), lamotrigine, and carbamazepine.
Antidepressants are used to treat depressive episodes but are rarely prescribed alone because their use can trigger mania. Examples of antidepressants include Prozac, Effexor, Celexa, and Lexapro. Antipsychotics are used when mood stabilizers and antidepressants fail to relieve symptoms of mania and depression. Olanzapine (Zyprexa), risperidone (Risperdal), aripiprazole (Abilify), and lurasidone (Latuda) are examples of these. Symbyax is a combination antidepressant/antipsychotic used to treat both depression and mania.
Risks and Dangers of Bipolar Medications
Medications used to treat bipolar disorder can be life-changing. For some people, the mood swings and symptoms of this condition are so severe and debilitating that they make living a normal life impossible. Medications can make a big difference, but it is also important to understand that they come with risks. Some of the drugs used for these patients have serious side effects or potential complications. Some examples include:
- SSRI antidepressants. This class of antidepressants includes Celexa, Lexapro, Prozac, Zoloft, and Paxil. These medications can cause suicidal thoughts and behaviors in patients under the age of 24. They may increase the risk of birth defects when used by pregnant women and may contribute to autism. These drugs also cause something called discontinuation syndrome if cessation occurs too quickly. The symptoms are similar to withdrawal from an addictive drug and can be dangerous.
- Risperdal. This antipsychotic may help stabilize mood, but it also comes with some serious risks. Maker Janssen Pharmaceuticals came under fire, for instance, when it was discovered that the company marketed this drug for use in children knowing that it could cause breast growth in boys. Risperdal and other antipsychotics may also cause death in elderly patients with dementia.
- Abilify. Also an antipsychotic, Abilify has been found to cause a very troubling side effect in some patients: compulsive behaviors. In several people this has taken the form of compulsive gambling, and many patients taking the drug report having become gamblers when they never were before and of having lost a lot of money as a result.
- Symbyax. Symbyax combines Prozac, an antidepressant, with Zyprexa, an antipsychotic. It carries the same risks as each of these drugs individually, including birth defects, death in elderly patients, and serotonin syndrome, a condition that can be life-threatening if not treated.
Bipolar disorder is a very serious, yet common, mental health condition. Many people struggle with it to varying degrees, from mild symptoms and disruption to severe mood swings and debilitating psychosis. Treating bipolar disorder is crucial and that often includes using prescription medications. Many of the drugs to treat this condition come with serious risks and these must be weighed against the risks of not treating it.