Bipolar Disorder

"It seems as though my mind has slowed down and burned out to the point of being virtually useless. I [am] haunt[ed] with the total, the desperate hopelessness of it all."

"Ideas are fast...all shyness disappears...people, things become intensely interesting...unbelievable feelings of ease, power, well-being...you can do anything."

"The fast ideas become too fast and there are far too many...overwhelming confusion replaces clarity...everything is now against the grain...you are irritable, angry, uncontrollable, and trapped."

Contents of this Page
What is Bipolar Disorder?
Symptoms
Brain Effects
Treatment
Children vs. Adults
References

What is Bipolar Disorder?

These quotations describe bipolar disorder (BD), an illness characterized by extreme changes in mood, behavior and energy levels. Also called manic-depressive illness, BD affects approximately 2.6% of the population age 18 years and older. Men and women are equally likely to develop BD. The disorder does tend to run in families and the rate of BD in identical twins is higher than that in fraternal (non-identical twins). Nevertheless, the specific genetic defect has not yet been identified and it is likely that both genetic and environmental factors contribute to BD.

The first bipolar episode often occurs in adolescence or early adulthood and may be triggered by a traumatic event such as the death of a family member. In between episodes, many people are symptom-free, while others are never free of symptoms. Once properly diagnosed and treated, people with BD can lead productive lives.

Symptoms of Bipolar Disorder?

Bipolar disorder is characterized by shifts in mood: the person cycles through phases of extreme "highs" (mania) and "lows" (depression). Sometimes symptoms of mania and depression are present at the same time.

Mania (the "high"): In this phase, the person experiences an abnormally elevated mood (lasting for a week or more), but they also experience at least three of the following symptoms:

  1. Inflated self-esteem
  2. Reduced need for sleep
  3. Excessive talkativeness
  4. Racing thoughts
  5. Distractability
  6. Activities done to excess (for example, spending money)
  7. Pursuit of risky behaviors or activities

Depression (the "low"): Mania can quickly and without warning change to a depressive episode. In addition to a general sad mood, a person in the depressive stage may experience:

  1. Loss of interest in activities they previously enjoyed
  2. Changes in appetite resulting in weight gain or loss
  3. Changes in sleep patterns resulting in difficulty sleeping or oversleeping
  4. Agitation
  5. Loss of energy
  6. Trouble concentrating or thinking
  7. Repeated thoughts of suicide or death

These episodes of mood changes can also be accompanied by:

  1. psychosis: an altered mental state that is characterized by hallucinations (hearing or seeing something which is not really there). An example of a hallucination is seeing a large purple floating rat and believing it is real.
  2. delusions: believing something about yourself that is not true. An example of a delusion is believing that you have the ability to fly.

How does BD affect the brain?

Two strategies have been used to investigate how BD affects the brain: examination of brain tissue after people with BD have died and brain imaging in people who have BD. Unfortunately, few studies of either type have been performed.
Reported changes in the brains of people with BD
  • Decreases in the number and density of glial cells in the prefrontal cortex.

  • Decreases in the number of neurons in part of the hippocampus.

  • Increases in the levels of some neuropeptides in the hypothalamus.

  • White matter hyperintensities: small abnormal areas in the white matter of the brain (especially in the frontal lobe) as seen using magnetic resonance imaging. These abnormalities may be caused by the loss of myelin or axons.

  • Decreases in the size of the cerebellum.

  • Reduced activity in the prefrontal cortex during the depressive stage.

What treatments are available?

Medications and therapy help control the symptoms of BD, but there is no cure. Continuous treatment has been shown to be more effective than an on-off approach; if left untreated, the episodes will generally worsen and become more frequent. Treatment is complicated because individuals respond differently to various medications, so a trial-and-error approach is used. Many people respond to taking lithium. Lithium is a mood-stabilizing drug that is often effective in treating the manic phase of BD. Lithium is usually used with other antidepressant drugs such as monoamine oxidase inhibitors, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). These antidepressants work on brain pathways using the neurotransmitters called serotonin and norepinephrine. For example, SSRIs increase serotonin activity within the synapse by preventing the uptake of serotonin back into the presynaptic terminal.

Normal Synapse

Synapse With Reuptake Inhibitor

Medications used for controlling seizures (anticonvulsants) work for some people; in particular, valproate and carbamazepine work in many cases either with lithium or as an alternative to lithium. Newer anticonvulsant drugs (for example, lamotrigine, gabapentin, and topiramate) are being studied to determine how well they work at combating the symptoms of BD.

Some antipsychotic drugs such as clozapine or olanzapine may prevent mania in some people with BD, but more research is needed to see if long-term use is safe and effective.

Is bipolar disorder in children the same as in adults?

Not as much is known about bipolar disorder in children as in adults; it is difficult to diagnose because many of the symptoms can be caused by other disorders such as attention-deficit-hyperactivity disorder, panic disorder, depression, obsessive-compulsive disorder, or Tourette's syndrome. Children experience faster mood swings than adults, often cycling (changing from mania to depression) many times within a day. Children, more often than adults, exhibit a "mixed" state that is a mix of mania and depression. It is known that pediatric cases of BD are associated with a higher risk of substance abuse and suicide, so proper diagnosis and early treatment are vital for the child's well being. The following behaviors may indicate that the child needs to be evaluated by a mental health professional:
  1. Saying they want to kill themselves/saying they want to die
  2. Trying to jump out of a moving car
  3. Throwing tantrums/destructive rages that continue after the age of four

Pediatric cases (under the age of 18 years) generally are treated with lithium, but valproate and carbamazepine may also be used. Researchers are evaluating the safety and effectiveness of these and other medications in children and adolescents. Some studies have shown that valproate causes unwanted hormonal changes in teenage girls and polycystic ovary syndrome in some women. Mood-stabilizing medications must be used first, as treatment with stimulants or antidepressants alone can trigger mania or increased aggression. Modifying the child's environment, such as reducing stress, offering nutritional meals, and encouraging good sleep and exercise habits can help stabilize the child's moods.

Bipolar disorder is a serious, chronic illness. As with adults, it is important to have children examined by mental health professionals. For example, psychiatrists are medical doctors who specialize in mental illnesses and can prescribe medications. The criteria for diagnosis of bipolar disorder in children are the same as in adults.

Did you know?

?

  • Approximately 2.3 million people in the US suffer from bipolar disorder. (Statistic from the National Institute of Mental Health)

  • Many famous people are believed to have had BD:

    • US Presidents: Abraham Lincoln (1809-1865) and Theodore Roosevelt (1858-1919)
    • Composers: George Handel (1685-1759), Robert Schumann (1810-1856), Ludwig van Beethoven (1770-1827)
    • Writers: Leo Nikolayevich Tolstoy (1828-1910), Virginia Woolf (1882-1941), Ernest Hemingway (1899-1961), Charles Dickens (1812-1870)
    • Physicist: Sir Isaac Newton (1642-1727)
    • Actors: Patty Duke, Linda Hamilton, Jean-Claude Van Damme

References and Links:

  1. National Institute of Mental Health booklet on BD

  2. Child and Adolescent Bipolar Foundation (CABF)

  3. Biploar Depression Links

  4. Stoll, A.L., Renshaw, P.F., Yurgelun-Todd, D.A. and Cohen, B.M. Neuroimaging in bipolar disorder: what have we learned, Biological Psychiatry, 48:505-517, 2000.

  5. Vawter, M.P., Freed, W.J. and Kleinman, J.E. Neuropathology of bipolar disorder, Biological Psychiatry, 48:486-504, 2000.

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Page prepared by Ellen Kuwana, Neuroscience for Kids Staff Writer
This page was last updated on September 27, 2005.