Bipolar disorder is a mental illness marked by extreme mood swings from high (mania) to low (depression) and low to high. The mood swings may even become mixed, so you might feel elated and depressed at the same time.

1. BIPOLAR DISORDER TEST
Bipolardisorderisa mental illnessmarkedbyextreme moodswingsfromhigh(mania) tolow
(depression) andlowtohigh.The moodswingsmayevenbecome mixed,soyoumightfeel elatedand
depressedatthe same time.
Bipolarisnot a rare diagnosis.More than5 millionpeopleinthe UnitedStatesare livingwithsome form
of bipolardisorder.Symptomstendtoappearina person’slate teensorearlyadultyears,buttheycan
occur in childrenaswell.Womenare more likelytoreceive bipolardiagnosesthanmen,thoughthe
reasonfor thisremainsunclear.
Bipolardisordercanbe hard to diagnose,butthere are warningsignsyoucan lookfor.
What are the warning signsof bipolar disorder?
Bipolardisordermayinclude the followingwarningsigns.
7 signsof mania
 feelingoverlyhappyor“high”forlongperiodsof time
 havinga decreasedneedforsleep
 talkingveryfast,oftenwithracingthoughts
 feelingextremelyrestlessorimpulsive
 becomingeasilydistracted
 havingoverconfidencein yourabilities
 engaginginriskybehavior,suchashavingimpulsive sex,gamblingwithlife savings,orgoingon
bigspendingsprees
7 signsof depression
 feelingsadorhopelessforlongperiodsof time
 withdrawingfromfriendsandfamilyorlosinginterestinactivitiesthatyouonce enjoyed
 havinga significantchange inappetite
 feelingseverefatigueorlackof energy
 speakingslowly
 havingproblemswithmemory,concentration,anddecision-making
 thinkingaboutorattemptingsuicide,orhavinga preoccupationwithdeath
 Suicide prevention
 If you thinksomeone isatimmediate riskof self-harmorhurtinganotherperson:
 Call 911 or yourlocal emergencynumber.
 Stay withthe personuntil helparrives.
 Remove anyguns,knives,medications,orotherthings thatmaycause harm.
 Listen,butdon’tjudge,argue,threaten,oryell.

2. Types ofbipolar disorder
Althoughthere are fourcommontypesof bipolardisorder,there are twotypesthatare most often
diagnosed.
Bipolar I
Thisclassicform of bipolardisorderusedtobe called“manicdepression.”InbipolarI,manicphasesare
clear.The person’sbehaviorandmoodsare extreme,andtheirbehaviorquicklyescalatesuntil they’re
out of control.The personmayendup inthe emergencyroomif leftuntreated.
To have bipolarI,a personmusthave manicepisodes.Inorderforanevent tobe consideredamanic
episod,itmust:
 include moodsorbehaviorsthatare unlike the person’susual behavior
 be presentmostof the day,nearlyeverydayduringthe episode
 lastat leastone week,orbe soextreme thatthe personneedsimmediatehospital care.
Bipolar II
BipolarIIis fourtimesmore commonthan bipolarI.It includessymptomsthatare muchlesssevere.
These symptomsare calledhypomanicsymptoms.BipolarIIisharderfor people tosee inthemselves,
and it’softenupto friendsorlovedonestoencourage someone withthistype togethelp.Hypomania
oftenbecomesworse withouttreatment,andthe personcanbecome severelymanicordepressed.
Rarer typesof bipolar
There are twoothertypesof the disorderthatare lesscommonthan bipolarIand II.Cyclothymic
disorderinvolvesmoodswingsandshiftssimilartobipolarIand II,but the shiftsare oftenlessdramatic
innature.A personwithcyclothymicdisordercanoftenfunctionnormallywithoutmedication,thoughit
may be hard. Overtime,aperson’smoodswingsmaydevelopintoadiagnosisof bipolarIor II.
Bipolardisordernototherwisespecifiedisageneral categoryfora personwhoonlyhassome bipolar
symptoms.These symptomsare notenoughtomake a diagnosisof one of the otherthree types.
What bipolardisorder feelslike
Hear fromreal people wholive withbipolardisorder.
How is bipolar diagnosed?
Bipolardisordercanbe difficulttodiagnose.Unlessyouhave severemania,the symptomscanbe hard
to spot.People whohave hypomaniamayfeel more energizedthanusual,more confidentandfull of
ideas,andable to getby onlesssleep.These are thingsthathardlyanyone complainsabout.You’re
more likelytoseekhelpif you’re depressed,butyourdoctormay notobserve the manicside then.

3. Whendoctors dosuspectbipolardisorder,theymayuse afew differentapproachestomake the
diagnosis:
 a physical examtorule out anyothermedical conditionsthat couldcause yoursymptoms,such
as thyroiddisease
 a mental healthevaluation,whichmayinclude aquestionnaireandinterviewswithfamily
members
 a mood-chartingdiarytokeeptrack of your sleeppatternsanddailymoods
the DiagnosticandStatistical Manual of Mental Disorders,whichcanbe usedto compare your
symptomswiththe official description
If you’re worriedthatyoumighthave bipolardisorder,the bestthingtodois educate yourself about
mooddisordersandtheirsymptoms.Thenshare yourlistof symptomswithyourdoctor.
It can be harderto addressif you’re concernedaboutafriendorlovedone havingbipolardisorder.Ask
for helpfromotherfriendsorfamilymembers.Peoplewithbipolardisorderoftendenyanyproblems,
especiallyduringmanicepisodes.Thinkof bipolardisorderasyouwouldanyotherseriousdisease,and
getprofessional helprightaway.
Bipolar and other illnesses
People withbipolardisordermayhave otherpsychological diagnoses,includingobsessive-compulsive
disorder,eatingdisorders,andsubstance abuse.The desire tomedicate theirbipolarwithdrugsor
alcohol can putthemat riskforsubstance abuse.Menare more likelytodeal withsubstance abuse
alongside theirbipolar.Womenmostoftenexperience thyroiddisease,obesity,andmigraineswith
bipolar.
Approximately1in5 people withabipolardiagnosisalsohave borderlinepersonalitydisorder.There are
some similaritiesbetweenthe twodisorders,butthere are alsomanydifferencesinthe symptomsand
causes. More researchisneededtounderstandthe relationshipbetweenthem.
How is bipolar treated?
Once you have a diagnosis,yourdoctorwill decideonatreatmentprogramthat worksbestfor you.
Bipolartreatmentmayinclude:
 medication
 behavioral therapy
 substance abuse treatment
 electroconvulsive therapy
A licensedpsychiatristusuallymanagesyourtreatment.Youmayalsohave a social worker,psychologist,
or psychiatricnurse practitionerinvolvedinyourcare.

4. Commonprescriptionsforpeople withbipolarinclude mood-stabilizingdrugs.Moodstabilizers,suchas
those containinglithiumandvalproicacid(Depakene),will helpwithmanicepisodes.If moodstabilizers
are notenoughto improve aperson’squalityof life,adoctormay nextprescribe antidepressant-
antipsychoticdrugcombinationssuchasfluoxetine-olanzapine(Symbyax).
Treatmentforbipolarmustbe ongoing.Whenpeople stoptakingmedicationormeetingwiththeir
doctor,theywill likelyhave manicanddepressive episodesagain.However,with the propertreatment,
bipolardisordercanbe controlledanda personcan leada healthyandproductive life.
Overview
Bipolardisordercanbe one of the most distinctanddramaticof mental illnesses.Itischaracterizedby
intense episodesof elationor irritabilityanddespair,withanycombinationof moodexperiencesin
between,includingperiodsof normal moods.Moodchangesare accompaniedbychangesinbehavior,
such as alteredpatternsof sleepandactivity.
Traditionally,one percentof the populationhasbeenaffectedbybipolardisorder,butasthe condition
has expandedtoinclude aspectrumof proposedbipolarconditions,thisnumberhasrisentoan
estimated2.6to 6.5 percent.Accordingtothe World HealthOrganization,bipolardisorderisthe sixth
leadingcause of disabilityamongpeople aged15to 44. It is lesscommonthanmajordepression,also
called“unipolar”depression,orsimply,“depression.”
The classicform of bipolardisorder,whichinvolvesrecurrentepisodesof maniaanddepression,iscalled
bipolarIdisorder.Some people,however,neverdevelopsevere maniabutinsteadexperiencemilder
episodes,calledhypomania,thatalternatewithdepression;thisformof the illnessiscalledbipolarII
disorder.Inaddition,there are twootherformsof bipolardisorder:bipolardisordernototherwise
specified(BP-NOS) andcyclothymicdisorder,orcyclothymia.BP-NOSisreservedforcaseswhere people
have symptomsof bipolardisorderthatdonot meetall the diagnosticcriteriaforbipolarIorII.
Cyclothymiaisamildformof bipolardisorderwherepeople have episodesof hypomaniathatshiftback
and forthwithmilddepressionforatleasttwoyears.The symptomsof cyclothymiaalsodonot fitinto
the diagnosticcriteriaforbipolar Ior II.
Studiesshowthatmenandwomenare equallylikelytodevelopbipolardisorder;however,thereis
some evidence thatwomenmayhave more depressive andfewermanicepisodesthanmenwiththe
illness.Womenseemtohave “mixedstates”(maniaorhypomaniaoccurringatthe same time as
depression) more oftenthanmen.Also,womenare more likelytohave the rapidcyclingformof the
disease,whichischaracterizedbyfouror more episodesof depression,maniaorhypomaniaayear,and
may be more resistanttostandard treatments.Womenare alsomore likelytohave bipolarII
disorder.BipolarDisorder
The symptomsof bipolardisordercanbe severe anddebilitating.Bipolardisease isnotcurable.
However,medicationcanhelpmanypeople achieveremission of symptoms.Treatmentand
maintenance of thisdisorderisnecessarythroughoutaperson’slifeonce bipolardisorderisdiagnosed.

5. Like some otherillnessesthatrequire lifelongtreatment,bipolardisorderposesunique medical
challengesforwomenwith the disorderwhoare pregnantorconsideringpregnancy.The notionthat
pregnancyitself isprotective forwomenwithbipolardisorderisnottrue.The riskof recurrence of
eitherdepressionormaniaduringpregnancyandpostpartumishigh.A recurrence duringthe
postpartumperiodoftendevelopsaspostpartumpsychosis.These risksare highforwomenwhostop
theirmood-stabilizingmedicationsandevenhigherforwomenwhostopthese medicationsabruptly.
So a womanwithbipolardisorderwhowantstobecome pregnantshoulddiscusshertreatmentoptions
withherhealthcare teambefore conception,if possible,orasearlyin herpregnancyas possible.
Concernsexistaboutthe potential harmful effectsmood-stabilizingmedicationsusedtotreatbipolar
disordermayhave on the developingfetusandthe nursinginfant.However,theseconcernsneedtobe
weighedagainstthe potential seriousrisksthatanepisode of maniaordepressionmaypose tothe
developingfetus,infantormother.
Diagnosis
Bipolardisorder,alsoknownasmanicdepression,generallystrikesinlate adolescence orearly
adulthood,mostoftenbetweenthe agesof 15 and 30, and usuallycontinuesthroughoutaperson’slife.
However,some people developtheirfirstsymptomsinchildhoodandothersdon’tdevelopthemuntil
laterinlife.
Researcherstheorizethatthere are a numberof contributingfactorsforwhyand how someone
developsbipolardisorder,includingageneticpredisposition,environmental influencesandbrain
chemistry.
Accordingto the National Institute of Mental Health(NIMH),closerelativesof peoplesufferingfrom
bipolarillnessare fourtosix timesmore likelytodevelopbipolardisorderthanthe general population.
It isimportantto note,however,thatnoteverybodywith afamilyhistorydevelopsthe illness.Noone
gene hasbeenidentifiedforthe disorder,butitappearslikelythatmanygenesacttogetherandin
combinationwithotherfactorsinthe personorthe person’senvironmenttocause bipolardisorder.
Studiesof identical twinswhoshare the same genesshow thatapersonwhohas an identical twinwith
bipolardisorderismore likelytodevelopthe disorderthansomeone whohasasiblingwiththe illness,
indicatingthatgenesare definitelyinvolved.However,an individual whohasatwinwithbipolar
disorderwill notalwaysdevelopthe illness,indicatingthatgenesandotherfactorsbothplaya role.
Studiessuggestthatstress,difficultyatworkor interpersonal relationshipsmaytriggerepisodesinthose
withbipolardisorder,particularlyif the stresscauseslossof sleep.The theoryisthatstressand/orloss
of sleepprecipitateschangesinbrainchemistryinsusceptible people.
Behaviorsandmoodscommonto bipolardisordermayinitiallybe attributedtoothermedical problems,
or othermental illnesses,whichcandelayanaccurate diagnosisandappropriate treatment.For
example,manypeople withbipolardisorderare misdiagnosedwithmajordepression.Inaddition,
alcohol anddrug abuse and/ordifficultieswithworkandschool performance maybe identified,but

6. theirunderlyingcause—bipolardisorder—maynotbe diagnosed.However,the disorderisnotdifficult
to diagnose bya well-trainedclinician.
Bipolardisorderisdiagnosedbasedonanevaluationof symptoms,the course of the illnessandfamily
history.Tobe diagnosedwithbipolardisorder,apersonmustmeetthe criteriaspelledoutinthe
DiagnosticandStatistical Manual of Mental Disorders,fourthedition(DSM-IV),publishedbythe
AmericanPsychological Association.Inadditiontoapsychiatricevaluation,acomplete medical exam
shouldbe completed.A physical examandbloodtestscanrule outmedical conditionsthat canmimicor
worsenbipolardisorder.
Physical tests,suchasa bloodtestor brainscan, cannotconclusivelyidentifythe illness,although
progressisbeingmade inthese areas.Forexample,brain-imagingstudiesusingmagneticresonance
imaging(MRI), positronemissiontomography(PET) andfunctional magneticresonanceimaging(fMRI)
proceduresallowresearcherstotake picturesof the brainto examine itsstructure andactivity.These
noninvasivetechniquesare beginningtohelpscientistslearnwhatgoeswronginthe brainto produce
bipolardisorderaswell asothermental illnesses.
Symptoms
The symptomsof bipolardisorderfall intoseveral categories:depression,maniaandmixedstate type of
episodes(inmixedepisodes,symptomsof bothdepression andmaniaare presentatthe same time).In
addition,people experiencinganyof these typesof moodepisodesmayexperience psychosis,whichisa
seriousinabilitytothinkandperceiveclearly,orlosingtouchwithreality.If youora familymember
experiencesanyof these symptoms,youshoulddiscussthemwithahealthcare professional and
requestathoroughevaluation,whichshouldinclude aphysical checkupandafamilyhealthhistory.
The symptomsof depressioninclude:
 constantor persistentsadness
 lossof pleasure andinterestinactivitiesthatwere once fun,includingsex
 significantchange inappetiteorweight(eitherincrease ordecrease)
 restlessnessoragitation
 irritabilityorexcessive crying
 change in sleeppatterns,eitheroversleeping orinsomnia
 lack of energy,feelingsloweddownmentallyandphysically
 feelingsof guilt,worthlessness,helplessness,hopelessness
 persistentphysical symptomsthatdonot respondtotreatment,suchas headaches,digestive
disordersandchronicpain
 difficultythinkingorconcentrating
 recurringthoughtsof deathor suicide
The symptomsof maniainclude:
 persistentandabnormallyelevatedmood(euphoria)

7.  irritability
 overlyinflatedself-esteemorfeelingsof importance
 a decreasedneedforsleep
 increasedtalkativeness
 racing thoughts
 increasedactivity,includingsexual activity
 distractibility
 increasedenergyand/orphysicalagitation
 excessiveinvolvementinriskybehaviors,suchasspendingmoneyirresponsibly
 poor judgment
 inappropriate social behavior
Significantdisruptioninyoursleep-wakecycle isanearlywarningsignof an impendingepisode.
Controllingyoursleep-wakecycle andmaintainingaregularpatterniscritical to avoidmakingthe illness
worse.Decreasedanddisruptedsleepoccursfrequentlyfornew mothers.Itisimportantforwomen
withbipolardisorderwhoare pregnantorconsideringpregnancytotalkwiththeirhealthcare providers
aboutways to reduce theirsleepdisruptionsaftergivingbirth.
Othersymptomsof manicdepressioninclude psychosis,whichinvolveshallucinationsanddelusions
(falselybelievinginsomethingwithconviction,despiteproof orevidence tothe contrary).
Mixedstate episodesincludesymptomsof bothdepressionandmania,oftenincludingagitation, trouble
sleeping,change inappetite,psychosisandthoughtsof suicide.
Symptomsof mania,depressionormixedstate are episodicandtypicallyrecur.Episodesmaybecome
more frequentwithage if the conditionisn’tproperlytreated.These episodes,especiallyearlyinthe
course of the illness,are separatedbyperiodsof wellness,whensomeone suffersfew ornosymptoms.
Womenwithbipolarsyndrome are more likelytoexperience psychosisandmanicepisodesduring
pregnancyandafter givingbirth.This riskishigherforwomenwhostoptheirmood-stabilizing
medicationsandevenhigherforwomenwhostopthese medicationsabruptly.
The combinationsandseverityof symptomsvaryfrompersontoperson.Some people have severe
manicepisodesinwhichtheyfeel outof control,have tremendousdifficultyfunctioningandsevere
psychosis.Otherpeoplehave milder“hypomanic”episodesthatinclude increasedenergy,euphoriaand
irritability.Some suffercompletelyincapacitatingperiodsof depressionandare unable tofunction
withintheirnormal dailyroutine.Hospitalizationisnecessarytotreatsevere episodesof maniaor
depression.
If you have bipolardisorder,youmayhave difficultyacknowledgingyourmoodswingsevenif familyand
friendstell youabout these behaviors.
Duringa manicepisode,youmightabuse alcohol,scheduletoomanyeventsormeetingsforone day,
drive recklessly,goona spendingspree,make unwiseorriskybusinessdecisionsorbe unusually

8. promiscuoussexually.Untreated,the manic phase canlastfromdays to months.Asitfades,a periodof
normal moodand behaviormayoccur. Sometimesthe depressive phase of the illnessthensetsin,but
anothermanicepisode couldalsofollow.
Whenyou’re experiencingadepressedepisode,youmightlose complete interestineverythingyou
usedto enjoy,notbe able tostop crying,feel completelyhopelessandcontemplate suicide.Insome
people,depressionoccursimmediatelyafteramanicepisode orwithinthe nextfew months.Butwith
others,there isa longinterval before the nextmanicordepressiveepisode.The depressive phase has
the same symptomsas majordepression(alsocalled“unipolar”depression).
People withbipolardisordermayhave abnormal thyroidglandfunction.Because toomuchor toolittle
thyroidhormone alone canleadtomood andenergychanges,itisimportantthat yourhealthcare
professionalcloselymonitoryourthyroidlevels.Additionally,if you’retreatedwithlithium, thatmay
cause lowthyroidlevels.
Treatment
If you have bipolardisorder,youwillneedlifelongtreatment.Regularmonitoringandconsultationwith
a healthcare professional isnecessarytoestablishwhichmedicationorcombinationof drugsworks
best.
Medicationscalled“moodstabilizers”are mostoftenprescribedtohelpcontrol bipolardisorder,and
several typesof moodstabilizersare available.Ingeneral,peoplewithbipolardisordercontinue
treatmentwithmoodstabilizersforanextendedtime tomanage theirillness,usuallyforyears.Other
medicationsare sometimescombinedwithmoodstabilizerswhennecessarytotreatpowerful episodes
of maniaor depressionthatmaybreakthroughdespite the moodstabilizer.These additional
medicationsmayinclude:anantipsychoticforpsychosisormania;anantidepressantfordepression;
and/ora benzodiazepineforagitation.
For nearly40 years,the moodstabilizerlithiumhasbeenone of the maintreatmentsforpeople with
bipolardisorder.
Lithiumevensoutmoodssoyoudon’tfeel ashighor as low,but it’sunclearexactlyhow the medication
worksinthe brain.Lithiumisnotusedjustfor manicattacks,but rather as an ongoingtreatmentto
preventall typesof episodes.Itcantake up to three weekstostartreducingsevere manicsymptoms.It
mighttake a fewmonthsof medicationbefore the illnessisundercontrol.
Whentakenregularly,lithiumcaneffectivelycontrol depressionandmaniaandreduce the chancesof
recurrence.However,whileitiseffective treatmentformanypeople,itdoesn’tworkfor everybody.
Regularbloodtestsare a must if you’re takinglithium.The levelof lithiuminyourbloodcanbe
measuredwithabloodtest.Thislevel isusedbyyourdoctor,alongwithyoursymptoms,todetermine
the appropriate dose of lithiumforyou.Toosmall a dose mightnotbe effective andtoolarge might
produce unwantedside effects,includingweightgain,tremors,excessive thirstandurination,
drowsiness,weakness,nausea,vomitingandfatigue.

9. Saltintake alsoaffectsthe amountof lithiuminyourbody.A dramatic reductioninsaltintake,excessive
exercise andsweating,fever,vomitingordiarrheamaycause lithiumtobuildupinyourbodyto toxic
levels.Anoverdose of lithiumcancause confusion,delirium,seizures,comaandmay result,although
rarely,indeath.
In additiontolithium, othermoodstabilizersusedinthe treatmentof bipolardisorderinclude
anticonvulsants.Theymaybe combinedwithlithiumorwitheachotherformaximumeffect.Specific
onesusedforbipolarsyndrome include:
 Anticonvulsants.Antiseizure medications(alsocalledanticonvulsants)suchasvalproicacid
(Depakene) anddivalproex (Depakote) canhave amood-stabilizingeffectinpeople withbipolar
disorder.There issome evidence thatvalproicacidmayresultinhormonal changesinteenage
girlsand polycysticovariansyndrome(PCOS)inwomenwhobegantakingthe medicationbefore
age 20. Young womenshoulddiscussthisriskwiththeirhealthcare professionals,andthose
takingvalproicacidshouldbe monitored carefullyforpossiblehormonal problems.The
anticonvulsantscarbamazepine(Tegretol) andoxcarbazepine (Trileptal) alsohave some effects
as moodstabilizers,althoughtheyare notyetapprovedforbipolardisorderbythe U.S.Food
and Drug Administration(FDA).Atthispoint,there ismore evidence onthe effectivenessof
Tegretol thanTrileptal.Andthe anticonvulsantlamotrigine(Lamictal) isFDA-approvedforthe
long-termtreatmentof adultswithbipolardisorder.Itisspecificallyusedtotreatthe depressive
episodesinvolvedwithbipolardisorder.Someanticonvulsantscandecrease the effectivenessof
hormonal contraceptives,suchasbirthcontrol pills.Itisimportantto discussyourmethodof
contraceptionwithyourhealthcare providertodetermineif there isaninteraction.
Severelyill patientsmayrequire acombinationtreatmentwithmoodstabilizersandotherdrugs,
including:
 Antidepressantmedications.Several classesof antidepressantmedicationsare sometimesused
to treat the depressive symptomsof bipolardisorder,includingfluoxetine (Prozac),paroxetine
(Paxil),sertraline (Zoloft) andbupropion(Wellbutrin).However,the use of antidepressantsin
people withbipolardisorderiscontroversial,since antidepressantsmaynotbe anymore
effectivethanmoodstabilizersattreatingdepressive episodesinpeople withbipolardisorder
and can triggermanicepisodes.Make sure youtell yourhealthcare professional aboutanyprior
symptomsof hypomaniaormania(episodesthatinclude increasedenergy,euphoriaand
irritability) before beginningantidepressants.Sideeffectsandeffectivenessdifferforeachclass
of antidepressant,aswell asforthe individual brands.
 Antipsychotics.If you’re experiencingpsychoticormanicsymptomsduringan episode of bipolar
disorder,healthcare practitionerswill sometimesprescribeantipsychoticmedicine aloneorin
combinationwithatraditional moodstabilizertocontrol symptoms.Olanzapinecanalsobe used
alone forthe treatmentof bipolardisorder.Examplesof antipsychoticsusedinclude:olanzapine
(Zyprexa),ziprasidone (Geodon),quetiapine (Seroquel),aripiprazole(Abilify) andrisperidone
(Risperdal),all FDA-approvedforthe treatmentof bipolardisorder.Inaddition,antianxiety
medicationssuch asbenzodiazepinesmaybe usedinsome people withbipolardisorderwith

10. acute mania to helpwithsleep.There isapotential forabuse of orphysical dependence on
benzodiazepines.Therefore,these medicationsare oftenprescribedonlyforalimitedtime, such
as duringan acute episode.
Be patient.Itmaytake up to three weeksof regularuse of a new drug before yoursymptomsimprove
or subside.Stayinclose communicationwithyourhealthcare professional andlethimorherknowif
youdon’tfeel like youare respondingtotreatment.Insome cases,treatmentplansneedtobe changed
to effectivelycontrol symptoms.
Electroconvulsive therapy(ECT)
isanothertreatmentoptionforbipolardisorderandothertypesof majordepression.Itisusuallyonly
usedto treatbipolardisorderwhenmedication,psychosocial treatmentorthe combinationof these
treatmentsare ineffective orworktooslowlytorelieve severesymptomssuchaspsychosisorthoughts
of suicide.ECTmayalsobe consideredwhencertainmedical conditions,suchaspregnancy,make the
use of medicationtoorisky.
Justprior to ECT treatment,you’re givenamuscle relaxantandsometimesgeneral anesthesia.
Electrodesare thenattachedto yourscalp.An electriccurrentcausesa brief convulsion.Treatments
usuallylastfor30 to 90 seconds.Youwon’trememberthe treatmentsandwill probablyawake slightly
confused.Youwill mostlikelyrecoverinfive to15 minutesandbe able to go home the same day.Acute
treatmentsusuallyoccurthree timesperweekforaboutamonth.Maintenance treatmentsmaybe
givenafterthatat a reducedfrequency.
ECT has beenusedformore than 70 yearsand has beenrefinedsince itsearlyintroductionasa
treatmentfordepression.AccordingtoMental HealthAmerica,ECT isadministeredtoanestimated
100,000 people ayear,primarilyingeneral hospital psychiatricunitsandinpsychiatrichospitals.
Researchers don’tunderstandexactlyhow itworkstoimprove symptomsof depressionand/ormaniain
some individuals,butthe evidence isclearthatitdoeswork.
Althoughmythsandnegative perceptionscontinuetobe perpetuatedaboutECT,itisa veryeffective
treatmentformanypeople withseveredepressive,manicormixedepisodeswhodon’trespondtoor
have bad effectsfromothertreatmentsorcan’ttake othertreatmentsforsome reason.Researchhas
shownthat patientswhoreceiveECTfollowedbymaintenancelithiumtherapyhave betteroutcomes
than patientswhoreceivelithiumalone.Aswithall othertreatments,youshouldundergoacomplete
physical evaluationbefore beginningECTtherapy.
Side effectscaninclude permanentmemorylossandconfusion.These side effectswere more of a
concernin the past,and modernECT techniqueshave reducedthemsignificantly.However,the benefits
and risksof ECT shouldstill be carefullyweighedbefore anindividualorhisor herfamilyandfriends
decide togo withthe treatment.
Psychotherapy.

11. As withall mental illnessesandotherseriousconditions,bipolardisordercandevastate aperson’sself-
esteemandrelationships,especiallywithspousesandfamily.Withouttreatment,people withthe illness
may jeopardize theirfinances,theircareers,theirfamiliesandtheirlives.Thus,inadditiontotreatment
withmedications,psychotherapy(“talktherapy”) isalsorecommendedforindividualswiththe disorder,
as well asfor theirfamilymembers.
Bipolar Disorder and Pregnancy
Womenwithbipolardisorderwhowanttobecome pregnantneedtoconsiderseveral issues.Careful
planningforpregnancycanhelpwomenwithbipolardisease bestmanage theirillnesswhile avoiding
risksto theirbabies.The goal isto maintainastable moodduringpregnancyandpostpartum.Itis
extremelyimportanttoconsiderboththe risksof the medicationstothe unbornbaby,as well asthe
risksof untreatedbipolardisordertoboththe motherandunbornbaby.These shouldbe weighed
carefullyin athoroughdiscussionwithyourhealthcare provider.
Afterdiscussingrisksandbenefitswithyourhealthcare professional,if youprefernottouse medication
duringpregnancy,atrial off medications(followingagradual taper) priorto pregnancy,possiblyonly
stoppingmedicationsafterconception,mightbe anoption.Mosthealthcare professionalssuggest
avoidingsuddenchangesinmedicationduringpregnancy,whichcanincrease the riskof relapse.
Overall,studiesshowthattakingonlyone moodstabilizerduringpregnancyposeslessof ariskto the
developingfetusthandoestakingmultiple medications.Some anticonvulsantshave beenshowntobe
harmful tofetuses,possiblyleadingtobirthdefects.However,ratesof problemsvarywidelybasedon
the medication.Discusspossiblemedicationsandtheirriskswithyourhealthcare professional and
alwaysweighthisagainstthe riskof untreatedbipolardisorder.
Some of these medicationscanbe usedwhile breastfeedingbutall optionsshouldbe discussedwith
your healthcare professional.Overall,if youare pregnantor planningtobecome pregnantandyouhave
bipolardisorder,be sure todiscusssafetyof varioustreatmentoptionsduringandafterpregnancywith
your healthcare professional.
ECT has alsobeenusedfordecades(withappropriate adjustments) inpregnancytotreatsevere mania
or depression.
Prevention
Patientsandtheirfamiliesneedtounderstandthatbipolardisorderwill notgoaway,andthere isno
wayto preventthe disorderfromdeveloping.The onlywaytokeepthe disorderundercontrol is
throughcontinuedcompliancewithtreatment.
Facts to Know
 Bipolardisorderinvolvesepisodesof maniaanddepression.
 Traditionally,one percentof the populationhasbeenaffectedbybipolardisorder,butasthe
conditionhasexpandedtoincludeaspectrumof proposedbipolarconditions,thisnumberhas

12. risento an estimated2.6to 6.5 percent.Accordingtothe WorldHealthOrganization,bipolar
disorderisthe sixthleadingcause of disability amongpeopleaged15 to 44.
 Most people withbipolardisordercanexpectthateventheirmostseveremoodswingswill be
relievedwithtreatment.
 Like otherseriousillnesses,bipolardisorderisnotonlydifficultforthe personwhohasitbut
alsohard on familymembers,friendsandemployers.Familymembersof people withbipolar
disorderoftenhave tocope withseriousbehavioral problems(suchaswildspendingsprees)
and the lastingconsequencesof these behaviors.
 Bipolardisordergenerallystrikesbetweenthe agesof 15 and 30.
 Bipolardisordertendstorunin families,andmanyresearchersbelieveitisgenetic.Researchers,
however,have notassociatedaspecificgeneticdefectwiththe disease.
 Noteverybodywithafamilyhistoryof manicdepressiondevelopsthe illness.
 Studiessuggestthatstress,difficultyatworkor withinterpersonalrelationshipsmaytrigger
episodesinpeople withbipolardisorder,particularlyif the stresscauseslossof sleep.
 Lithiumhasbeenthe treatmentof choice for people withbipolardisorderbutdoesn’tworkfor
everyone withthe disorder.Othereffectivetreatmentoptionsare available.
 Bipolardisordercangetworse duringand afterpregnancy.Because of potential risktothe
developingfetusdue tobothuntreatedillnessaswell assome medications,the diseasemustbe
carefullytreatedbyahealthcare professional duringthistime.
Key Q&A
1. What isbipolardisorder?Also calledmanicdepressive illnessormanicdepression,thismental
illnessischaracterizedbyepisodicmoodswingsthatrange fromoverly“high”and/orirritable to
sadnessandhopelessness,andthenbackagain,withperiodsof normal moodinbetween.
2. Who usuallyisaffectedbybipolardisorder?Menandwomenare equallylikelytodevelopthe
condition,usuallybetweenthe agesof 15 and30. However,researchhasshownthatwomen
are more likelythanmentodevelopthe rapidcyclingformof the condition—withepisodes
occurringfour or more timeswithina12-monthperiod.Mostoften,symptomsbeginbetween
age 15 and 30. Researchhas shownthatthere is a geneticcomponenttothe disorderandthat
people withaclose relative withbipolardisorderare fourto six timesmore likelytodevelopit
than people withnofamilyhistory.
3. Can the disorderbe effectivelytreated?Yes.Fornearly40 years,lithiumhasbeenthe treatment
of choice forpeople withbipolardisorder.Itlevelsoutmoodswingssothatpatients don’tfeel
as highor as lowand isusedas an ongoingtreatment.Symptomsmaydiminishafterone to
three weeksof treatment,butitmighttake a few monthsof medicationtocontrol the illness.
Newerdrugsdevelopedforthe disorder,usedaloneorincombinationwithlithium, are also
prescribed.
4. Can bipolardisorderbe cured?No.Treatmentforthe illnessinconsideredlifelong.Ongoing
maintenance andperiodicconsultationwithaknowledgeablehealthcare professional istypical.
5. What if I can’t tolerate lithium?There are anumberof othereffective treatments.Yourhealth
care professionalmightprescribeseveral medicationsincludingbothantidepressantsand

13. anticonvulsantmedications.However,itmaytake several monthstodetermine the proper
medication,dosage andfrequency.
For more informationvisitusourwebsite:http://www.healthinfi.com