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What Is Bipolar Disorder? By M. Glaser, MD The definition of bipolar disorder has expanded over the last few decades. It used to refer to periods of mania sometimes followed by depression. These phases would occur in cycles with phases of normalcy in between. Due to the cycles of mania and depression, the original name for bipolar disorder is manic-depression. The two opposite points in mood high and low. Thus from that came bipolar disorder, or "two poles". In the last few years, bipolar has taken on to mean more than that described above. The above description is now informally referred to as classic bipolar disorder. For some reason it seams, psychiatrists do not see as much of that as they used to. We now see more of mixed episodes. The two phases of bipolar disorder are mania and depression. A third possible phase is a mixture of the two called a Mixed episode. Mania means a mood that is expansive, lots of energy. A person typically does not need to sleep. They can stay up all, or most of the night for days or weeks and not feel tired the next day. In classic mania, a person feels fantastic! They feel like a superhero. They experience flight of ideas, racing thoughts and speach. They are overly excited. The period of time one must experience these symptoms is contreversial. Some doctors require this period to last for a few hours while others require days or weeks. Classic mania required days of consistent euphoria. Usually people with mania have too much energy to organize their thoughts. Thus, with the exception of cleaning the house, they are unable to complete complex, goal oriented tasks. Periods of rage often occur in bipolar disorder, but getting angry or rageful by itself is not enough to meet the criteria for bipolar disorder. Mood swings often occur in bipolar disorder but by itself, it is not sufficient to be diagnosed as bipolar. Mood swings refer to a mood that changes quickly and is much greater in intensity of expression than most people would feel over a similar stressor. The mood can swing from normal to rage or from intense happyness to sadness. An individual can experience a mixed episode. This means a person has both extra energy but instead of feeling terrificly wonderful, they feel depressed at the same time. Another potential symptom is psychotic features. In bipolar disorder as well as in major depression, a person can experience hallucinations during times of mania or depression but no hallucinations when their mood is well and stable. Most people who have bipolar disorder seek treatment initially for depression and anxiety. So all individuals who are being evaluated for depression and anxiety should also be screened for bipolar. Another condition that has similar symptoms to bipolar disorder is ADHD (attention deficit hyperactivity disorder or ADD). Early signs of mania and depression are inattention and hyperactivity. However, stimulants are the treatment for ADHD but can worsen Bipolar. Thus, all ADHD patients should be screened for bipolar disorder as well. A negative reaction to ADHD medications or antidepressant medications can be a sign that it is instead bipolar disorder. Mitchell Glaser, MD. What Causes Bipolar Disorder? Bipolar disorder is highly genetic. Twin studies show that identical twins (monozygotic) have a rate of both twins getting the disorder of 70%-90%. While nonidentical (fraternal) same sex twins (dizogotic) have a rate of 16%-35%. What could explain this. First, genes are very important. Second, environment plays a role. If you get the right genes and the right environment, you get bipolar illness. Environmental conditions that help cause or worsen bipolar disorder are stress, traumas, and drug/alcohol use or exposure. What Can I Do To Prevent or Help Treat Bipolar Disorder? If you already have the condition, you must take medication for years, and possibly your entire life. I know that is a real pain in the behind, but it is fact. Second, DO NOT DRINK ANY ALCOHOL, SMOKE ANY MARIJUANA, USE ANY ILLEGAL DRUGS OR UNAUTHORIZED PRESCRIPTIONS OF ANY KIND EVER. Drinking or using drugs is the surest way to mess up your future and prognosis. Using drugs and drinking in excess is bad for every one, but for people with bipolar disorder, it will cause them to lose their mind and go insane permanently. Naturally, this does not often happen right away (although sometimes it does). It usually takes a few years, but that is the nature of addiction. It will cause the bipolar brain to lose brain cells at a much faster rate than a brain without bipolar disorder. Drugs and alcohol will also induce the brain to have a manic or depressed episode which leads to further brain cell loss. To learn about the effects of bipolar disorder on the brain, read my section on bipolar disorder treatment. Mitchell Glaser, MD. Child, Adolescent, Adult Psychiatrist |
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