Bipolar Disorder: Who Does It Affect?

Bipolar disorder causes extreme mood swings.

Bipolar disorder (BD) is a psychiatric diagnosis that includes episodes with both mood changes and altered activity or energy. In the past, bipolar disorder was called manic depression (or affective psychosis in the 1800s). All of these names describe the episodes in bipolar disorder that include elevated mood and increased activity (or mania), often followed by periods of low mood (depression) disorder in the past. Bipolar disorder is a serious, often lifelong, mental illness that causes serious disruptions in lifestyle and health. However, there are effective treatments for bipolar disorder, and people with this diagnosis can live full and productive lives.

• Bipolar disorder includes episodes of extreme, elevated mood and energy lasting many days or weeks. These episodes are more than just mood swings or feeling good or happy.
• Everyone has occasional highs and lows in their moods. But people with bipolar disorder have extreme mood changes. They can go from feeling very sad, despairing, helpless, worthless, and hopeless (depression) to feeling as if they are on top of the world, hyperactive, creative, irritable or euphoric, and grandiose (mania or hypomania).
• Bipolar disorder takes its name from the opposite poles of mood, from mania or hypomania to major depression or sadness (depression).
• Mania is an episode lasting at least a week that causes significant impairment in a person's ability to function at work, home, or other settings. Hypomania lasts at least four days and is not as extreme or impairing as a full-blown manic episode.
• Symptoms of both mania and depression sometimes occur together in an episode described as having "mixed features."
• The extremes of mood usually occur in cycles. Much of the time, manic or hypomanic episodes are followed by a major depressive episode. In between these mood episodes, people with bipolar disorder are often able to function fully, hold a job, and maintain relationships with family and friends.
• When a person is in the grip of this disease, chaos can occur. Bipolar disorder can cause major disruption of family and finances, loss of a job, and marital problems.
• Severe depression can be life-threatening. It may be associated with self-harm, thoughts of suicide, suicide attempts, or death by suicide.
• Extreme mania can sometimes lead to aggressive behavior, including dangerous risk-taking behaviors, or violence, which could occasionally include homicidal acts.
• People with bipolar disorder may also have other psychiatric diagnoses. Substance use disorders, including alcohol or other drugs, are particularly common.

The symptoms of bipolar disorder tend to have two peaks of when they begin: between 15 and 25 and from 45-54 years of age.

The mean age for the first manic, hypomanic, or major depressive episode in someone with bipolar disorder is 18 years old. Diagnosis before the age of 18 is challenging due to developmental changes in children and teenagers. Behavioral problems can be easily confused with bipolar disorder, so careful evaluation by a trained child-adolescent psychiatrist is critical to make the right diagnosis and to treat appropriately.

Even though many people are first diagnosed with bipolar disorder in their late teens or twenties, the onset can occur throughout the life cycle, even into the 60s or 70s. However, onset at older ages is quite uncommon, and medical professionals must first rule out other non-psychiatric causes (for example, the effect of drugs or medications; other medical conditions such as brain injuries, strokes, or dementia). Sometimes, a diagnosis may be delayed until there have been multiple manic, hypomanic, or depressed episodes and the pattern of bipolar disorder is clearer.

Worldwide, bipolar disorder affects about two people in every 100 during their lifetime (2% lifetime prevalence). Bipolar disorder affects men and women equally, in contrast to major depression and anxiety disorders which tend to affect more women than men. Bipolar disorder does not appear to have rates of different races and ethnicities, but there is limited research in this area. Countries with higher incomes seem to have higher rates of bipolar disorder than those with lower incomes, but the meaning of this association is unclear.

Bipolar disorder does appear to run in families. People who have close family members with bipolar disorder are about 10 times more likely to develop bipolar compared to someone without affected relatives. There is also some genetic link between schizophrenia and bipolar disorder since these two mental illnesses tend to associate in families.

While no single cause of the bipolar disorder has been identified, there are a number of factors that contribute to the development of this illness.

As with most psychiatric diagnoses, we are learning more but still do not fully understand bipolar disorder. Most experts agree that an interaction between genetic and environmental factors (for example, stress, exposure to certain drugs or medical conditions, etc.) causes bipolar disorder. More and more genes are being identified with an association with bipolar disorder, but there is no single gene that causes this condition. It is likely that many genes are involved and that individuals with bipolar may each have different sets of genes related to their diagnosis. The genetic component to bipolar disorder is demonstrated by the pattern of bipolar disorder within families; when one person has bipolar disorder, their family members have a higher chance of also developing bipolar disorder. Close relatives have a higher risk, and the identical twin of a person with bipolar disorder is at the highest risk for developing the condition. However, genes alone are not enough, but the interaction between genes and stress of some kind often is needed to trigger the onset of the disease. Stresses can also trigger a manic or depressive episode in people who are known to have the condition -- for this reason, practices that support good mental health are important.

Bipolar disorder involves chemical imbalances within the brain. The brain's functions are controlled by chemicals called neurotransmitters. Like depression, bipolar disorder was thought to involve an imbalance in one family of neurotransmitters called monoamines. The monoamines include serotonin, norepinephrine, and dopamine. Increased dopamine activity is associated with mania (and psychosis). In contrast, decreased serotonin and norepinephrine activity are associated with major depression and may also have a role in the depressed episodes of bipolar disorder. However, we now know from medication treatment trials that bipolar depression is different than major depression (unipolar depression) and may involve other neurotransmitters. Another class of neurotransmitters, like brain-derived neurotrophic factor (BDNF) are involved with strengthening connections between nerve cells in the brain -- a process known as plasticity. BDNF and other related brain chemicals are also involved with bipolar disorder, and much ongoing research is trying to understand this relationship and hopefully design new treatments.

Not everyone with severe mood swings or a change in personality has bipolar disorder. When a person first develops symptoms, it is important for their doctors to investigate all reasonable medical causes for any acute change in someone's mental health or behavior. Symptoms of either mania or depression can be caused by other medical conditions that need to be diagnosed and treated properly. Additionally, both prescription medications and drugs of abuse can also cause symptoms similar to bipolar disorder. Medical conditions or medications and drugs that could cause bipolar symptoms to include the following:

• Head trauma (blood clot or bleeding in the brain)
• Thyroid problems (both underactive and overactive)
• Autoimmune disorders that can affect the brain, including systemic lupus erythematosus (SLE)
• Brain tumors
• Epilepsy (seizures)
• Sleep disorders, including severe insomnia or sleep apnea
• Frontotemporal dementia (particularly with new onset of symptoms in the 60s or 70s)
• Neurosyphilis (a form of the sexually transmitted disease, syphilis, that has spread to the brain because it went untreated too long; this is rare today)
• HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome) affecting the brain
• Delirium (a condition with abnormal brain function due to other medical issues, including infections, abnormal electrolyte levels, or other conditions)
• Certain prescription medications can trigger mania-like symptoms, including stimulants (ADHD medications like Ritalin or Adderall), corticosteroids (like prednisone), and others.

Other psychiatric conditions and drug abuse may also mimic bipolar disorder:

• Attention-deficit/hyperactivity disorder (ADHD)
• Borderline personality disorder (BPD)
• Delusional disorder
• Eating disorders (including anorexia nervosa or bulimia nervosa)
• Post-traumatic stress disorder
• Schizoaffective disorder
• Substance use disorders (particularly stimulants such as cocaine or methamphetamine)

Mania and depression are the opposing poles of bipolar disorder. Bipolar symptoms are related to these two types of episodes:

• Mania (the "high" of bipolar disorder): A person in the manic phase may feel indestructible, full of energy, and ready for anything. Other times, that person may be irritable and ready to argue with anyone who tries to get in the way.
  • Unrealistic plans, spending sprees, stealing, an increase in sexual affairs, or other reckless behavior, such as wild driving, also may occur.
  • Disregard for the risks or dangers of these and other impulsive behaviors.
  • A decreased want or need for sleep, different than insomnia (when a person wants to sleep, but can't, and feels tired).
  • Increased goal-directed activity: starting lots of projects and tasks (but often not finishing any of them)
  • The person with mania can stay up all night but may find that not much was accomplished because he or she was easily distracted.
  • The person in a manic phase may talk very quickly and jump from subject to subject, as if his or her mouth can't keep up with the rapid thoughts (flight of ideas).
  • The person may be unable to respond to social cues to stop talking, and other people can't get a word in (pressured speech).
  • Increased physical activity, including fidgeting, restlessness, or hyperactivity, may be seen.
  • Poor temper control and irritability can be especially upsetting to friends and loved ones.
  • Self-esteem may be inflated. A person may have exaggerated sense of self-confidence and may inappropriately believe they have increased self-importance and abilities.
  • Decisions regarding business and finances are often made hurriedly and without careful consideration; this poor judgment may be the result of inappropriate optimism.
  • They are grandiose and may have delusions (false ideas) of grandeur (greatness).
  • In severe cases, delusions (false, fixed beliefs) and hallucinations (seeing or hearing things that aren't real) may be seen.
  • Hypomania refers to a milder form of mania. People affected by this mood disorder have many of the same features as those with mania, to lesser extremes, without the negative impact on day-to-day functioning. In fact, they may seem to have a great deal of energy and can be very productive, needing less rest than others.
  • These behaviors, which can be quite upsetting, usually prompt a family member to take notice and try to get the person help.
  • Most people who are going through the manic phase of bipolar disorder deny that anything is wrong with them and refuse to see a medical professional.

• Depression (the "low" of bipolar disorder): Over half of manic episodes will be followed by a major depressive episode. Although mania is the more characteristic phase of bipolar disorder, most people spend more time in depressive episodes than manic ones.
  • Depressive symptoms in bipolar disorder are identical to those in major depression (or unipolar depression).
  • Sadness and crying spells are common, as are excessive worrying and guilt.
  • People who are depressed may not care enough to wash or comb their hair, change clothes, or even get out of bed in the morning.
  • During depression, most people sleep too much (hypersomnolence) and/or have difficulty getting to sleep (insomnia). A loss of energy may result from the change in sleep habits.
  • Many of these people have no interest in food or have no appetite and lose weight. However, some have an increased appetite, eat more, and gain weight.
  • People with depression have trouble thinking; they may forget to do important things such as paying bills because they feel so down and have difficulty focusing on tasks.
  • They withdraw from friends, and social interactions suffer.
  • Hobbies and activities that used to bring pleasure suddenly hold no interest for people who are depressed (anhedonia).
  • Depression brings feelings of hopelessness, helplessness, pessimism, and worthlessness.
  • People who are depressed may not see a point in living anymore and may actually think about ways to kill themselves.
    • Untreated bipolar disorder has a 15% risk of death by suicide.
    • The risk of attempted suicide is nearly 10 times higher in patients with manic-depressive illness than in the general population.
• In bipolar disorder, the manic or depressed episodes last weeks or months. When a person's mood swings quickly from one extreme to the other within a few days, or even a single day, this suggests a different diagnosis than bipolar disorder. This is one reason a careful psychiatric assessment is important.
• When a person with bipolar disorder has more than four episodes of mania or depression (each lasting weeks or months) in a single year, it is referred to as rapid cycling.
• Individuals who have bipolar disorder often have other psychiatric diagnoses too. Anxiety disorders (such as panic attacks or social anxiety) are the most common secondary diagnosis, in about three-fourths of people with bipolar. Additionally, over half of those with bipolar disorder also have alcohol or other substance use disorders. People often use alcohol or drugs to try to feel better when they are depressed or disregard consequences when they are manic. However, the use of drugs or alcohol can trigger or worsen mood episodes (mania or depression). Other psychiatric conditions that frequently co-occur with BD include impulse control and conduct disorders or attention-deficit/hyperactivity disorder (ADHD).

When the bipolar disorder symptoms are causing serious problems at work, home, or other settings, medical care should be sought. This is particularly true if someone is having thoughts of suicide, or has even made plans, preparations, or attempts to end their life. Many people are reluctant to seek care for a psychiatric condition. This may be due to a fear of being considered crazy or of being stigmatized by friends, family, and others. At other times, the person may not believe that anything is wrong with them; this is particularly true during manic episodes. It can be helpful if a family member or close friend can encourage the person to seek help or even go with them. The person needs to be seen by a medical professional in these situations:

• When changes in personality, including extreme moodiness and episodes of rage, start to affect a person's life, ruin relationships with others, or threaten basic health
• When changes in sleep and appetite begin to affect health, the person needs to be evaluated.
• When the mood swings have become so severe that a person cannot function at home or work
• When depressive symptoms include thoughts of suicide, especially with a specific plan as to how to take his or her own life
  • If the person might be a danger to self or others, he or she should be seen in a hospital emergency department.
  • Suicidal patients may need to be hospitalized until their suicide risk and mood can be stabilized.
  • If the person refuses to go to the hospital, you may need assistance in getting him or her there. Call 911 if the situation is dangerous.
  • Be sure of your own safety first. A person with bipolar disorder may not be thinking clearly when in severe mania or depression.
• With a suicide attempt, call 911 so that the person can be treated in the emergency department. Don't try to take a person who has attempted suicide to the hospital by yourself.
• Although they are not as common, homicidal thoughts, threats, or behaviors require immediate intervention. Assure your own safety, and then call 911 for help.

No specific blood, head imaging, or genetic tests will tell the health care professional that a person definitely has bipolar disorder. The diagnosis is made on the basis of all the signs, symptoms, and history. Psychiatric doctors use guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to establish the diagnosis of bipolar disorder and other psychiatric conditions.

To diagnose BD, one has first to rule out any non-psychiatric medical illness that may be the cause of the behavioral changes. Once medical causes have been ruled out, a psychiatric diagnosis such as bipolar disorder could be considered. The diagnosis will best be made by a licensed mental health professional (preferably a psychiatrist) who can evaluate the patient and carefully sort through a variety of mental illnesses that might look alike at the initial examination.

• The physician will examine the person in an office or in the emergency department. The physician's role is to ensure that the patient doesn't have any other medical problems, including active drug use, since those conditions can mimic the symptoms of bipolar. The doctor takes the patient's history and performs a physical examination.
• A detailed interview will focus on the signs and symptoms of bipolar disorder, particularly those associated with mania such as periods of racing thoughts, risky behavior, and inflated self-esteem followed by periods of depression.
• Certain tests may be ordered to rule out medical conditions that could cause similar mood symptoms, especially when the first manic episode occurs after the age of 40. Blood will tests may be performed to check the balance of electrolytes and sugar in the blood, thyroid function, blood cell counts, and the presence of drugs or alcohol.
• CT scan or MRI of the head may be ordered to check for blood clots, bleeding, tumors, or evidence of other brain disorders (for example, dementia and autoimmune conditions).
• Rarely, an EEG (electroencephalogram), a study of the electrical impulses in the brain, may be ordered if the person is thought to have a seizure disorder or delirium. Electrodes are placed all over the scalp and secured by an adhesive. The electrodes are hooked up to a machine that traces brain signals. This is seldom performed in the emergency department.
• A spinal tap (lumbar puncture) may be ordered to get a sample of spinal fluid. This will be done if signs suggest a brain infection, such as meningitis or encephalitis. Such an infection is generally only considered a possibility if the behavior change happened relatively recently or if a fever or other signs of infection are present. The laboratory will study the fluid and be able to tell if an infection is present.
• Family members or friends of the person can help by giving the doctor a detailed history and information about the patient, including behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous physicians and psychiatrists. A history of hospitalizations is also helpful so that old records at these facilities might be obtained and reviewed.

Once other possible causes have been eliminated, the psychiatric symptoms will be reviewed to confirm a diagnosis of bipolar disorder. The diagnosis of bipolar disorder in the DSM-5 is based on the pattern of manic, hypomanic, and depressive episodes.

• Bipolar I disorder requires a current or past manic episode lasting a week or more, and can't be better explained by other psychiatric diagnoses, medical conditions, or drug use. Although hypomanic and major depressive episodes are common in bipolar I, they are not required for the diagnosis.
• Bipolar II disorder requires a current or past hypomanic episode and a current or past major depressive episode. As with bipolar I, other psychiatric, medical, and drug-induced causes must be ruled out before the diagnosis can be made.
• Cyclothymic disorder is similar to the bipolar disorders, but the mood episodes are less severe but overall more persistent. The diagnosis of cyclothymia requires multiple episodes of hypomanic and depressive symptoms that are never severe enough to be diagnosed as either a full-blown hypomania or major depressive episode. These symptoms must last for at least two years, with no more than two months free of symptoms.

Manic episodes are defined by the following characteristics:

• Mood is abnormally and persistently elevated or irritable accompanied by persistently increased energy/activity. This must last at least one week for most of each day. (A manic episode may be shorter only if it is severe enough to require hospitalization.)
• At least three other symptoms of mania (described earlier) must also be present.
• The symptoms of mania are serious enough to cause problems in functioning or to require hospitalization to prevent harm to self or others.

Hypomanic episodes are similar but neither last as long (they must be four days or longer), nor or they as severe as full-blown mania. Although hypomanic episodes do not cause serious impairment like mania, the episode is a clear period of persistent, uncharacteristic behavior for that person.

Major depressive episodes are identical to those for people with major depressive disorder and were described earlier. These episodes must last at least two weeks, most of the day for every day during this period, and also cause serious impairment in functioning.

Because of the extreme and risky behavior that goes with bipolar disorder, it is very important that the disorder be identified. With proper and early diagnosis, this mental condition can be treated. Bipolar disorder is a long-term illness that will require proper management for the duration of a person's life.

There is no cure for BD but, with proper therapy, people with this disease can lead stable and productive lives. Bipolar disorder will not get better without medical treatment. The most complete treatment plan for bipolar disorders include both mood-stabilizing medication(s) and psychotherapy.

Self-Care at Home

Bipolar disorder is a serious condition, and most people will need to stay on prescription mood stabilizers through their lives. Self-treatment of BD without medical treatment is not recommended and could be risky as there are likely to be more serious mood episodes. However, in addition to medications and appointments with doctors, there are many ways that a person with bipolar disorder can take care of themselves, and involvement of family and friends can be a vital support in maintaining good mental health. Regular routines, particularly around sleep and social activity, are critical for improving stability. Avoiding the use of excessive alcohol and non-prescribed drugs and medications can also improve health and avoid triggers for episodes. Supporting this type of healthy lifestyle changes in your loved one with bipolar disorder, as well as encouraging them to take their prescriptions regularly, can improve their mental and physical health.

Medical Treatment

Optimal treatment of bipolar disorder includes both (1) medications to stabilize mood episodes and prevent future episodes and (2) specific types of psychotherapy (talk therapy) with a licensed therapist. However, therapy is more successful with strong support from family and loved ones.

There is no test to determine which medication is best for an individual with bipolar disorder. Because of this, a number of medications may need to be tried before the right combination is found. Also, medications usually take weeks to have their full effect, so it is important to stay on the medications long enough (and to work with your doctor) to make sure they are working. While medication adjustments are being made, support from their friends and family can encourage the person with bipolar disorder hold on to hope while they are recovering from a mood episode.

In addition to medications, interventional treatments can also be very effective. Electroconvulsive therapy (ECT) is a procedure performed in a hospital setting that can be extremely effective for treating both depressive and manic episodes in bipolar disorder. In ECT, an electrical pulse is used to cause a seizure in a controlled way. It is thought that the seizure causes the release of large amounts of neurotransmitters that trigger plastic changes in the brain circuits involved in mood regulation. Many people misunderstand ECT based on inaccurate portrayals in movies and on TV. However, modern ECT is very safe and humane, and with qualified psychiatrists and anesthesiologists performing the procedure, it is tolerated with very few risks or side effects. ECT is a critical option for pregnant women for whom medications may be unsafe and for patients who are not getting better with medications.

During a severe episode of mania or depression, the person with BD may be at risk of suicide or other dangerous behavior. Psychiatric hospitalization may be required during those times to protect the person and others. In the hospital, medical staff can more quickly start and adjust medications to treat symptoms and stabilize mood. While in the hospital, group and individual therapy sessions can provide education about self-care and bipolar disorder, as well as strategies to avoid suicidal acts, maintain sobriety, and physical health. Not all episodes are serious enough to require hospitalization. Many people can be treated as outpatients.

A variety of prescription medications are available to treat bipolar disorder and are usually referred to as mood stabilizers. Mood stabilizers are from a few different classes of medications, including anticonvulsants, antipsychotic medications, some antidepressants, and anxiolytic (anti-anxiety) drugs. Some of these medications are more effective at treating mania, depression, or longer-term prevention of future mood (manic or depressive) episodes.

Lithium is the first medication used as a mood stabilizer. It is a salt found in nature.

• We still do not know how lithium works, but it is still one of the most effective of the mood stabilizers, especially for depression.
• When used as a mood stabilizer, it may reduce the risk of suicide for patients with BD.
• Over time, lithium can affect kidney and thyroid function. Regular blood tests will be needed to monitor this.
• Levels of the drug must be closely monitored with blood tests.
• Drink plenty of fluids and do not restrict intake of salt while taking lithium because dehydration can cause the level of the drug in the blood to be dangerously high.

Some anticonvulsant (anti-seizure) medications also function as mood stabilizers. Antiseizure medicines that are sometimes used to treat bipolar disorder include the following:

• Carbamazepine (Tegretol)
  • Carbamazepine may be helpful with mania and rapid cycling bipolar disorder.
  • Blood tests to monitor drug levels and blood counts are needed over time.
• Valproic acid (Depakote)
  • Valproate may be helpful with mania and rapid cycling bipolar disorder.
  • Blood tests to monitor drug levels, liver function, and blood counts are needed over time.
• Lamotrigine (Lamictal)
  • Lamotrigine is one of the best mood stabilizers for treating depression.
  • The medication needs to be started gradually to avoid a serious and potentially life-threatening skin condition.
• Other anticonvulsant medications have also been tried, but there is little evidence that they are effective. Some of these are oxcarbazepine (Trileptal), gabapentin (Neurontin), and topiramate (Topamax).
• The second-generation antipsychotic medications used to treat psychosis are sometimes used to treat bipolar disorder; these medications have been shown to be effective for acute mania, some for depression, and some for long-term mood stabilization. They include the following:
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Paliperidone (Invega)
  • Lurasidone (Latuda)
  • Asenapine (Saphris)
  • Cariprazine (Vraylar)
  • Aripiprazole (Abilify)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)
• Antipsychotic medications can be very effective and helpful medications but also carry the possibility of serious side effects. If you are taking one of these medications, it is important that you follow up regularly with your doctor to monitor your health and get regular blood tests:
  • Antipsychotics can affect blood sugar levels and may increase the chance of developing diabetes, and this will need to be monitored over time. They can also cause weight gain.
  • Patients known to have diabetes need to watch for poorer control of their blood sugar when taking these drugs. Weight gain is possible, with or without problems with blood sugar.
  • There may be increased levels of blood lipids (fats) and cholesterol in people who are prescribed this medication. These should be monitored over time.
  • There is a possibility of extrapyramidal side effects (EPS) at higher doses of this medicine. These are abnormal muscle movements or stiffness.
• All medications have side effects, and each person with bipolar disorder needs close monitoring for the side effects while taking the medication.
• Antidepressant medication is sometimes taken with a mood-stabilizer medication during depressive episodes. However, from clinical trials, it is not clear that these medications are as effective for bipolar depression as they are for major depression. Additionally, antidepressant medication alone might trigger mania and should be closely monitored with the person's doctor.

The choice of medications is customized for each person.

• Be sure to tell your health care professional about any other medical conditions you have.
• Tell your health care professional about all medications you take, including over-the-counter drugs and herbal preparations. These may interact with the medications used for bipolar disorder. For example, the herbal preparation known as St. John's wort may reduce the effectiveness of some medications. Also, since it is itself an antidepressant, it may trigger a manic episode in a person with BD who is not on another mood stabilizer.
• Women also should discuss any plans for pregnancy and breastfeeding with their health care professional, because a change in medication may be necessary.

For most people with bipolar disorder, medications do not relieve symptoms completely. Psychological counseling (psychotherapy) complements drug therapy and is considered a crucial part of effective therapy.

• There are a few specific types of therapy that have been shown to be effective for bipolar disorder. Therapy may be individual or in a group; both can be effective.
• Psychoeducation teaches a person about their illness so that they are able to recognize triggers or signs of relapse. This allows them to get help early before symptoms are severe.
• Psychoeducation is also valuable for teaching how to implement healthy lifestyle changes that are particularly important for maintaining stable mood. Sleep hygiene, exercise/activity, and healthy eating are some of these critical areas.
• Cognitive behavioral therapy (CBT) teaches people how to identify and change negative thought patterns and behaviors. This is probably most effective for depressive episodes.
• Family-focused therapy helps to improve communication between people with BD and their families. Families learn how to recognize early symptoms so that they can get help for their loved one. Maintaining healthy social relationships has been shown to be important for positive outcomes with bipolar.
• Interpersonal Social Rhythm Therapy (IPSRT) teaches people to track their moods, sleep patterns, and other behaviors over time (rhythms) so that they can identify relapses early, improve their relationships with others (interpersonal), and optimize social functioning.
• It is often very important for the spouse or other family members to be involved during visits to the therapist.
  • It is important to treat the whole family, not just the person with bipolar disorder, not because they are all "sick," but because this disorder affects them all.
  • Family members can learn valuable ways to deal with their loved one's mood swings.

It is critically important for people with bipolar disorder to take all medication as directed. You will very likely be tempted to stop your medication, especially when you start to feel well. Instead, talk it over with your health care professional. There may be options to adjust or change your medication rather than just stopping it. Stopping your medication will probably cause your symptoms to come back. It may also cause uncomfortable or alarming withdrawal symptoms.

Depending on which medication is used, you may need regular blood tests to monitor levels and to check for side effects of the drug.

You should have regular appointments with your health care professional to see how well the treatment is working and detect any instability of your mood.

Regular sessions with a psychotherapist or counselor are also important.

Ongoing education for you and your family is crucial to help everyone deal with the disease.

You and your family should be taught to watch for early warning signs of crisis and ways to deal with stress to prevent recurrences.

Nothing is known to prevent bipolar disorder. It is best to avoid drugs that may trigger the disease (such as cocaine or methamphetamine). Adopting a healthy lifestyle with regular sleep and exercise also may help.

Relapses can be prevented or made less severe by following the treatment recommendations of your health care professionals. This includes taking medication as directed and attending counseling sessions.

Living With Bipolar Disorder

Bipolar disorder is a long-term condition with no actual cure, only ways to control the symptoms.

With treatment, most people are able to lead normal lives. Some (about one in 10) may never have another manic episode. However, at least one-third of people with bipolar may continue to have residual symptoms and difficulty returning to full function. Ongoing treatment and support from loved ones will give them the best chance of gradual recovery.

Some people have speculated that people with bipolar disorder tend to be more creative and artistic. Many famous historical authors, musicians, and artists were either known to, or speculated to, have bipolar disorder. This school of thought speculates that the experiences of extremes of mood in bipolar disorder somehow may be linked to artistic creativity and an ability to see things in a unique way.

People with bipolar disorder and their families and friends can learn to pay attention to signs and symptoms of the depression or mania emerging and have their medications adjusted to prevent a relapse of the low or high. Through education and support, they can be able to monitor themselves, and reduce the number of relapses.

Others battle mood episodes of bipolar disorder for the rest of their lives. With proper medication and regular psychotherapy, however, the disease can be well controlled with fewer recurrent episodes.

If untreated, bipolar disorder may lead to risky activities, dysfunction in family and work, and even suicide or homicide.

It can be quite helpful to talk to other people who have dealt with or are dealing with manic depression. Family members can also benefit from support groups because they can share tips on coping that have worked for them. The following is a list of resources and support groups:

Befrienders International
To find a local suicide prevention hotline, log on to the web site of this suicide prevention group.

Depression and Bipolar Support Alliance (DBSA)
Phone: 800-826-3632

Bipolar Lives

Depression and Related Affective Disorders Association (DRADA)
Phone: 410-955-4647

Mood Challenge Support Group
Phone: 309-671-8000

Mood Disorders Support Group, Inc.
Phone: 212-533-MDSG

National Alliance for the Mentally Ill (NAMI)
Phone: 800-950-NAMI (6264)

Suicide Prevention Lifeline
Phone: 800-273-8255

Where Can People Find Additional Information on Bipolar Disorder?

Reliable information about bipolar disorder and other psychiatric diagnoses can be found at the

• National Alliance for Mental Illness (NAMI) and the
• National Institute of Mental Health (NIMH).

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Psychiatric Association
http://www.psych.org

American Psychological Association

National Mental Health Association (NMHA)