Bipolar Disorder

Bipolar Disorder 1

Bipolar Disorder

The event of bipolar disorder has been a mystery since the 16th century. Records have shown that this problem can appear in almost anyone. It is clear that in our social world many people live with bipolar disorder. Regardless of the number of people suffering from the disease, we are still waiting for an explanation regarding the causes and cure. One fact of which we are aware, is that bipolar disorder severely undermines its' victims ability to obtain and maintain social and occupational success. Bipolar disorder has such devastating symptoms, that it is important we remain determined in searching for explanations of its causes and treatment.

Bipolar disorder affects approximately one percent of the population in the United States. Bipolar disorder involves feelings of mania and depression. Which is where individuals with manic episodes experience a period of depression. The depression episodes are characterized by a persistent sadness, almost inability to move, hopelessness, and disturbances in appetite, sleep, in concentration, and driving. The manic episodes are characterized by elevated or irritable mood, increased energy, decreased need for sleep, poor judgment and insight, and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). As the National Depressive and Manic Depressive Association (MDMDA) have demonstrated, bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters. In addition, bipolar states and psychotic states are misdiagnosed as schizophrenia, but a closer look at speech patterns can help distinguish between the two (Lish, 1994).

The beginning of Bipolar disorder usually occurs between the ages of 20 and 30. A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have larger cases may experience more episodes of mania and depression closer and more frequent, without a period of remission (DSM III-R). The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive (Hirschfeld, 1995). Hypomania then progresses into mania and the transition is marked by loss of judgment (Hirschfeld, 1995). Lastly, the third stage of

Bipolar Disorder 2

mania is evident when the patient experiences delusions with often-paranoid themes. Speech is generally rapid and hyperactive behavior is apparent, and sometimes associated with violence (Hirschfeld, 1995).

When both manic and depressive symptoms occur at the same time it is called a mixed episode. Those afflicted are at a special risk because there is a combination of hopelessness, agitation, and anxiety that makes them feel like they "could jump out of their skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of depressed moods. Patients report feeling unhappy; yet, they exhibit the energy associated with mania. Rapid cycling mania is also a presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12-month period. However, there is now evidence to suggest that sometimes rapid cycling may be a brief demonstration of the bipolar disorder. This form of the disease exhibits more episodes of mania and depression than bipolar.

There are medications that can be prescribed, that can help control the disease, and let people affected lead normal lives. Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960's. Its main function is to stabilize the cycling characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was 78% (1990). Lithium is also the primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression. Unfortunately, as many as 40% of bipolar patients are either unresponsive to lithium or cannot tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder.

Another problem associated with lithium is the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolar disorder. Preliminary evidence also suggest that hypothyroidism may actually lead to rapid cycling (Bauer et al., 1990). Pregnant women experience another problem associated with the

Bipolar Disorder 3

use of lithium. Its use during pregnancy has been associated with birth defects, particularly Ebstein's anomaly. Based on current data, the risk of a child with Ebstein's anomaly being born to a mother who took lithium during her first trimester of pregnancy is approximately 1 in 8,000, or 2.5 times that of the general population (Jacobson et al., 1992).

There are other effective treatments for bipolar disorder that are used in cases where he patients cannot tolerate lithium or have been unresponsive to it in the past. The American Psychiatric Association's guidelines suggest the next line of treatment to be Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful a antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid cycling, or have comorbid alcohol or drug abuse.

Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them is rapid, but there are risks involved in their use. Because of the often-severe side effects, Benzodiazepines are often used in their place. Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects.

Antidepressants such as the selective serotonin reuptake inhibitors (SSRI's) fluovamine and amitriptyline have also been used by some doctors; as treatment for bipolar disorder. A double-blind study by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi showed that fluvoxamine and amitriptyline are highly effective treatments for bipolar patients experiencing