Bipolar disorder is the modern term for mood swings that used to be called manic depression. It is a fairly common yet serious mental illness, affecting between one and five per cent of Americans of all ages. Unfortunately there is usually a delay of several years before the diagnosis is made.
Bipolar disorder has no known cure. The likelihood is that the individual will need long-term medication and ongoing support. But if it is well managed, with help from family, friends, support groups and health professionals, the person with bipolar disorder can lead a productive and satisfying life: many people with bipolar disorder are married, have families, work, study and pursue pastimes of their choice.
Advances in drug therapy together with new approaches to non-medical treatment are making the future appear more optimistic for patients.
In a Nutshell, What is Bipolar Disorder?
Bipolar disorder involves extreme mood swings from mania (a form of euphoria or feeling like one has a lot of energy) to deep depression. It has no simple cause, but there is strong evidence that it is associated with changes to various brain chemicals. The precise way in which this happens is not yet known. It may be triggered by the stress of everyday life or a traumatic event or, in rare cases, physical trauma such as a head injury.
The average age of people diagnosed with bipolar disorder used to be 32, but during the past decade it has dropped to under 19. This is probably partly due to increased awareness of the disorder among the public and mental health practitioners.
There is much debate about the ethics of labeling children and young people with a bipolar diagnosis — not least because there is no definitive test for the illness. But one of the advantages of a correct diagnosis is that it may allow for early and more effective treatment of young people.
The Bipolar Disorder Diagnosis
In recent years, diagnoses of bipolar disorder have become more sophisticated. Diagnoses such as Bipolar I or Bipolar II, reflect differences in both the severity and duration of moods. This helps doctors to assess the right balance of medical and non-medical treatment that will best reduce the frequency and severity of mood swings.
Some people recognize their symptoms early enough to seek diagnosis and care, whereas others fight hard to deny they are ill until a crisis forces them to accept they need help.
Once the diagnosis is accepted, the patient is able to develop insight which can highlight impending episodes. Warning signals are specific to the individual, but in mania might include difficulty sleeping, irritability, feeling oversexed, staying out late and spending too much. With depression there are also early warning signals such as tiredness, not wanting to visit friends or losing interest in sex. Episodes are often triggered by specific problems, such as relationship stress or career difficulties.
When this happens, an action plan can be followed, with a series of practical responses. Effective management of bipolar disorder also means maintaining good mental health between episodes, such as regularly reviewing anxieties and stresses which can stop them building up and provoking a major crisis.
Medication for Bipolar Disorder
Treatment includes drug and psychological approaches. Drug treatment is based initially on mood stabilizers (including lithium), which reduce the extreme changes of mood and activity. However, to be effective, they need to be taken continuously. Sodium valproate and carbamazepine, both anticonvulsants, are also used in an attempt to stabilize mood.
The severe depression aspect of bipolar disorder seems to be experienced more frequently among patients nowadays than in previous decades. Its treatment is a challenge, not least because it does not respond instantly to medication, typically taking up to six weeks to show a benefit.
Some of the newer anticonvulsant drugs are particularly promising. Lamotrigine is a novel maintenance therapy; it appears to alleviate bipolar depression and may prevent recurrence. In June 2003 it became the first medication since lithium to be granted approval by the Food and Drug Administration (FDA) for the maintenance treatment of bipolar disorder type I.
In studies, lamotrigine has been found to control episodes of bipolar states in people who have not responded well to lithium, carbamazepine and/or sodium valproate.
It may have significantly more effect on depression than either of these two drugs — lifting patients from depression without triggering a manic episode. But its utility in the management of acute manic symptoms is debatable because the dosage must be slowly increased up to the therapeutic level, to avoid a potentially-serious form of skin rash.
Another new anticonvulsant, zonisamide, may also help treat bipolar depression.
To treat manic episodes in bipolar disorder, certain antipsychotic drugs, including chlorpromazine, quetiapine, and olanzapine, are used. Recently, researchers have investigated the use of an anti-seasickness drug called scopolamine. It has shown a “robust” response among depressed patients.
A drug often used for Lou Gehrig’s disease is also a potential candidate for bipolar disorder therapy. Riluzole has been shown to have antidepressant properties in a number of recent studies of mood and anxiety disorders.
Experts are also looking at the effectiveness of the breast cancer drug tamoxifen for bipolar disorder. Recent findings suggest that it rapidly reduces mania.
The exact combination of drugs prescribed to each person will vary significantly. Those who don’t respond to one mixture may have success with another, so the optimum choice of drugs may take time, even several years, to pinpoint.
Nutritional Help for Bipolar Disorder
One alternative to the purely pharmaceutical treatment approach is in nutrition. Omega-3 fatty acids have been used as a possible treatment for the condition, alongside drugs. Early positive results have not always been confirmed, but it has been suggested that the benefit lies with the eicosapentaenoic acid (EPA), found in food and supplement sources of omega-3s. It is worth noting that the typical highly-processed Western diet contains fewer omega-3s than ever before. This affects cell membranes and physiology in a way that may be linked to psychiatric disorders.
Other compounds which hold promise for alleviating the symptoms of bipolar disorder include B vitamins such as folic acid, and the mineral magnesium. Further nutrients are currently under investigation. The hope is that they will work as adjuncts to medicines, allowing people to take fewer medicines and/or lower doses.
Psychotherapy for Bipolar Disorder
A variety of psychotherapies can also help supplement medications to help a person learn to better control and stabilize their moods.
Cognitive behavior therapy (CBT) helps people change their “depressive” style of thinking; interpersonal therapy and family therapy both focus on relationship issues; and social skills training helps improve communication. These have all been shown to help people with bipolar disorder. They are often useful alongside self-help and support groups which may be particularly beneficial in the early stages of the disorder, at the time when people are accepting their diagnosis and developing strategies to cope.
Whatever the severity of their condition, people with a bipolar diagnosis are increasingly developing ways of managing their mood swings, working out ways of reducing their frequency and severity, and lessening the disruptive effect they can have on jobs, relationships and lives. There is much to be optimistic about, because more has been discovered about bipolar disorder in the past ten years than was discovered in the previous 50. Enormous strides have been made on all fronts, including removing the stigma attached to the condition.