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Overview

Bipolar disorder also known as manic-depressive illness is a brain disorder that causes unusual shifts in a person's mood energy and ability to function. Different from the normal ups and downs that everyone goes through the symptoms of bipolar disorder are severe. They can result in damaged relationships poor job or school performance and even suicide. But there is good news: bipolar disorder can be treated and people with this illness can lead full and productive lives.

Bipolar disorder typically develops in late adolescence or early adulthood and affects both men and women about equally. An estimated 440000 Canadians between the ages of 25 and 64 have experienced at least one manic episode suggestive of bipolar disorder. More than half of them has also suffered a major episode of depression.

Causes

Most scientists now agree that there is no single cause for bipolar disorderrather many factors act together to produce the illness.

Because bipolar disorder tends to run in families researchers have been searching for specific genesthe microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and growpassed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story.

There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research scientists will gain a better understanding of the underlying causes of the illness and eventually may be able to predict which types of treatment will work most effectively.

Treatment

Most people with bipolar disordereven those with the most severe formscan achieve substantial stabilization of their mood swings and related symptoms with proper treatment. A strategy that combines medication and psychosocial treatment is best for managing the disorder over time.

In most cases bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment mood changes can occur and should be reported immediately to your doctor. He or she may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with your doctor and communicating openly about concerns and options can make a difference in the effectiveness of your treatment.

In addition keeping a chart of daily mood symptoms treatments sleep patterns and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general people with bipolar disorder continue treatment with mood stabilizers over the course of many years. Other medications are added when necessary typically for shorter periods to treat episodes of mania or depression that break through despite the mood stabilizer.

The treatment of bipolar disorder has evolved significantly in the last decade with many new medications. These can be managed by your family doctor but "shared care" with a specialist is likely a good idea.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania or of developing rapid cycling during treatment with antidepressant medication. Therefore "mood-stabilizing" medications generally are required alone or in combination with antidepressants to protect people with bipolar disorder from this switch.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland function. As well common medications for bipolar disorder such as lithium can affect thyroid function. Because too much or too little thyroid hormone alone can lead to mood and energy changes it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also certain drug treatments may cause low thyroid levels in some people resulting in the need for thyroid supplementation.

Psychosocial Treatments

As an addition to medication psychosocial treatmentsincluding certain forms of psychotherapy (or "talk" therapy)are helpful in providing support education and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability fewer hospitalizations and improved functioning in several areas. A licensed psychologist social worker or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number frequency and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy psycho-education family therapy and a newer technique interpersonal and social rhythm therapy.

Other Treatments

In situations where medication psychosocial treatment and the combination of these interventions prove ineffective or work too slowly to relieve severe symptoms such as psychosis or suicidal thinking electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions including pregnancy make the use of medications too risky. ECT is a highly effective treatment for severe depressive manic and/or mixed episodes. The possibility of long-lasting memory problems although a concern in the past has been significantly reduced with modern ECT techniques. However the potential benefits and risks of ECT and of available alternative interventions should be carefully reviewed and discussed with individuals considering this treatment and where appropriate with family or friends.

Omega-3 fatty acids found in fish oil are being studied to determine their usefulness alone and when added to conventional medications for long-term treatment of bipolar disorder.

Additional Resources