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Bipolar Disorder

Reviewed by: HU Medical Review Board | January 2012

Bipolar disorder is an illness where a person’s mood cycles between the state of mania or hypomania, stability, and depression. Thought to be caused by chemical and possibly electrical abnormalities in the brain, bipolar disorder is considered a serious mental illness. Statistics show that 15-20% of patients commit suicide and 25-50% attempt suicide at some point in their lives. In addition, bipolar can keep a person from holding down a job, cause financial ruin from uncontrolled spending, lead to criminal behavior, be disabling — the list goes on and on.

There are three prominent forms of bipolar disorder — Bipolar I, Bipolar II, and Cyclothymia.

In Bipolar I, the single diagnostic criterion is that the patient has had a manic episode — a state of abnormally high or irritable mood with an abnormal increase in activity or energy. Hallucinations or delusions may be present, and hospitalization may be necessary. People with Bipolar I typically also have hypomanic and major depressive episodes. An episode is a period of time spent in a single mood state.

People with Bipolar II have hypomanic and major depressive episodes only. This means they don’t experience psychosis during their elevated or energetic irritable moods, and don’t need to be hospitalized for them. This doesn’t mean the symptoms aren’t serious — they can be.

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During the depressive phase of both Bipolar I and II, hospitalization may be required, and hallucinations or delusions may be present.

Patients with Cyclothymia have hypomanic episodes as well, but the depression they experience is not severe enough to fall into the category of a major depressive episode. People tend to brush off Cyclothymia as a “mild” version of bipolar disorder, but in fact the hypomanic symptoms can be just as serious as in a person with Bipolar I or II Disorder.

Symptoms of Bipolar Disorder

Symptoms that mania and hypomania have in common include reduced need for sleep, flamboyant behavior, hypersexuality, excessive or inappropriate anger, rapid speech, skipping rapidly from topic to topic while talking, an exaggerated sense of self-worth, severe restlessness, inability to concentrate, and indulging in risky behaviors, among others.

Major depression symptoms include prolonged feelings of sadness, emptiness, worthlessness or low mood, uncontrollable crying, fatigue, body aches, being physically slowed down, losing interest in activities normally enjoyed, being unable to sleep properly or sleeping too much, trouble making decisions or concentrating, and thoughts of suicide, along with others. As mentioned above, psychotic symptoms may be present as well.

In the depressed phase of Cyclothymia, the most severe symptoms such as suicidality and psychosis are not present, and the depressed mood is not disabling.

Treatment of Bipolar Disorder

The primary treatment for bipolar is medication therapy, and some form of talk therapy is also recommended. Medications for mania and hypomania include mood stabilizers such as lithium and anticonvulsants (drugs which are used to treat seizure disorders like epilepsy), along with antipsychotic medications. Medications for depression include antidepressants, sedatives and antipsychotics. Some mood stabilizers also have antidepressant properties.

Many people with bipolar disorder also need anti-anxiety medications, as it’s very common for bipolar and anxiety disorders to be present together.

One of the challenges in treating bipolar disorder is that medications used to treat depressed mood can contribute to the appearance of the opposite mood. In fact, many people who are initially diagnosed with Major Depressive Disorder turn out to have bipolar when they are given antidepressants that trigger hypomania or mania.

Bipolar Disorder and Migraines

People with bipolar disorder have an increased risk of having migraines. In one study, 8.6% of migraineurs were found to have bipolar disorder, and in another, patients with either bipolar disorder or major depressive disorder who also had a family history of bipolar were found to be 4.4 times more likely to have migraines than the others. Still another study found that migraines were very common in patients with Bipolar II disorder and less so in Bipolar I, both exceeding the migraine frequency in the general population. Since some of the medications used to treat bipolar have also been found effective in treating migraines, identifying migraineurs who have bipolar may indicate a better course of treatment for both conditions.