Also called manic-depressive
disorder, bipolar disorders are characterised by extreme
fluctuation in moods ranging from acute depression to
hysterical elation. Persons suffering from this disorder may
have weeks to months of either very sad mood or an elated
euphoric mood. Mood changes are associated with the
behavioural changes one might expect with each of these mood
states e.g. Euphoric persons may need less sleep, indulge in
risky impulsive behaviours etc.
How is it caused?
The exact cause of the disorder
is unknown. Bipolar disorders seem to be inherited, that is
relatives of individuals with bipolar disorders are more at
risk of developing the same than the general population.
What are the symptoms?
The symptoms of mania and depression
alternate in individuals with bipolar disorder. However,
some people have only manic episodes without any depressive
spells and vice versa. In order for the diagnosis of bipolar
disorder to be made the person must have at least one manic
episode. The disorder often starts with a period of
depression, which may last for a few months. A shorter
period of mania may follow before the cycle is repeated. The
illness seems to manifest itself in early adulthood the late
twenties to early thirties being typical. A manic phase is
characterised by:
Irritability
Extreme elation
Delusions of grandiosity and high self
esteem
Hyperactivity and increased
distractibility
Surge of ideas often creative, associated
with increased productivity at work
Excessive talking
Decreased need for sleep, the person
often getting by on just a few hours
Destructive and often bizarre behaviour.
The symptoms of a depressive phase are in sharp contrast to
those in the manic phase, and the personality of the person
seems to undergo a drastic change. Symptoms of depression
include:
Extreme sadness and irritability
Decreased mental activity and lethargy
Silence and no expression of emotions
Chronic fatigue
Lack of concentration, interest and
curiosity of the surrounding environment
Social withdrawal
Decreased libido
How is it diagnosed?
The disorder is brought to light when the
patient has such a depressive or manic episode. A person may
have several depressive episodes before a manic spell and
this often delays the diagnosis. A psychologist or a
psychiatrist will take into account several factors
including a family history, the age of onset and medical
conditions before arriving at a diagnosis. There is
unfortunately no physical test such as imaging or blood test
which can confirm the diagnosis. It is based entirely on an
observation of behaviour and a history. Hospitalization may
be necessary and helps with staff being able to monitor
behaviour round the clock. A complete medical, family and
chronological history of the individual is taken.
What is the treatment?
The primary medications used to treat bipolar
disorder, especially in prevention of future episodes are
mood stabilizers. Lithium and Valproate are the most
commonly used. Often manic spells require the addition of an
antipsychotic medication or a benzodiazepine. Depressive
spells may require the addition of an antidepressant.
Electro-convulsive therapy (ECT) or shock treatment may be
used to treat severe depression or mania. It is extremely
fast and effective and has no lasting side effects.
Psychotherapy is an important part of treatment to help the
person and family cope with this chronic illness.
The prognosis of people with bipolar disorder is good with
adequate treatment compliance. However, few people are
willing to consider lifelong medication until they have had
several episodes. There is a high rate of return of symptoms
when medication is discontinued. Some people may have side
effects from medications but there are several alternatives
in each type of medication and usually some are better
tolerated by an individual. Constant care by a psychiatrist
is essential to maintain optimal treatment.
Medications Used for Bipolar Disorder
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