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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Bipolar Disorder

What is it?

Bipolar disorder is a condition characterized by episodes of low mood (depression) or elated mood (mania), separated by periods of normal mood and functioning. Mania is marked by inflated self-esteem; an elated, euphoric, or grandiose mood; increased activity; and a decreased need for sleep. Episodes of mania or depression can last from a few weeks to several months and are frequently severe enough to affect day-to-day functioning at work and at home. Men tend to have more bouts of mania; women have more episodes of depression (see Depression for more information). Bipolar disorder has also been called manic-depressive illness.

Affecting about 1 percent of the general population, bipolar disorder typically begins between ages 20 and 30, though it can start at any age. For most patients, the condition is recurring. The rate of this "cycling" varies among individuals. Fortunately, although bipolar disorder can be a lifelong condition, treatment helps the majority of patients to have less frequent and less severe episodes.

What Causes It?

  • Genetics play a primary role in the development of bipolar disorder. If you have a family history of bipolar disorder, there is a greater chance that you will be vulnerable to it.
  • Recurrent manic episodes may be caused by sleep deprivation or antidepressant drug therapy.
  • The more episodes a patient has had, the more likely he or she is to have another.

Prevention

  • There is no way to prevent bipolar disorder, but medications such as lithium, carbamazepine, and divalproex sodium may prevent recurrences.

Diagnosis

  • Physical examination and patient history by a mental health professional are necessary. Because symptoms of a single manic episode occasionally mimic those of schizophrenia (see Schizophrenia for more information), patients may need several exams before getting an accurate diagnosis.
  • Laboratory tests should be done to rule out an underlying medical illness (such as hyperthyroidism), an adverse drug reaction, another medical or psychiatric condition, or the effects of alcohol or illicit drugs.

How to Treat It

  • Lithium and divalproex sodium are the treatments of choice for mania. Carbamazepine is also effective. Beneficial effects appear in two to six weeks.
  • Because of the slow therapeutic response to these medications, antipsychotic medications may be administered for treatment of severe mania.
  • Severe manic episodes may need to be treated in the hospital.
  • Depressive episodes are typically treated with anti-depressant drugs, psychotherapy, or both.

When to Call a Doctor

  • Call a doctor if you or someone you know shows significant signs of bipolar disorder.