Bipolar Disorder

This is also called manic depressive disorder. It is a common mood disorder that unfortunately is associated with a bad name. But the truth is that bipolar disorder can be a blessing sometimes if properly treated as Dr K Jamison wrote in her book, The Unquiet Mind. “So why would I want anything to do with the illness because I honestly believe that as a result of it I have felt more things, more deeply, had more experience, loved more and been more loved, laughed more, laughed more for having cried more often, appreciated more the springs, for all the winters”. Dr Jamison did not write that unless she had been properly treated. Unfortunately sometimes bipolar disorder can not be diagnosed properly and that leads to a lot of problems for the patient. It is now known that giving usual anti-depressant medication to a patient with bipolar disorder without mood stabilizers can lead to agitation and adverse effects of the medication. Bipolar patients can be enjoyable to work with as they all share common features of being outgoing people and have a sense of humor when they are stable. Universally speaking patients with Bipolar Disorder all hate taking medication which is the most challenging part in treatment, especially when they are in a hypomanic phase. I have many times heard the following statement from a patient in hypomanic phase “Why are you upset that I am happy, I am finally happy. Do you want me to be depressed so you can make more money, I hate you.“ The problem with hypomania is that if it is not controlled it can lead to either a manic or severe depressive episode.

So how do you make the diagnosis of Bipolar Disorder? The DSM IV RT describes bipolar disorder as a mood disorder that is characterized by having at least one manic episode for type I and at least one hypomanic episode for type II.

So what is a manic episode?
A manic episode is one side of the coin of bipolar disorder which is a mood disorder. During a manic episode there is a noticeable change in mood from the normal non-depressed state to either an elevated or irritable mood, that lasts for at least a week or more. Remember the mood change has to be present. The mood change has to be associated with at least 3 or 4 of the following:

  • Distractibility. This is the most common symptom and is usually characterized by the inability to pay attention to any activity for very long.
  • Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep.)
  • Grandiosity. Patients with this symptom have an inflated sense of themselves, which, in severe cases, can be delusional. Close to 60% of all manic patients experience feelings of omnipotence. Sometimes they feel that they are godlike or have celebrity status.
  • Flight of ideas. Thoughts literally race.
  • Activity. An increase in intensity in goal-directed activities occurs, which is related to social behavior, sexual activity, work, school, or combinations.
  • Speech. Excessive talking is present.
  • Thoughtlessness. Excessive involvement in high-risk activities is present (e.g., unrestrained shopping, promiscuity). Mood disturbance may be severe enough to damage one’s job or social functioning or relationships with others, or which requires hospitalization to prevent harm to others or to the self.

Mixed or Pure Mania.
Manic episodes themselves can be characterized as mixed mania or pure mania:

In pure mania, either euphoria or irritability is present along with other symptoms of mania and there are no indications of depression.

In mixed mania (also called a mixed state), depressed mood and manic symptoms occur for at least a week. Depression is present most of the day and nearly every day. Symptoms of mania are also present to a significant degree.

What is a hypomanic episode?
Hypomania. With hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically as mania. Notice that the difference is mainly about the severity and length of the episode. In hypomania there is no impairment of the judgment. In fact, all patients consider it as a positive period in there life because they are more productive and can catch up with what they did not do when they were depressed, i.e. cleaning the house, doing laundry, Taxes, work project or painting the garage. This helps to understand the statement of the angry hypomanic patient to their psychiatrist when he/she wants to treat the hypomanic episode.

Bipolar Disorder should be highly suspected in the following population of depressed patients:

  • Any patient with a family history of bipolar disorder in the 1st degree relative should be treated as if they are bipolar even if they never had a manic or hypomanic episode.Psychotic symptoms associated with first episode of mood disorder.
  • Patient who has failed an adequate trial of at least 3 anti-depressants or the antidepressant worked very fast but stopped working shortly thereafter.
  • Patient who became manic or psychotic on antidepressant or other med or Marijuana.
  • Post partum depression.
  • Family history of alcoholism.
  • Patients who have attention deficit & mood disorders.

For more information about bipolar disorder ask your mental health professional or go to www.mentalhealth.com mood disorder.

For information about meds go to www.crazymeds.com.