Bipolar Disorder

What is bipolar disorder?                                   • Distractibility
Bipolar I Disorder is the more severe form,               How is bipolar disorder treated?
characterized by extreme manic ...
treatment of bipolar disorder depressive episodes.           affect the body and its chemical
Risperidone (Risperdal) and ...
development to difficult childhood and adulthood
                             life events (for example, abuse, death in th...
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Bipolar Fact Sheet


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Bipolar Fact Sheet

  1. 1. Bipolar Disorder What is bipolar disorder? • Distractibility • Increased goal-directed activities or new projects Bipolar disorder, formerly known as manic-depressive • Excessively irritable, agitated and/or aggressive illness, is a brain disorder characterized by extreme behavior (feeling “jumpy” or “wired”) shifts in mood, thought, energy and behavior. People • Decreased need for sleep without experiencing with bipolar disorder can go from extreme energy to fatigue deep despair within a very short period of time — or • Grandiose thoughts (especially about one’s abilities) can experience milder mood shifts, going from irri- and inflated sense of self-importance tability or restlessness to sadness. The “highs”, called • Racing speech or thoughts, or flight of ideas mania or hypomania (a milder form of mania), are (i.e., going from one unconnected subject or idea generally less frequent than depressions. Unlike the to the next) mood changes everyone experiences, bipolar mood • Impulsiveness, poor judgment, reckless behavior shifts can have a devastating impact. Mood swings (for instance, involving drugs, sexual activity, can last for hours, weeks or months, causing damage spending sprees) to relationships, school or work performance. A • In the most severe cases, delusions and hallucina- person with bipolar disorder may also experience psy- tions (sometimes called psychosis) chotic symptoms, such as delusions or hallucinations. Symptoms of Depression** More than 5 million Americans over the age of 18 are • Long-lasting sadness or unexplained crying spells estimated to have bipolar disorder. Symptoms typi- • Loss of interest or pleasure in activities that were cally emerge in late adolescence or early adulthood, once enjoyed (e.g., being with family and friends, although they can appear in childhood or in later life. sex, going out), and social withdrawal Bipolar disorder affects men and women equally, is • Significant changes in appetite, sleep patterns, or usually a lifelong illness, tends to run in families, and other habits *Three or more of the mania • Anger, irritability, worry, agitation, anxiety symptoms together with ele- appears to have a genetic component. A person with vated mood most of the day, the disorder is at increased risk for suicidal behavior • Hopelessness, pessimism, indifference nearly every day, for one week and suicide. • Loss of energy, fatigue or longer is considered a • Feelings of guilt, worthlessness, helplessness manic episode. In the presence of irritable mood, which is a Once diagnosed, bipolar disorder is treatable, and a • Difficulty concentrating, remembering, making less specific symptom and can person with this illness can lead a full and productive decisions be caused by other factors, • Chronic aches and pains not caused by physical four additional symptoms are life as long as the disease is well-managed. necessary to be mania. injury or illness What are the symptoms of bipolar • Recurring thoughts of death or suicide, planning **If five or more of the or attempting suicide depressive symptoms last most disorder? of the day, nearly every day, for a period of two weeks or A person with bipolar disorder experiences episodes How is bipolar disorder diagnosed? longer, then it is considered a depressive episode. Some de- of mania or hypomania and depression that they pressive symptoms in bipolar might describe as their “highs and lows”. Diagnosis is based on symptoms, course of illness disorder can be different than and family history. Clinicians rule out other medical in typical depression. Instead of loss of appetite, weight loss, Symptoms of Mania* conditions, such as a brain tumor or stroke and or inability to sleep seen in • Increased physical and mental activity and energy, neuropsychiatric illnesses that also may cause depression, bipolar disorder mood disturbance. depressive symptoms include restlessness excessive sleep, increased • Excessively high or overly happy or outgoing mood appetite and weight gain. The Brain and Behavior Research Fund
  2. 2. Bipolar I Disorder is the more severe form, How is bipolar disorder treated? characterized by extreme manic episodes. People who are affected experience one or more manic episodes While no cure exists for bipolar disorder, it is treatable or mixed episodes (mania and depression) nearly and manageable with psychotherapy and with medica- every day for at least one week, and have experienced tions. Bipolar disorder is much better controlled when one or more major depressive episodes. treatment is continuous. Mood changes can occur even when someone is being treated and should be re- Bipolar II Disorder is characterized by one or more ported immediately to a physician; full-blown episodes depressive episodes accompanied by at least one may be averted by adjusting the treatment. episode of hypomania. Those affected experience a period of persistently elevated, expansive or irritable Mood stabilizers and Anticonvulsants mood, lasting at least four days, that is clearly different from the person’s usual non-depressed Mood stabilizing medications are usually the first mood. With hypomania, one may feel good and be choice treatment. Lithium (also known as Eskalith or productive, but without proper treatment hypomania Lithobid), the first Food and Drug Administration can sometimes become severe mania or switch into (FDA)-approved mood-stabilizing medication, is depression. Hypomania usually occurs between often effective in preventing recurrence of manic and depressive episodes and is usually recurrent. depressive episodes. Anticonvulsant medications are usually used to treat seizure disorders, but also have Bipolar Disorder Not Otherwise Specified is mood-stabilizing effects. In 1995, the FDA approved diagnosed when a person has some but not all of the the antiseizure medication valproic acid (Depakote) symptoms of bipolar disorder, and does not fulfill for mania treatment. More recently, the anticonvul- the full criteria for Bipolar I or II. sant lamotrigine (Lamictal) received FDA approval for maintenance treatment. Other anticonvulsants Cyclothymic Disorder or Cyclothymia is a mild used include gabapentin (Neurontin), topiramate form characterized by periods of hypomania and (Topamax) and oxcarbazepine (Trileptal), though no mild depression. large studies have shown they are more effective than mood stabilizers. Cycles of mood swings can vary. Initially, episodes of depression and mania tend to occur close together Lithium may cause side effects, such as restlessness, and happen frequently. Eventually, the interval be- dry mouth, bloating or indigestion, acne, unusual tween extremes of mania and depression may stabilize discomfort in the cold, joint or muscle pain, brittle and become longer. Rapid cycling bipolar disorder nails or hair and other complications. Common side occurs in about 5 percent to 15 percent of people effects of other mood stabilizing medications include with bipolar disorder, and is defined by a person hav- drowsiness, dizziness, headache, diarrhea, constipa- ing four or more episodes of depression, hypomania, tion, heartburn, mood swings, and cold-like mixed states or mania in a single year. Rapid cycling symptoms (congestion, etc.) These medications also tends to occur later in the illness and affects more may have rare but serious side effects, such as women than men. electrolyte imbalance, hair loss, or hyperthyroidism. New NARSAD-supported research to Atypical Antipsychotics improve bipolar disorder diagnosis includes: • Identifying genetic patterns that are Atypical antipsychotic medications, a type of specific to bipolar disorder antipsychotic developed about 40 years ago, help • Identifying biomarkers (from the blood, treat symptoms of mania and psychotic symptoms or from brain scans) that can help to (i.e., delusions, hallucinations). Olanzapine identify people with bipolar disorder as (Zyprexa), when given with an antidepressant, may help relieve severe mania or psychosis, and when in- early as possible jected, can quickly treat mania-associated agitation. • Studying patterns of brain circuitry and It is also used as a maintenance treatment even in the activity that can be used to diagnose absence of psychotic symptoms. However, olanzapine bipolar disorder is associated with weight gain and other side effects • Identifying people at very high risk for that increase diabetes and heart disease risk. Aripipra- bipolar disorder to identify and treat the zole (Abilify) is approved for treatment of a manic or disease early on mixed episode, is used for maintenance treatment after a severe or sudden episode, and can be injected for urgent treatment of manic or mixed episode symptoms. Quetiapine (Seroquel) is used for severe and sudden manic episodes, and in 2006 was the first atypical antipsychotic approved by the FDA for
  3. 3. treatment of bipolar disorder depressive episodes. affect the body and its chemical Risperidone (Risperdal) and ziprasidone (Geodon) processes are other atypical antipsychotics that may be • Doing animal research to understand the prescribed for controlling manic or mixed episodes. effect of mood stabilizers, antipsychotics Most recently, asenapine (Saphris) was approved by and antidepressants on the brain the FDA to treat acute manic or mixed episodes of bipolar I disorder. • Trying to reverse the weight gain and metabolic problems that come with Antidepressants olanzapine by using acetaminophen, a common over-the-counter medicine Antidepressants may be used for depressive symptoms. Doctors usually prescribe mood stabilizers with anti- Living with bipolar disorder depressants because antidepressants can increase the risk of mania or hypomania, or rapid cycling symp- A person with bipolar disorder often lives for years toms. However, a recent large study showed adding an without being correctly diagnosed. People may not antidepressant to a mood stabilizer is no more effective see their high energy or euphoric periods as a prob- in treating the depressive symptoms than using only lem, and don’t look for treatment. In fact, initially, a mood stabilizer. Examples of antidepressants used people may feel these periods are highly productive include: Fluoxetine (Prozac), paroxetine (Paxil), and positive. A person with bipolar disorder usually sertraline (Zoloft), and bupropion (Wellbutrin). first seeks treatment because of depressive periods. He or she may then be misdiagnosed as having pure, Psychotherapy “unipolar” depression. Misdiagnosis can happen when the patient is not thoroughly evaluated or In addition to medication, psychotherapy provides neglects to discuss the “up” periods, not recognizing support, guidance and education to people with anything peculiar or detrimental about the “highs.” bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease After being diagnosed, a person with bipolar disorder hospitalizations and improve functioning. Common may believe life will never be the same. It can be techniques include cognitive behavioral therapy, painful to review how the illness has affected his or psychoeducation, and family therapy. A newer her life. Someone who needs to be hospitalized may technique, interpersonal and social rhythm therapy, experience feelings of failure, shame or embarrass- helps people improve relationships and manage daily ment due to the stigma of mental illness. At this routines and sleep schedules; it is thought to protect time, support from family, friends, and health care against manic episodes. providers can be essential. Electroconvulsive Therapy (ECT) Treatment can be very effective and positive plans and goal-setting can motivate a person with the Another treatment, ECT, may be used when medica- condition to take it day by day towards wellness. tion and psychotherapy do not provide effective results Friends and family can encourage a person with or use of medications is deemed too risky (for example, bipolar disorder towards a healthier lifestyle with in pregnancy). ECT is also highly effective for severe reminders to keep a regular sleep cycle, eat well, depressive, manic and mixed episodes. Side effects may exercise, avoid alcohol and substance abuse, join include disorientation, confusion and memory loss, support groups and keep regular health care but they usually clear soon after treatment. appointments while continuing treatment. Since loss of sleep can precipitate acute manic episodes, Sleep Medications also can be prescribed for people it is important for patients to maintain regular sleep whose sleep cycle does not normalize after being hours even when they travel and change time zones. treated with bipolar medications. After adjusting to life with bipolar disorder, people New NARSAD-supported research to who are treated successfully develop more positive improve treatment of bipolar disorder feelings about the future. They reach a stage where includes: the illness no longer defines them. • Using brain imaging to study chemical changes in the brain after antidepressant What causes bipolar disorder? treatment and family focused therapy • Using a technique called focused ultra- Like other serious psychiatric illnesses, bipolar sound pulse that can affect brain function disorder is a highly complex disease believed to result from an interaction between genetic vulnerability and and is a potential new treatment life stress. Stressors can be anything from pregnancy • Studying the way lithium and other drugs and birth complications that affect early brain
  4. 4. development to difficult childhood and adulthood life events (for example, abuse, death in the family, Help support NARSAD’s divorce, or job loss). research on bipolar disorder Studies of twins show the importance of genes in For the past 23 years, NARSAD has been at the contributing to the disorder. But not all identical forefront of research on mental illness. From twins of people with bipolar disorder also develop the 1987 through 2009, NARSAD has given more illness, indicating that environment also plays a role. than $252 million in grants to support innovative research by more than 2,800 scientists at lead- It is unlikely that a single gene is responsible for ing universities, medical centers and research bipolar disorder. Several genes related to specific institutions around the world. Besides bipolar neurotransmitters (serotonin, dopamine, glutamate) disorder, NARSAD funds research on schizo- and to brain cell growth or maintenance of brain phrenia, depression, anxiety disorders, and cells pathways (NRG1, DISC1 and BDNF) have childhood mental illness. For bipolar disorder been implicated. Research also suggests that genetic research specifically, NARSAD has provided: mutations may be involved when they affect how • 442 grants to researchers studying the brain develops and functions. bipolar disorder and related diseases • $30 million dollars for those research grants Newer brain-imaging techniques, such as functional MRI, may reveal the circuitry involved in the disrup- NARSAD supports research on all aspects of tion of mood and behavior in bipolar disease. With bipolar disorder and other mental illnesses— further research on the causes of the illness, scientists the causes and nature of the disease, struc- hope to be able to predict which treatments work tural and functional changes in the brain, most effectively for any individual, and ultimately chemical abnormalities, genetics, pharmaco- learn to prevent the illness altogether. logical and non-pharmacological treatments, and social and behavioral aspects of the ill- New NARSAD-supported research trying ness. NARSAD’s grantmaking program is to understand the causes of bipolar guided by its Scientific Council, a volunteer disorder include: group of 116 leading neuroscientists, which • Looking for clues to bipolar disorder by reviews and recommends research proposals studying pregnancy and birth records, for funding. childhood growth and early neuropsy- chological functioning NARSAD relies on the generosity of thousands • Using the latest genetic techniques to of donors and volunteers to support this research, which has yielded great progress in study genes that may increase the risk the understanding, diagnosis and treatment of of bipolar disorder mental illnesses. Formerly known as the Na- • Studying brain regions associated with tional Alliance for Research on Schizophrenia emotions and reward using brain and Depression, NARSAD is a 501 (c)(3) organi- imaging, new analytic techniques, and zation that receives no government support. neuropsychological testing All donations are tax-deductible. To donate to • Determining whether certain electroen- NARSAD and to learn more about our work, cephalography (EEG) patterns may be please call (800) 829-8289, write to related to mood cycling, or visit our website. • Studying the interaction between genes and the environment in brain develop- For more information, go to ment, to understand what can go wrong at the molecular level Updated in October 2009. Content in this fact sheet was reviewed by a member The Brain and Behavior Research Fund of NARSAD’s Scientific 60 Cutter Mill Road, Suite 404, Great Neck, N.Y. 11021 Council. 516-829-0091 • 800-829-8289