Oct 07, 2014
By: Elinore F. McCance-Katz, M.D., Ph.D., FAAAP, Chief Medical Officer, and Paolo del Vecchio, M.S.W., Director, Substance Abuse and Mental Health Services Administration
Bipolar disorder, sometimes called “manic-depressive illness,” is a serious mental illness that causes unusual shifts in mood, energy, and activity levels. In any given year, it impacts approximately 2.6 percent of the American public.
Bipolar disorder can be severe enough that it interferes with day-to-day activities such as going to school or work or socializing with friends. Symptoms of bipolar disorder can include mood swings that go from severe, sometimes suicidal depression to euphoria, agitation and psychosis. Those experiencing mania may have racing thoughts and speak rapidly or have concentration problems and rapid shifting from one activity to another, often with poor judgment and risky behaviors. Depression associated with bipolar disorder can include severe feelings of sadness, guilt and worthlessness, poor concentration, appetite and sleep, low energy and thoughts of or attempts at suicide. Severe mood swings may occur infrequently—perhaps a few times a year—but some will experience these mood shifts several times a day. More than 50 percent of those with bipolar disorder will have symptoms before age 25 with some experiencing onset in childhood or adolescence.
The causes of bipolar disorder are likely a combination of genetic and environmental factors that increase the risk of developing the illness. The disorder can run in families. Brain changes in those experiencing bipolar disorder are not yet well understood. Experiencing trauma, stress, or significant losses may play a role in developing this disorder. Bipolar disorder must be differentiated from other medical disorders that can affect mood such as thyroid disease or other mental illnesses that have similar symptoms including major depression, attention deficit hyperactivity disorder, schizophrenia, schizoaffective disorder, or substance use disorders such as stimulant (cocaine or methamphetamine) misuse.
Lithium is a first line medication to treat the symptoms of bipolar disorder. Side effects that can occur with lithium treatment include restlessness, dry mouth, indigestion, acne, muscle/joint pain, brittle nails, tremor, and effects on the kidneys. Lithium toxicity can occur if the dose is too high; therefore people must have blood samples taken to determine lithium levels as well as testing for kidney and thyroid function.
Mood stabilizer medicines may also be prescribed to help balance mood. Common side effects include weight gain, dizziness, sleepiness, and rarely blood or liver problems. Antipsychotic medications are sometimes used for people with mania or who do not respond to mood stabilizers. These medications may have side effects of weight gain, blurred vision, drowsiness, tremor or rapid heartbeat for some. Antidepressants may be prescribed for severe low mood, usually in combination with a mood stabilizer, because antidepressants alone in those with bipolar disorder may trigger a manic episode.
In addition to medication treatment, psychotherapies including cognitive-behavioral therapy, psychoeducation, family therapy, individual or group therapy can be helpful. In addition, recovery supports and wellness activities can also be important in achieving and sustaining recovery. These include peer services, support groups, stress reduction using meditation or relaxation techniques such as yoga, getting enough sleep, avoiding alcohol and illicit drug use, and participating in healthy activities such as exercise, hobbies or other recreational activities.
Bipolar disorder can take several forms that differ in severity and symptoms. It is a disorder that requires medical care and a team approach. Psychiatrists are medical doctors skilled in diagnosing and treating this disorder and other mental and/or medical illnesses that may co-occur. Psychologists are often helpful in providing psychotherapies. Psychiatric nurses, social workers, and counselors are an important part of the team working to help with understanding the illness and its treatments and any social supports needed. Peers are people with lived experience of mental illnesses who can help a person to better understand their condition, navigate systems, and be a supportive ally in the recovery process.
Bipolar disorder is a serious mental illness, but one that can be treated and from which people can have long term recovery with the appropriate ongoing support. SAMHSA’s Treatment Locator can help a person experiencing these symptoms to find the care they need for this and other conditions.