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Bipolar Disorder: Symptoms, Diagnosis and Treatment

Bipolar disorder is a chronic cyclical mental disorder where periods of manic, mixed-manic and depressive episodes are interspersed with relatively normal states of well-being. It affects approximately 5.7 million adults, or about 2.6 percent of the adult population in the United States, according to the United States Census Bureau.

A diagnosis of major depression does not evoke much response, either a stigmatizing or supportive, from a person's social network, a study indicated.
A diagnosis of major depression does not evoke much response, either a stigmatizing or supportive, from a person's social network, a study indicated.
Credit: Oleg Golovnev | shutterstock

Symptoms

Bipolar disorder is characterized by three phases: manic episode, depressive episode and an intermediate mixed-manic episode, which includes both symptoms of mania and depression, according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-IV. Although manic episodes can be further divided into different gradients of severity, the primary symptoms of mania include heightened mood (could be euphoric or irritable), flight of ideas, increased energy, decreased need for sleep and hyperactivity. The average duration of the first manic episode is about three months.

In contrast to typical major depression, the depressive episodes of bipolar disorder often occur acutely, can take place over a few weeks and without significant precipitating factors. Aside from depressed mood, depression episodes may also be accompanied by sleep problems, apathy or agitation, loss of energy, suicidal thoughts and more.

Bipolar disorder is divided into several subtypes by the DSM-IV based on severity of manic symptoms. Bipolar I Disorder patients suffer from at least one manic episode and one depressive episode and these mood swings can be severe enough to create difficulties in school, at work and in relationships.  Bipolar II Disorder is less severe than Bipolar I disorder. Individuals experience at least one hypomanic episode, which is less severe than full-blown mania, and at least one major depressive episode. For these people, periods of depression typically last longer than periods of hypomania, with minor effects to daily routines, according to the Mayo Clinic.

 

Diagnosis & Tests

The DSM-IV, a widely-used benchmark for diagnosing bipolar disorder, states that the most distinguishing feature of bipolar disorder is the course of the illness. Unlike other mental disorders, a person left untreated will revert to normal functioning in between episodes of mood disturbances, of which at least one will be a manic episode.

Since bipolar disorder cannot be detected through blood tests or brain scans, part of the diagnosis will be based on the patient's medical and family history, according to the National Institute of Mental Health. It's important to note that people are more likely to seek help during depressive episodes, when they appear to be suffering from major depressive disorder. Therefore the NIMH suggests that input and description of symptoms from family members and friends can create a more accurate picture and avoid a wrong diagnosis.

Treatments & Medications

Currently, bipolar disorder is a lifelong recurrent illness with no available cure. However, medications and therapeutic treatments may be used to help smooth out the mood swings and related symptoms and manage bipolar disorder on a long-term basis to avoid relapse, according to the Mayo Clinic.

Medications usually fall into two broad categories: mood stabilizers and adjunct medication. Mood stabilizers, such as lithium and valproate, are used to prevent the extreme highs and lows, according to the Mayo Clinic. It's important to note that a possible side effect of lithium treatment is low thyroid levels, which has been associated with rapid mood cycles and weight gain in some people, especially women during their first two years of lithium treatment, according to a 2002 study in the Journal of Psychiatry and Neuroscience. Patients on lithium may also need to take thyroid medication in order to avoid these adverse effects.

Adjunct medication is any medication that can be used to treat specific symptoms, which may include antidepressents, anticonvulsants and antipsychotics. Anticonvulsants such as valproic acid (Depakene), gabapentin (Neurontin), topiramate (Topamax) and lamotrigine (Lamictal) also act as mood stabilizers and appear to possess a broad spectrum of effectiveness, according to a 2010 review published in the journal Current Opinion in Psychiatry. However, the Food and Drug Administration and a 2010 study published in the Journal of the American Medical Association both warned that there's an increased risk of suicidal behavior among patients using seizure medication and they should be monitored for notable changes in behavior.

Electroconvulsive therapy (ECT) has also proven to be an effective, safe, and underutilized treatment for people with severe bipolar disorder. It's particularly suitable for highly agitated or suicidal patients or those with psychotic or catatonic symptoms, according to the NIMH. ECT involves administering a brief electrical stimulus through the scalp to the surface of the brain. Though the treatment is generally effective, especially to those who are not responding to medication, there's concern as to whether the therapy could cause long-term permanent memory impairment and deficits, according to a 2007 article in the Journal of Psychiatry & Neuroscience.

Coping & Management

Beyond medication, patients with bipolar disorder can also seek additional help and emotional support through psychotherapy such as cognitive behavior therapy. Various programs and support groups can also help the patient stay focused on recovery goals, according to the Mayo Clinic. Patients can also gain additional relief and better control over their episodes through exercise, yoga, meditation and other relaxation techniques. Since the disease and its symptoms can affect spouses, family members, friends and caregiver, it is also important to extend emotional support to them and help prevent physical and mental exhaustion, the NIMH said.

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