About Bipolar Disorder

What is Bipolar Disorder?

Bipolar disorder—commonly known as manic-depressive illness—is a brain disorder that causes extensive changes in a person's mood, energy and ability to function.

  • Bipolar I disorder is the most severe form of the illness and consists of alternating periods of mania and depression.
  • In comparison, Bipolar II disorder consists of alternating periods of recurrent depression and less intense episodes of mania, called hypomania.

Alcohol and drug abuse are common among people suffering from bipolar disorder, and studies have shown there may also be an increased tendency for anxiety disorders, as well.

People often suffer for years before bipolar disorder is properly diagnosed and treated. Once diagnosed, most people can respond to treatment that combines medication, education and support. The goals of treatment are to stabilize the acute episode and to prevent the recurrence of future episodes.
Reprinted from Semel Institute UCLA

What is the difference between Bipolar I and Bipolar II?

Bipolar I disorder, formerly termed manic-depressive illness, is defined by at least one lifetime manic or mixed episode. Mania must last at least one week or require hospitalization. Manic symptoms include irritability or euphoria along with decreased need for sleep, grandiose ideas, impulsive behavior, racing thoughts, flight of ideas, increased activity, and distractibility. Episodes of major depression are defined by two or more weeks of intense sadness or loss of interests, accompanied by symptoms such as fatigue, insomnia, psychomotor agitation or retardation, weight gain or loss, cognitive dysfunction, and suicidal ideation or attempts. Most, but not all people with BD I experience periods of depression.

Bipolar II is defined by at least one lifetime hypomanic episode, along with at least one episode of major depression. Hypomania is characterized by the same symptoms as mania but lasts for shorter intervals (four or more days) and, although noticeable to others, is not associated with functional impairment. “Converting” from BD II to BD I is rare.

What are the symptoms of bipolar disorder in childhood?

Some people become overly happy and excited or giddy or overly irritable and angry. They may feel like they can do things that no one else can do (grandiosity). They may sleep less than usual or not at all, do many things at once, have more energy, talk faster and express many ideas (some realistic and some unrealis tic), and be easily distracted. They may do things that are impulsive when manic, like spend a great deal of money unwisely, drive recklessly, or become sexually impulsive.

People may experience the symptoms of depression at other times, which can include feeling very sad, down, irritable, or anxious, losing interest in people or things, sleeping too much or being unable to sleep, having little or no appetite, having trouble concentrating or making decisions, feeling fatigued or low in energy, moving or talking slowly, feeling very bad or guilty about oneself, or contemplating suicide or actually carrying out suicide attempts.

Many people with bipolar illness have “mixed” symptoms, in which they feel manic and depressed at the same time. They may feel (or act) irritable, sped up, “tired but wired,” and unable to sleep; at the same time they may feel worthless, have suicidal thoughts, or may lose interest in everything. Some people alternative rapidly between these different extremes of mood (“rapid cycling”).

Some people have Bipolar I with mood swings that go from severely depressed to severely manic or mixed. Others have Bipolar II which is severe depression alternating with less intensive “hypomanias,” or periods of high energy and activity that may not disrupt the person’s functioning. Diagnoses can be challenging, and often requires extended periods of observation to confirm.

How Does Bipolar Disorder Affect the Family?

Bipolar disorder affects the person’s ability to relate to others in the family or in the work or school setting, especially when ill. Most commonly, spouses, parents or siblings of the person with bipolar disorder complain about the person’s irritability, stubbornness, and impulsive outbursts of rage. Some families complain of a “toxic” atmosphere in the household when the person’s mood is cycling. Family problems may be most apparent during or just after an episode of mania or depression, but then may improve as your family member gets better. Part of the mindfulness treatment program offered through the Danny Alberts Foundation involves teaching people to regulate their more extreme emotions when faced with conflicts.

What Causes Bipolar Disorder?

Having bipolar disorder means that the person has dysregulations in the emotional regulation “circuitry” of the brain, especially the amygdala and the prefrontal cortex. Children often inherit these dysregulations from parents or grandparents, even though these relatives may not have the disorder themselves. People with bipolar disorder are also be affected by life stress or sudden changes in sleep–wake habits.

How Is Bipolar Disorder Treated?

You should get a diagnostic evaluation first. This usually means several sessions with a psychiatrist or psychologist, sometimes working together. After these sessions, a treatment plan is developed, or you will be given referrals for care. The Child and Adolescent Mood Disorders clinic at UCLA operates this way.

A variety of medications are employed to treat the disorder. It is common for mood stabilizing medications such as lithium, Depakote, or Lamictal, or “atypical antipsychotic” medications like Seroquel, Risperdal, Zyprexa, Abilify, or Geodon to be prescribed. Some people also take antidepressant medications for depression, anxiety, or sleep. Some people require treatment with several of these medications at once. These medications require close monitoring and frequent check-ups of both behavior and possible side effects. Many people also benefit from group or family support sessions.

Mindfulness-based cognitive therapy is conducted in groups of up to 10 people, where the goal is to learn to use mindfulness meditation to handle stress. Therapy may also be helpful for the person and his or her family to learn more about the disorder, how to prevent relapses, how to monitor moods and sleep–wake cycles, and how to function better in the family and work or school environment. The CHAMP clinic specializes in one type of therapy that has been shown to be effective in pediatric bipolar disorder: family-focused treatment (FFT), which combines education about coping with bipolar disorder, communication enhancement training, and training in problem-solving skills.

What Does the Future Hold for People with Bipolar Disorder?

Many people with bipolar disorder have recurrences of mood disorder throughout their lifetime, but there is every reason to be hopeful. With the help of a regular program of medication, therapy, and support from others, mood disorder episodes become less frequent and less extreme. With help, a person with bipolar disorder may be able to accomplish many of his or her goals for the future. By working closely with people with bipolar disorder and their families, our hope is that the Danny Alberts program will significantly advance our knowledge of effective diagnosis, treatment, and prevention of bipolar mood disorders in children and adults.